When was bloodletting common

This article delves into a brief history of phlebotomy to provide you with better insight. Phlebotomy was known as bloodletting when it was first used and dates back to the ancient Egyptians, around BC.

They believed that the process of releasing blood from the body would cure various diseases, such as the plague and acne.

Some even believed that it could cast out evil spirits. In Greece, a prominent Greek physician known as Galen of Pergamon, discovered that arteries as well as veins had blood. Previously it was thought that arteries were filled with air. Instead, they thought that it stagnated in the extremities. During this time, treatment involved giving the patient an emetic to encourage vomiting.

Galen of Pergamon developed quite a complex system for the quantity of blood which should be removed and from what specific areas of the body. As time moved on, bloodletting became quite a common practice throughout Europe, and it was believed that the disease left your system along with the blood. The reality was that it simply spread the infection to everyone else. Pre-nineteenth century, blood was simply thought to be something that caused lots of the conditions associated with sickness and ailments.

He believed that in order for a human being to remain in optimum health, the concentrations of these four humours in the body must remain balanced in the appropriate proportions [2].

As a result, the recommended treatment intended to rid the body of the excess of a particular humour through purging, vomiting, starving, or bloodletting [3]. In its infancy, bloodletting was accomplished via the most primitive methods, including using sharp thorns or animal teeth [4].

Bloodletting became such a popular phenomenon that even barbers, who served as pseudo medical providers during the Middle Ages, began to participate in this treatment [5]. Historians suggest that the classic red-and-white barber pole is linked to bloodletting, with red representing blood and white representing the tourniquet used to slow the bleeding [5].

At its peak, bloodletting was a phenomenon that was well-regarded by the medical community as a viable treatment strategy for almost any disease process.

It was not a throwaway treatment given to individuals of reduced means, but rather a pervasive treatment strategy recommended to rich and poor alike. There are several famous cases of bloodletting, but perhaps the most poignant case for American audiences is that of our founding father and first president, George Washington. On December 13, , a mere 30 months into his retirement, Washington began suffering from a cough, which quickly progressed to difficulty swallowing and a fever [6].

Over the course of the next 12 hours, several physicians were called upon and they attempted treatment modalities that included enemas and various types of tea [6]. In addition, they reportedly removed over 80 ounces 2. On December 14, , Washington succumbed to his illness [6]. Gradually, bloodletting began to fall out of favor as physician-scientists utilized the scientific method to conduct studies with increased validity.

For example, in the early 19th century, French physician-scientist Pierre Charles Alexandre Louis evaluated the medical records of 77 patients with pneumonia and analyzed the duration of illness and mortality data for patients who underwent bloodletting, compared to those who did not undergo the procedure [7].

However, there are certain conditions in which therapeutic phlebotomy is considered effective. For example, hereditary hemochromatosis is a genetic disorder that results in increased intestinal iron absorption and iron deposition throughout tissues and vital organs [9].

Therapeutic phlebotomy is often conducted on these patients in order to remove excess iron from the bloodstream. He compared the results in patients treated with bloodletting in the early phase versus the late phase of the illness. Subsequent studies by Pasteur, Koch, Virchow, and others confirmed the validity of the new scientific methods, and the use of bloodletting gradually diminished to a few select conditions.

Bloodletting today Today phlebotomy therapy is primarily used in Western medicine for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda. Hemochromatosis is a genetic disorder of iron metabolism leading to abnormal iron accumulation in liver, pancreas, heart, pituitary, joints, and skin. It is treated with periodic phlebotomy to maintain ferritin levels at a reasonable level so as to minimize further iron deposition.

Polycythemia vera is a stem cell bone marrow disorder leading to overproduction of red blood cells and variable overproduction of white blood cells and platelets. Its treatment includes phlebotomy to reduce the red blood cell mass and decrease the chance of dangerous clots. Porphyria cutanea tarda is a group of disorders of heme metabolism with an associated abnormality in iron metabolism.

Phlebotomy is also used to decrease iron levels and prevent accumulation in various organs. Hirudo medicinalis can secrete several biologically active substances including hyaluronidase, fibrinase, proteinase inhibitors, and hirudin, an anticoagulant. The leech can help reduce venous congestion and prevent tissue necrosis. In this way it can be used in the postoperative care of skin grafts and reimplanted fingers, ears, and toes.

Why did it persist? We may wonder why the practice of bloodletting persisted for so long, especially when discoveries by Vesalius and Harvey in the 16th and 17th centuries exposed the significant errors of Galenic anatomy and physiology.

With our present understanding of pathophysiology we might be tempted to laugh at such methods of therapy. But what will physicians think of our current medical practice years from now?

In the future we can anticipate that with further advances in medical knowledge our diagnoses will become more refined and our treatments less invasive. We can hope that medical research will proceed unhampered by commercial pressures and unfettered by political ideology. And if we truly believe that we can move closer to the pure goal of scientific truth. Magner LN. A History of Medicine.

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