practice of bloodletting has been used by almost all cultures and
societies at some point in their medical history. The controversy over the usefulness of it has been raging since
the fifth century B.C.E. It was considered to be part of the treatment for practically every ailment that you can
think of: asthma, spitting blood, bruises, cough, consumption, contusion, convulsions, cramps, deafness, delirium,
epilepsy, giddiness, gout, whooping cough, hydrocephalus, head ache, intoxication, lethargy, lunacy, measles, palsy,
rheumatism, sciatica, shortness of breath, and sore throat. It was also, though not as commonly, used as a punishment
and as a form of worship to a superior power. In seventeenth century England, for example, the use of bloodletting
was very popular for the treatment of hysteria. It was believed that hysteria gave rise to an accumulation of "putrid
humors" which impaired the organs whose function it was to purify the blood and caused this physical affliction.
Bleeding and purging were the universal remedies for these humours and so they were employed for the treatment
of hysteria as well. The patient would be bled and then administered medicines that "fortified" the blood,
such as iron fillings. This practice continued into the eighteenth century. The idea for bloodletting was taken
from the animal world. People observed that animals self-inflicted wounds and they assumed this was for medicinal
practices. They also observed similar occurrences through human forms of spontaneous bleeding such as nosebleeds,
menstruation, and injury. Bloodletting was very popular from ancient times until the Middle Ages. It experienced
a great vogue in the eighteenth and nineteenth centuries. Beliefs about health and disease in the eighteenth century
were based on those held by the ancient Greeks. For more on the humoral theory see the section on medical blood
in Bloodlines .Blood
was a humor and was believed to be made up of food. The idea was that if the humors were in balance then the body
was healthy and if they were out of balance the result would be disease. One of these diseases was plethora. Plethora
was an over-abundance of body humors and was characterized by fevers and inflammations. It was treated by the removal
of the offending humours. This removal could be brought about by inducing vomiting, starvation, and bloodletting.
The patient was often starved so that the veins would become empty of food and then the blood, which had escaped
into the arteries, could be absorbed. This procedure was drawn out and very uncomfortable for the patient, so bloodletting
was increasingly used instead as a quick way to relieve the patient of extra blood.
Venesection is often mentioned in connection with Anglo-Saxon leechcraft. But the importance seems to be placed on the timing of the operation rather than the procedure itself. This is an example of a diagnosis given for paralysis: "Scarify the neck after the setting of the sun, pour in silence the blood into running water, after that spit three time, then say, 'Have thou this unheal, and depart away with it': go again on a clean way to the house, and go either way in silence."(The Book of Anglo-Saxon Leechcraft) This pre-occupation with timing is seen over and over again. In the Leech Book of Bald there are precise directions given for the correct times for a patient to be bled. Here is another example: "...and there is no time for bloodletting so good as in early Lent, when the evil humours are gathered which be drunken in during the winter, and on the kalends of April best of all, when trees and worts first up sprout..."(The Book of Anglo-Saxon Leechcraft) As time went by the most scrutiny fell more and more on the actual removal of the blood and less and less on the particular timing of the event.
There were three main ways of letting blood. One was phlebotomy, which is the direct cutting of a vein to release blood. It was often done with a knife and then later the spring loaded lancet, which is basically a spring loaded knife. If the patient was too young, old, or weak to stand phlebotomy, Cupping was often used. This was the act of applying a cup, in which a vacuum had been created through the use of fire, to either intact skin to cause it to tumefy or to a place where small incisions had been made, to draw out blood. Another practice was Leeching. Leeching was popular because it required little skill; one could do it oneself in the home and the leeches were ready to suck blood at any time. An adult would use between twenty and fifty leeches. They were also popular because (click me for bigger image) they could be used in places that phlebotomy and cupping could not, such as internal membranes. They were often also applied inside the nose, ear, eyes, mouth, anus, and vagina.
ONE of the controversies surrounding bloodletting was how to judge how much
blood to let. One of the general thoughts on the amount of blood to let was to bleed the patient until syncope.
Syncope is defined here in this 1848 medical dictionary: "Complete and, commonly, sudden loss of sensation
and motion, with considered diminution, or entire suspension of the pulsations of the heart and respiratory movements."
In the current day, this condition is not very differently thought of than shock. This is why, as time moved on,
bloodletting was practiced more and more by skilled surgeons who were thought to be better educated in how to bleed
without death or permanent damage. In the Early Middle Ages bloodletting was almost entirely done by barber -surgeons.
They identified themselves by putting a pole outside their business and hanging a blood collecting dish from it. The pole represented
the the stick that the patient gripped to encourage the flow of blood, the white stripes represented the tourniquet
and the blue or red stripes represented veins or blood. But once again as time moved on this practice became more
and more the domain of skilled surgeons, especially during the aforementioned vogue of the eighteenth and nineteenth
centuries. The use of bloodletting declined as better cures were found for the problems it treated. Some aspects
of bloodletting still exist today. Leeches are used in limb re-attachment and re-constructive surgery to keep a
steady flow of blood through the tissue, and it has been said that a man should give blood once a year to lower
the risk of a heart attack.
The word "phlebotomy" is now, in the modern day, defined as the practice of removing or "letting" blood for diagnostic, rather than therapeutic reasons. This is now the only form of medicinal bloodletting that is generally practiced. Phlebotomy is done with a syringe. The piston-and-cylinder syringe was first used on wounds to extract pus. The invention of this device is attributed to the son of a barber in Alexandria, Egypt around 280 B.C. The use of an evacuated blood collection system became popular in 1943 with the marketing of the VACUTAINER Brand system. The National Phlebotomy Association was established in 1948. The founding of this organization spurred on the search for better and better ways to collect blood. Today phlebotomy is a distinct professional field.
Appel, Toby and Audrey Davis. Bloodletting Instruments in the National Museum of History and Technology. Smithsonian Institution Press. Washington, 1979.
Burroughs and Wellcome, The Book of Anglo-Saxon Leechcraft: An Historical Sketch of Early English Medicine. Burroughs and Wellcome Co. London, 1912.
Pendergraph, Garland E. Handbook of Phlebotomy. Lea and Febiger. Philadelphia, 1984.
Veith, Ilza. Hysteria:The History of a Disease. University of Chicago. Chicago, 1965.
Encyclopedia Britannica: Bloodletting-The encyclopedia definition of bloodletting and related topics.
Images from the History of Medicine- This gives you access to a collection of images of tools and medicinal practices from the history of medicine. Using the search word "bloodletting" will bring up 67 images.