Gilbert R. Seigworth, M.D
Vestal, New YorkBloodletting is a procedure that was performed to help alleviate the ills of mankind. For an operation with a 3,000-year history, bloodletting has attracted little attention in recent historic accounts of medicine. Bloodletting began with the Egyptians of the River Nile one thousand years B.C., and the tradition spread to the Greeks and Romans; its popularity continued throughout the Middle Ages. It reached its zenith during the beginning of the nineteenth century, but had virtually died as a therapeutic tool by the end of that century.he custom of bloodletting as practiced over the centuries might seem repulsive to the modern practitioner of medicine. However, the physician and his treatment must be judged in the light of the contemporary theory of disease. Primitive man looked on disease as a curse cast on him by an evil spirit; his treatment consisted of driving out the demon that possessed him. Neolithic man of the late Stone Age used flint tools for trepanning the skull as a method for releasing the demon; the logic of the treatment was sound, but the premise on which it was based was wrong. The premise was that the evil spirit of disease was contained within the skull and could be drawn out. In much the same way as trepanning allowed demons to escape from the head, bloodletting was supposed to facilitate the release of evil spirits from elsewhere in the body. Later use of bloodletting in hypertension, apoplexy, dropsy, and nervous disorders had a more physiologic explanation.
The story of bloodletting is intertwined in the mysterious fabric of medical lore; it originated from magic and religious ceremonies. The physician and priest were one and the same since disease was thought to be caused by supernatural causes. Witch doctors and sorcerers were called on to drive out the evil spirits and demons. Bloodletting was a method for cleansing the body of ill-defined impurities and excess fluid. The early instruments included thorns, pointed sticks and bones, sharp pieces of flint or shell, and even sharply pointed shark's teeth. Miniature bow and arrow devices for bloodletting have been found in South
America and New Guinea. A small bloodletting instrument resembling a crossbow was once used in Greece and Malta. Wall paintings dating from 1400 B.C. depict the use of leeches for drawing blood from human beings.
Four body humors
Prior to the time of Hippocrates (460
to 377 B.C.), all illness was attributed to one disease with variable symptoms. Careful clinical observations by Hippocrates led to the recognition of specific disease states with identifying symptoms. It was during this time
that the concept of body humors developed. The four fluid substances of the body were blood, phlegm, yellow bile, and
black bile. Health depended on the proper balance of these humors. Bloodletting was, therefore, a method used for adjusting on of the four body humors to proper balance. This clinical concept led to the decline in the doctrine of evil spirits in disease.
It was thought that blood carried the vital force of the body and was the seat of the soul; body weakness and insanity were ascribed to a defect in this vital fluid. Blood spurting from fallen gladiators was drunk with the hope that it would transfer strength to the recipient. Caspar Bartholin, M.D., (1655 to 1738) described an epileptic girl at Breslau who drank the blood of a cat. The girl, so the report goes, became endowed with the characteristics of a cat. She climbed on the roofs of houses and imitated the manner of a cat by jumping, scratching, and howling. Not content with that, she would sit for hours
gazing into a hole in the floor.
Indications for venesection
Venesection was the most common method of general bloodletting. The specific indications have varied over the years. The following translation from
Old English is advice given by Ambroise Paré in a 1634 text.2
But blood is let by opening a vein for five respects: the first to lessen the abundance of blood, as in plethoric bodies, and those troubled with plentitude. The second is for diversion, or revulsion, as when a vein of the right arm is opened to stay the bleeding of the left nostril. The third is to allure or draw down, as when the vein is opened in the ankle to draw down the menstrual flow in women. The fourth is for alteration or introduction of another quality, as when in sharp fevers we open a vein to breathe out that blood which is heated in vessels, and cooling the residue which remains behind. The fifth is to prevent imminent disease, as in the spring and autumn we draw blood by opening a vein in such as are subject to spitting of blood, quinsy, pleurisy, falling sickness, apoplexy, madness, gout, or in such as are wounded, for to prevent the inflammation which is to be feared. Before bloodletting, if there be any excrement in the guts, they shall be evacuated by a gentle clysters, or suppository, lest the mesenteric veins should thence draw unto them any impurity.