Bloodletting

Passages from the Ebers Papyrus may indicate that bloodletting by scarification was an accepted practice in Ancient Egypt.^[9][10][11] Egyptian burials have been reported to contain bloodletting instruments.^[12] According to some accounts, the Egyptians based the idea on their observations of the hippopotamus,^[13] confusing its red secretions with blood and believing that it scratched itself to relieve distress.^[14][15]

In Greece, bloodletting was in use in the 5th century BC during the lifetime of

Therapeutic uses of bloodletting were reported in 60 distinct cultures/ethnic groups in the eHRAF database, present in all inhabited continents. Bloodletting has also been reported in 15 of the 60 cultures in the probability sample files (PSF) list.^[22] The PSF is a subset of eHRAF data that includes only one culture from each of 60 macro-culture areas around the world. The prevalence of bloodletting in PSF controls for pseudo replication linked to common ancestry, suggesting that bloodletting has independently emerged many times. Bloodletting is varied in its practices cross-culturally, for example, in native Alaskan culture bloodletting was practiced for different indications, using different tools, on different body areas, by different people, and it was explained by different medical theories.^[23]

According to Helena Miton et al.'s ^[22] analysis of the eHRAF database and other sources, there are several cross-cultural patterns in bloodletting.

• Bloodletting is not self-administered. Out of 14 cultures in which the bloodletting practitioner was mentioned, the practitioner was always a third party. 13/14 of the cultures had practitioners with roles related to medicine, while one culture had a practitioner whose role was not related to medicine.
• Idea of bloodletting removing 'bad blood' that needs to be taken out was common, and was explicitly mentioned in 10/14 cultures studied with detailed descriptions of bloodletting.
• Bloodletting is not thought to be effective against illness caused supernaturally by humans (e.g. witchcraft). This is surprising, because in most cultures witchcraft and sorcery can be blamed for ailments.^[24] But out of 14 cultures with detailed bloodletting descriptions, there was no evidence of bloodletting being used to cure witchcraft-related ailments, while bloodletting was recorded as a cure for ailments of other origins. The Azande culture has been recorded to believe that bloodletting does not work to cure human-related witchcraft ailments. ^[25]
• Bloodletting is usually administered directly to the effected area, e.g. if the patient has a headache, a cut is made on the forehead. Out of 14 cultures with information on the localization of bloodletting, 11 at least sometimes removed blood from the affected area, while 3 specifically removed blood from a different area from the area in pain. Europe is the only continent with more instances of non-colocalized than colocalized bloodletting.

In a

Bloodletting as a concept is thought to be a cultural attractor, or an intrinsically attractive / culturally transmissible concept. This could explain bloodletting's independent cross-cultural emergence and common cross-cultural traits.[22]

Middle Ages

The

Bloodletting became a main technique of heroic medicine, a traumatic and destructive collection of medical practices that emerged in the 18th century.^[27]

Even after the humoral system fell into disuse, the practice was continued by

A number of different methods were employed. The most common was phlebotomy, or venesection (often called "breathing a vein"), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. In arteriotomy, an artery was punctured, although generally only in the temples. In scarification (not to be confused with

William Harvey disproved the basis of the practice in 1628,^[2] and the introduction of scientific medicine, la méthode numérique, allowed Pierre Charles Alexandre Louis to demonstrate that phlebotomy was entirely ineffective in the treatment of pneumonia and various fevers in the 1830s. Nevertheless, in 1838, a lecturer at the Royal College of Physicians would still state that "blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly",^[28] and Louis was dogged by the sanguinary Broussais, who could recommend leeches fifty at a time. Some physicians resisted Louis' work because they "were not prepared to discard therapies 'validated by both tradition and their own experience on account of somebody else's numbers'."^[29]

During this era, bloodletting was used to treat almost every disease. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed.^[30]

There were also theories that bloodletting would cure "heartsickness" and "heartbreak". A French physician, Jacques Ferrand wrote a book in 1623 on the uses of bloodletting to cure a broken heart. He recommended bloodletting to the point of heart failure (literal).^[31]

Leeches became especially popular in the early 19th century. In the 1830s, the French imported about 40 million leeches a year for medical purposes, and in the next decade, England imported 6 million leeches a year from France alone. Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe.^[32]

Bloodletting was also popular in the young United States of America, where

One reason for the continued popularity of bloodletting (and purging) was that, while

Barbara Ehrenreich and Deirdre English write that the popularity of bloodletting and heroic medicine in general was because of a need to justify medical billing. Traditional healing techniques had been mostly practiced by women within a non-commercial family or village setting. As male doctors suppressed these techniques, they found it difficult to quantify various "amounts" of healing to charge for, and difficult to convince patients to pay for it. Because bloodletting seemed active and dramatic, it helped convince patients the doctor had something tangible to sell.^[27]

Controversy and use into the 20th century

Bloodletting gradually declined in popularity over the course of the 19th century, becoming rather uncommon in most places, before its validity was thoroughly debated. In the medical community of

Some researchers used statistical methods for evaluating treatment effectiveness to discourage bloodletting.^[35] But at the same time, publications by Philip Pye-Smith and others defended bloodletting on scientific grounds.^[38]

Bloodletting persisted into the 20th century and was recommended in the 1923 edition of the textbook The Principles and Practice of Medicine.^[40] The textbook was originally written by Sir William Osler and continued to be published in new editions under new authors following Osler's death in 1919.^[41]

Phlebotomy

Bloodletting is used today in the treatment of a few diseases, including

References

Books cited

• Carter, K. Codell; Barbara R. Carter (2005). Childbed fever. A scientific biography of Ignaz Semmelweis. Transaction Publishers.
  ISBN 978-1-4128-0467-7
  .
• Carter, K. Codell (2012). The Decline of Therapeutic Bloodletting and the Collapse of Traditional Medicine. New Brunswick & London: Transaction Publishers.
  ISBN 978-1-4128-4604-2
  .
• Kang, Lydia; Nate Pederson (2017). Quackery: A Brief History of the Worst Ways to Cure Everything. Workman Publishing Company.^[ISBN missing]

Further reading

• McGrew, Roderick. Encyclopedia of Medical History (1985), brief history pp. 32–34^{[ISBN missing]}

External links

Wikimedia Commons has media related to Bloodletting.

• The History and Progression of Bloodletting
• Medical Antiques: Scarification and Bleeding
• Pictures of antique bloodletting instruments Archived 2 May 2012 at the Wayback Machine
• PBS's Red Gold: The Story of Blood
• Huge collection of antique bloodletting instruments
• "Breathing a Vein" Archived 14 September 2015 at the Wayback Machine phisick.com 14 Nov 2011