Bloodletting

Following a ride in blistering cold weather, George Washington awoke at 2 a.m. on December 14, 1799, with a fever, sore throat, and respiratory difficulties. A believer in the healing powers of bloodletting, Washington asked to be bled. After a series of medical procedures, including blisterings, emetics, laxatives, and the draining of nearly 40 percent of his blood, Washington died that evening, of what has been diagnosed retrospectively as epiglottitis and shock.

George Washington Bloodletting
After a series of medical procedures, including the draining of nearly 40 percent of his blood, Washington died on the evening of December 14, 1799.

Humor Me

Bloodletting was in existence long before Washington’s time, dating back 3,000 years; first with the Egyptians, then onto the Greeks and Romans, the Asians and Arabs, and then throughout Europe, and during the Middle Ages.

The practice gained wide acceptance and application during the time of Hippocrates (~460–370 BC). The Greek physician, who is considered by many as one of the most important figures in the history of medicine, believed in a form of Humorism, in that…

“The Human body contains blood, phlegm, yellow bile and black bile. These are the things that make up its constitution and cause its pains and health. Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.” Source

Being ill, Hippocrates believed, meant having an imbalance of the four humors. His prescription? Remove the excessive humor by any means necessary: bloodletting, purging, diuresis, and so on.

Galen & Hippocrates
(Left) Galen & (Right) Hippocrates

Galen’s Humor

Galen of Pergamon (129-210 AD) was a physician, surgeon, and philosopher in the Roman Empire. Arguably the most revered medical researcher of all of antiquity, Galen influenced developments in anatomy, physiology, pathology, pharmacology, and neurology.

By the power of his pen and through force of personality, Galen declared blood as the most dominant humor; a view that strongly influenced Western medical science for more than 1,300 years.

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Bloodletting Tools & Methods

Bloodletting is largely divided into two methods: (1) venesection and arteriotomy; (2) scarification with cupping and leeches.

The most common method, venesection, involved the removal of blood from the circulatory system through a cut or puncture of a vein; usually the median cubital vein at the elbow. The instruments favored by physicians were called lancets and fleams.

Bloodletting in 1860
Bloodletting in 1860, one of only three known photographs of the procedure.

Lancets typically came in the form a thumb lancet; a small sharp-pointed, two-edged instrument, whereas fleams were devices with multiple, variably sized blades that folded into a housing like a pocketknife. 

Bloodletting Thumb Lancet & Fleam
(Left) An antique thumb lancet that is unsigned, maker unknown. Appears to have a faux tortoiseshell handle that the blade folds into when not in use. (Right) An antique fleam bleeder that is signed Manhattan Cutlery Sheffield.

Bloodletting could also be achieved through scarification; the scraping and cutting of the skin with a cube-shaped brass box containing multiple small knives. The cutting of the skin would then be followed by cupping; the placement of a dome-shaped glass over the skin, in which air would be extracted by suction or through the heating of the glass.

Brass Scarificator
Brass scarificator, with 12 lancets, in case, 19th century, with three sets of blades.

Leeches were also used for bloodletting. During a single feeding session, a leech can consume up to 10ml of blood, nearly 10 times its own weight.

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Barber-Surgeons

In 1163, after Pope Alexander III prohibited clergymen from performing bloodletting procedures on their parishioners, barbers—skilled with razors and steady hands—began to offer the service to their patrons; along with trims and shaves of course.

Known as barber-surgeons, they also pulled teeth, set bones, treated wounds, and provided amputations. Ambroise Pare, a 16th-century French physician who’s considered the father of modern surgery, started his career as a barber-surgeon.

Barber Pole
Antique turned and painted wooden barber pole, c. late 19th century. The red and white barber pole advertised more than a haircut in the nineteenth century.

The colors of the striped barber pole are linked to bloodletting, with red representing blood and white representing the bandages used to stop the bleeding. The pole itself is symbolic of the stick that a patient would squeeze in order to make his veins stand out for the procedure.

When barber poles began to appear in America, the color blue was added; either as a symbol of the veins cut during bloodletting, or as a show of patriotism to the American flag.

Bloodletting Today

By the late 1800s, bloodletting had fallen out of favor, as new treatments and technologies emerged, and studies by prominent physicians began to cast serious doubts on the effectiveness of the practice.   

Today, bloodletting remains a conventional therapy for a very small number of conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.

Medicinal Leech
Medicine leeches can be used to treat frostbite and help with recovery from face lifts.

The use of leeches, meanwhile, has experienced a renaissance in the last three decades, particularly in the field of microsurgery and replantation surgery. In this way, “mechanical leeches” are used in the postoperative care of skin grafts and replanted fingers, ears, and toes.

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