Perhaps none of the methods of treatment was so popular and did not take so many lives as bloodletting. Curiously, it was practiced in different eras, in different parts of the world and cultures, by magicians and secular doctors.
Bloodletting for more than three millennia. The first mention in ancient Egyptian papyri refers to the second Millennium BC. Bloodletting was used in Ayurvedic medicine of ancient India, where almost all its varieties were used: dissection of veins, blood banks, leeches and even therapeutic flagellation to the blood. Acupuncture, which originated in China and spread around the world, also probably originates from a bloodier procedure and has only recently been transformed into the now bloodless variant. Bloodletting was done by the Indians of pre-Columbian America, tribes in Africa and Northern Australia, the aborigines of Tasmania, the inhabitants of Patagonia, Fiji and Sumatra, the latter burying “bad blood” in the ground, so that evil could not return to the patient. Although often magical sense of the procedure was forgotten, sometimes healers remember that together with the blood leaving the body, living in it the evil spirits.
In Western medicine, bloodletting came from the ancient: Hippocrates already recommends releasing the patient’s blood until he loses consciousness. “Materialistic ” humoral medicine explained the use of the method by the need to remove excess blood. Galen described, with his usual thoroughness, where to cut the veins and how much blood to release, depending on the time of year, age, sex and temperament of the patient. He recommended bloodletting for fevers, inflammation, injuries, angina, amenorrhea , dementia, hepatitis, gout, epilepsy and, paradoxically, bleeding. Galen also prescribed preventive bloodletting: healthy people with a calm nature should be with the onset of spring in advance to get rid of excess blood.
The ancient Greeks and Romans used several techniques, but the simplest and most popular was phlebotomy-cutting a vein with a sharp instrument. There was a debate among bloodletting advocates as to which part of the body to make the incision, closer to the sore spot or as far away from it as possible, and which days to choose. Only the usefulness of the method was not in doubt.
After the fall of the Roman Empire with the works of Galen bloodletting penetrated into the Arab countries, where particular popularity was his version, called hijama (from the Arabic “sucking”). First, the patient put a jar, which creates a vacuum, burning it into a piece of tissue – this causes a noticeable swelling. After some time, the jar is removed, several incisions are made, re-put it in the same place and left there until the blood stops flowing. Prophet Muhammad himself was treated with hijama and recommended it to his friends. In one of the most authoritative collections of hadiths Jami at-Tirmizi mentioned that on the night journey to heaven the angels gave the prophet the message: “O Muhammad, tell your people to put banks”. Arab doctors not only put blood banks, but also used abundant bloodletting for pain relief during childbirth or in the correction of dislocation. Analgesic effect was achieved by the fact that due to the large blood loss, the patient for some time lost consciousness.
Bloodletting returned to Europe with ancient medicine and remained the most common procedure until the XIX century. They treated most of the diseases known to doctors of that time: fever, cancer, acne, herpes, strokes, pneumonia, tuberculosis, colds, epilepsy, dementia, gout, gangrene and even comatose conditions. In England in most abbeys, there was a house bloodletting – phlebotomy, where the monks on certain days of the year lose blood each other and patients.
Over time, this role passed from monks to hairdressers. However, the popularity of the procedure was so great that hairdressers competed representatives of various professions: doctors, pharmacists, Directors of stray leeches, and even Tinkers, which, passing from village to village, offered not only “to tin, repair, solder,” but let the blood anyone.
Hirudotherapy, or leech treatment – is no less ancient and no less popular method of bloodletting. These annelid worms stick to the skin of the victim and, biting through it, feed on blood. Their saliva contains substances that prevent blood clotting and cause local anesthesia. They have been used since Ancient Egypt, but the peak of popularity fell on Europe XVIII-XIX centuries: in the middle of the XIX century only France imported up to 40 million leeches a year. The use of leeches was not safe: one leech can suck no more than ten milliliters of blood at a time, but given the violation of blood coagulation loss can be up to fifty milliliters. And because some doctors put up to fifty leeches at a time, their use led to serious blood loss.
The understanding that the heart pumps the final volume of blood through a closed system of vessels, came only in the XVII century thanks to the works of William Harvey. Until then, the idea of the cyclic movement of blood was absent. According to Galen’s teachings, it was believed that all venous blood is re-formed in the liver, which means that the loss of even a large amount of blood is not terrible. Bloodletting was done repeatedly, while the total blood loss could be up to two liters per day. Since the volume of circulating blood is about four liters, this posed a serious threat to health. Patients treated with bloodletting often already suffered from dehydration, injuries and blood loss. In such cases, the patient needs an immediate restoration of blood volume, and applying bloodletting, the doctor did the opposite and dramatically reduced the chances of the patient.
As a result, bloodletting has become one of the deadliest treatments in medical history and probably claimed tens of thousands of lives. Many contemporaries understood this. This is how Moliere’s play “the Imaginary patient” (1673) parodies the Commission taking the examinations of a medical student. The student is asked how to treat different diseases, and all the questions he confidently answers the same phrase: “Enema, bleed, give laxatives.” Then satisfied the examiners solemnly declare him a doctor and certify the law “with impunity to stuff drugs, laxative feed, to bleed, to cut, to stab and kill across the Land.”
Enemas, vomiting, bloodletting and laxatives were often used simultaneously, exacerbating dehydration and worsening the patient’s condition. Here’s how, for example, looks like one of the recommendations of the German psychiatrist Heinrich Neumann: “the Patient should sit on a straight chair, to tie, to do the bloodletting to put on the head 10-12 leeches, to impose the body with ice towels, pour on the head 50 buckets of cold water and give a nice welcome laxative salt.” It was probably well-intentioned, but the patient was not to be envied.
In a serious disease, the chances of surviving such treatment in the patient are small. Bloodletting was the main method of fighting the cholera epidemic in 1831. Cholera itself causes severe dehydration, leading to death, and made against this background bloodletting deprived patients of the last chance of recovery. The death toll during this epidemic could have been much lower if not for the well-intentioned intervention of doctors. It is noteworthy that some of them drew attention to the negative results, but, instead of questioning the appropriateness of treatment, launched discussions about when it is better to use. So great was the conviction that the method, tested by centuries, recommended by their teachers and the great authorities of the past, could not be wrong.
☛ Among the victims of bloodletting were very famous people.
King Charles II of England, who ruled in the second half of the XVII century, suffered a stroke, after which the court physicians released 700 milliliters of blood from him. The king died, and the doctors who treated him wisely fled. Lord Byron died from encephalitis after that a few sessions of bloodletting and hasten his death. According to one version, Mozart died because of attempts in the treatment of rheumatoid fever intense bloodletting and laxative. And the first us President George Washington died after treating a cold, doctors released from him more than two and a half liters of blood. Napoleon Bonaparte suffered the intense bleeding and survived, but was after that call medicine “science killer”.