The history of bloodletting | BC Medical Journal The history of bloodletting Gerry Greenstone, MD With a history spanning at least 3000 years, bloodletting has only recently—in the late 19th century—been discredited as a treatment for most ailments. The practice of bloodletting began around 3000 years ago with the Egyptians, then continued with the Greeks and Romans, the Arabs and Asians, then spread through Europe during the Middle Ages and the Renaissance. It reached its peak in Europe in the 19th century but subsequently declined and today in Western medicine is used only for a few select conditions. Humors, Hippocrates, and Galen To appreciate the rationale for bloodletting one must first understand the paradigm of disease 2300 years ago in the time of Hippocrates (~460–370 BC). He believed that existence was represented by the four basic elements—earth, air, fire, and water—which in humans were related to the four basic humors: blood, phlegm, black bile, yellow bile.

Each humor was centred in a particular organ—brain, lung, spleen, and gall bladder—and related to a particular personality type—sanguine, phlegmatic, melancholic, and choleric.[ 1 ] Being ill meant having an imbalance of the four humors. Therefore treatment consisted of removing an amount of the excessive humor by various means such as bloodletting, purging, catharsis, diuresis, and so on. By the 1st century bloodletting was already a common treatment, but when Galen of Pergamum (129–200 AD) declared blood as the most dominant humor, the practice of venesection gained even greater importance.[ 2 ] Galen was able to propagate his ideas through the force of personality and the power of the pen; his total written output exceeds two million words. He had an extraordinary effect on medical practice and his teaching persisted for many centuries. His ideas and writings were disseminated by several physicians in the Middle Ages when bloodletting became accepted as the standard treatment for many conditions.

Methods of bloodletting Bloodletting was divided into a generalized method done by venesection and arteriotomy, and a localized method done by scarification with cupping and leeches. Venesection was the most common procedure and usually involved the median cubital vein at the elbow, but many different veins could be used. The main instruments for this technique were called lancets and fleams.[ 3 ] Thumb lancets were small sharp-pointed, two-edged instruments often with an ivory or tortoise shell case that the physician could carry in his pocket. Fleams were usually devices with multiple, variably sized blades that folded into a case like a pocketknife. Localized bloodletting often in­volv­ed scarification, which meant scraping the skin with a cube-shaped brass box containing multiple small knives, followed by cupping, which involved placing a dome-shaped glass over the skin and extracting the air by suction or prior heating.[ 4 ] Leeches used for bloodletting usually involved the medicinal leech, Hirudo medicinalis. At each feeding a leech can ingest about 5 to 10 ml of blood, almost 10 times its own weight.

The use of leeches was greatly in­fluenced by Dr François Broussais (1772–1838), a Parisian physician who claimed that all fevers were due to specific organ inflammation. He was a great proponent of leech therapy along with aggressive bloodletting. He believed in placing leeches over the organ of the body that was deemed to be inflamed.[ 5 ] his therapy was very popular in Europe in the 1830s, especially France, where 5 to 6 million leeches per year were used in Paris alone and about 35 million in the country as a whole. By the late 1800s, however, enthusiasm for leech therapy had waned, but leeches are still used today in select situations. Famous bleedings When Charles II (1630–1685) suffered a seizure he was immediately treated with 16 ounces of bloodletting from the left arm followed by another 8 ounces from cupping.[ 6 ] Then he endured a vigorous regimen of emetics, enemas, purgatives, and mustard plasters followed by more bleeding from the jugular veins.

He had more seizures and received further treatment with herbs and quinine. In total he had about 24 ounces of blood taken before he died. After riding in snowy weather, George Washington (1732–1799) developed a fever and respiratory distress. Under the care of his three physicians he had copious amounts of blood drawn, blisterings, emetics, and laxatives. He died the next night of what has been diagnosed retrospectively as epiglottitis and shock.[ 6 ] His medical treatment aroused significant controversy, particularly the bloodletting. Warring physicians The practice of bloodletting aroused deep emotions in both practitioners and detractors, with intense argument about the benefit and harm of venesection. Drs Benjamin Rush, William Alison, and Hughes Bennett exemplify this conflict. Dr Benjamin Rush (1745–1813) was one of the most controversial phy­sicians in his time. He was arrogant and paternalistic but dedicated to eradicating illness wherever he saw it.

He worked tirelessly during the yellow fever epidemics in Philadelphia in 1793 and 1797 and devoted much time to the problem of mental illness.[ 7 ] Unfortunately he had a very simplistic view of disease and thought that all febrile illnesses were due to an “irregular convulsive action of the blood vessels.” Therefore in his mind all therapy was directed at dampening down this vascular overexcitement. He was a great proponent of “depletion therapy,” which meant aggressive bloodletting and vigorous purging. He was known to remove extraordinary amounts of blood and often bled patients several times.

“It frequently strangles a fever… imparts strength to the body… renders the pulse more frequent when it is preternaturally slow… renders the bowels, when costive, more easily moved by purging physic… removes or lessens pain in every part of the body, and more especially the head… removes or lessens the burning heat of the skin, and the burning heat of the stomach…”[ 8 ] In addition he held a firm belief in his calomel purgatives, which were loaded with mercury and which he called “the Samson of medicine.” In numerous articles he boldly proclaimed the benefits of his therapy. He aroused both extremely positive and negative reactions in those around him, including many physicians. Some doctors referred to his practices as “murderous” and his prescribed doses as “fit for a horse.” He had a long-running feud with his college of physicians, which forced him to resign, and his application to the faculty of Columbia Medical School in New York was denied. However, Rush Medical College in Chicago was named in his honor and gained its charter in 1837.

At the Edinburgh School of Medicine Dr William Alison (1790–1859) and Dr Hughes Bennett (1812–1875) were a study in contrasts. The former was a dignified old-timer and strong believer in bloodletting, while the latter was an arrogant newcomer and resolute debunker of bloodletting. Whereas Dr Alison followed the old tradition of clinical experience and empirical observation, Dr Bennett believed in the new methods of pathology and physiology supported by the microscope and the stethoscope.[ 9 ] Central to their debate was the ob­servation that the improved outcome of patients with pneumonia paralleled the decreased usage of bloodletting. While Dr Alison ascrib­ed this to a “change in type” of illness which had gone from sthenic (strong) to asthenic (weak), Dr Bennett be­lieved it due to diminished use of a dangerous therapy. Both were implacable in their point of view, thereby underlining the significant gap between their beliefs in empirical observation versus scientific verification.

Dr Bennett had the ad­vantage of the latest techniques and “grounded his rejection of bloodletting on pathologic concepts of inflammation and pneumonia derived from microscopic studies of inflamed tissues.”[ 9 ] The tide turns In Paris Dr Pierre Louis (1787–1872) was another scientific-minded physician who wanted to assess the efficacy of bloodletting. He examined the clinical course and outcomes of 77 patients with acute pneumonia taken from his own and hospital records. He compared the results in patients treated with bloodletting in the early phase versus the late phase of the illness. In his conclusions he did not condemn bloodletting but concluded that the ef­fect of this procedure “was actually much less than has been commonly be­lieved.”[ 10 ] Subsequent studies by Pasteur, Koch, Virchow, and others confirmed the validity of the new scientific methods, and the use of bloodletting gradually diminished to a few select conditions.

Bloodletting today Today phlebotomy therapy is primarily used in Western medicine for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.[ 11 ] Hemochromatosis is a genetic disorder of iron metabolism leading to abnormal iron accumulation in liver, pancreas, heart, pituitary, joints, and skin. It is treated with periodic phlebotomy to maintain ferritin levels at a reasonable level so as to minimize further iron deposition. Polycythemia vera is a stem cell bone marrow disorder leading to overproduction of red blood cells and variable overproduction of white blood cells and platelets. Its treatment includes phlebotomy to reduce the red blood cell mass and decrease the chance of dangerous clots. Porphyria cutanea tarda is a group of disorders of heme metabolism with an associated abnormality in iron metabolism. Phlebotomy is also used to decrease iron levels and prevent accumulation in various organs. In the last 25 years leech therapy has made a comeback in the area of microsurgery and reimplantation sur­gery.

Hirudo medicinalis can secrete several biologically active substances including hyaluronidase, fibrinase, proteinase inhibitors, and hirudin, an anticoagulant. The leech can help reduce venous congestion and prevent tissue necrosis. In this way it can be used in the postoperative care of skin grafts and reimplanted fingers, ears, and toes. Because of concern regarding second­ary infections a “mechanical leech” has been developed at the University of Wisconsin.[ 12 ] Why did it persist? We may wonder why the practice of bloodletting persisted for so long, especially when discoveries by Vesalius and Harvey in the 16th and 17th centuries exposed the significant errors of Galenic anatomy and physiology. However as Kerridge and Lowe have stated, “that bloodletting survived for so long is not an intellectual anomaly—it resulted from the dynamic interaction of social, economic, and intellectual pressures, a process that continues to determine medical practice.”[ 9 ] With our present understanding of pathophysiology we might be tempted to laugh at such methods of therapy. But what will physicians think of our current medical practice 100 years from now?

They may be astonished at our overuse of antibiotics, our ten­dency to polypharmacy, and the blunt­ness of treatments like radiation and chemo­therapy. In the future we can anticipate that with further advances in medical knowledge our diagnoses will become more refined and our treatments less invasive. We can hope that medical research will proceed unhampered by commercial pressures and unfettered by political ideology. And if we truly believe that we can move closer to the pure goal of scientific truth. References 1. Magner LN. A History of Medicine. New York: Marcel Dekker, Inc; 1992:66-74. 2. Magner LN. A History of Medicine. New York: Marcel Dekker, Inc; 1992:86-96. 3. McCormic S. Blood and magic—the evolution of phlebotomy. (accessed 4 April 2009). 4. Seigworth GS. Bloodletting Over the Centuries. New York State Journal of Medicine 1980;Dec:2022-2028. (accessed 4 April 2009). 5. Adams SL.

The medicinal leech. Ann Intern Med 1988;109:399-405. 6. Parapia LA. History of bloodletting by phlebotomy. Brit J Haemat 2008;143:490-495. 7. North RL. Benjamin Rush, MD: Assassin or beloved healer? Proc Bayl Univ Med Cent 2000;13:45-49. 8. Rush B. A Defence of Blood-letting, as a Remedy for Certain Diseases. In: Medical Inquiries and Observations. Vol 4. Philadelphia, PA; 1815. Available online at: Arnebeck B. Benjamin Rush’s A Defence of Blood-letting, as a Remedy for Certain Diseases. (accessed 4 April 2009). 9. Kerridge IH, Lowe M. Bloodletting: The story of a therapeutic technique. Med J Aust 1995;163:631-633. 10. Morabia A. P.C.A. Louis and the birth of clinical epidemiology.

Clin Epidemiol 1996;49:1327-1333. 11. Lee GR, Foerster J, Lukens J, et al. Wintrobe’s Clinical Hematology. 10th ed. Baltimore, MD: Williams & Wilkins; 1999:1063,1079,1539. 12. Whitaker IS, Rao J, Izadi D, et al. Historical Article: Hirudo medicinalis: Ancient origins of, and trends in the use of medicinal leeches throughout history. Br J Oral Maxillofac Surg 2004;42:133-137. Dr Greenstone is a family physician in Surrey, BC. 7 Unusual Ancient Medical Techniques - History Lists History Lists March 25, 2014 By Evan Andrews Share this: 7 Unusual Ancient Medical Techniques Author 7 Unusual Ancient Medical Techniques URL Google Doctors are supposed to operate under the maxim “do no harm,” but history shows this has sometimes been easier said than done.

While the ancients were surprisingly sophisticated in their knowledge of injury, sickness and disease, they often resorted to some downright bloodcurdling methods in their misguided attempts to heal their patients. Get the facts on seven unconventional treatments prescribed by the physicians of old. Bloodletting For thousands of years, medical practitioners clung to the belief that sickness was merely the result of a little “bad blood.” Bloodletting probably began with the ancient Sumerians and Egyptians, but it didn’t become common practice until the time of classical Greece and Rome. Influential physicians like Hippocrates and Galen maintained that the human body was filled with four basic substances, or “humors”—yellow bile, black bile, phlegm and blood—and these needed to be kept in balance to maintain proper health. With this in mind, patients with a fever or other ailment were often diagnosed with an overabundance of blood. To restore bodily harmony, their doctor would simply cut open a vein and drain some of their vital fluids into a receptacle. In some cases, leeches were even used to suck the blood directly from the skin.

While it could easily result in accidental death from blood loss, phlebotomy endured as a common medical practice well into the 19th century. Medieval doctors prescribed blood draining as a treatment for everything from a sore throat to the plague, and some barbers listed it as a service along with haircuts and shaves. The practice finally fell out of vogue after new research showed that it might be doing more harm than good, but leeching and controlled bloodletting are still used today as treatments for certain rare illnesses. Trepanation Humanity’s oldest form of surgery is also one of its most gruesome. As far back as 7,000 years ago, civilizations around the world engaged in trepanation—the practice of boring holes in the skull as a means of curing illnesses. Researchers can only speculate on how or why this grisly form of brain surgery first developed. A common theory holds that it may have been some form of tribal ritual or even a method for releasing evil spirits believed to possess the sick and mentally ill. Still others argue that it was a more conventional surgery used to treat epilepsy, headaches, abscesses and blood clots.

Trepanned skulls found in Peru hint that it was also a common emergency treatment for cleaning out bone fragments left behind by skull fractures, and evidence shows that many of the patients survived the surgery. Mercury Mercury is notorious for its toxic properties, but it was once used as a common elixir and topical medicine. The ancient Persians and Greeks considered it a useful ointment, and second-century Chinese alchemists prized liquid mercury, or “quicksilver,” and red mercury sulfide for their supposed ability to increase lifespan and vitality. Some healers even promised that by consuming noxious brews containing poisonous mercury, sulfur and arsenic, their patients would gain eternal life and the ability to walk on water. One of the most famous casualties of this diet was the Chinese Emperor Qin Shi Huang, who supposedly died after ingesting mercury pills designed to make him immortal. From the Renaissance until the early 20th century, Mercury was also used as a popular medicine for sexually transmitted diseases like syphilis. While some accounts claimed the heavy metal treatment was successful in fighting off the infection, patients often died from liver and kidney damage caused by mercury poisoning.

Animal Dung Ointments The ancient Egyptians had a remarkably well-organized medical system, complete with doctors who specialized in healing specific ailments. Nevertheless, the cures they prescribed weren’t always up to snuff. Lizard blood, dead mice, mud and moldy bread were all used as topical ointments and dressings, and women were sometimes dosed with horse saliva as a cure for an impaired libido. Most disgusting of all, Egyptian physicians used human and animal excrement as a cure-all remedy for diseases and injuries. According to 1500 B.C.’s Ebers Papyrus, donkey, dog, gazelle and fly dung were all celebrated for their healing properties and their ability to ward off bad spirits. While these repugnant remedies may have occasionally led to tetanus and other infections, they probably weren’t entirely ineffective—research shows the microflora found in some types of animal dung contain antibiotic substances. Cannibal Cures Suffering from persistent headaches, muscle cramps or stomach ulcers? Once upon a time, your local physician may have prescribed an elixir containing human flesh, blood or bone. So-called “corpse medicine” was a disturbingly common practice for hundreds of years.

The Romans believed that the blood of fallen gladiators could cure epilepsy, and 12th century apothecaries were known for keeping a stock of “mummy powder”—a macabre extract made from ground up mummies looted from Egypt. Meanwhile, in 17th century England, King Charles II was known for enjoying a draught of “King’s Drops,” a restorative brew made from crumbled human skull and alcohol. These cannibalistic medicines were thought to have magical properties. By consuming the remains of a deceased person, the patient also ingested part of their spirit, leading to increased vitality and wellbeing. The type of cure prescribed usually corresponded to the type of ailment—skull was used for migraines, and human fat for muscle aches—but getting fresh stock could be a gruesome process. In some cases, the sickly would even attend executions in the hope of getting a cheap cup of the freshly killed person’s blood. Wandering Womb Ancient Greek doctors believed that a woman’s womb was a separate creature with a mind of its own.

According to the writings of Plato and Hippocrates, when a woman was celibate for an extended time, her uterus—described as a “living animal” eager to bear children—could dislodge and glide freely about her body causing suffocation, seizures and hysteria. This curious diagnosis endured in some form into the time of the Romans and Byzantines—well after doctors had learned that the womb was held in place by ligaments. To prevent their wombs from going on walkabout, ancient women were counseled to marry young and bear as many children as possible. For a womb that had already broken free, doctors prescribed therapeutic baths, infusions and physical massages to try to force it back in position. They might even “fumigate” the patient’s head with sulfur and pitch while simultaneously rubbing pleasant-smelling lotions between her thighs —the logic being that the womb would flee from the bad smells and move back into its rightful place. Babylonian Skull Cure For the ancient Babylonians, most illnesses were thought to be the result of demonic forces or punishment by the gods for past misdeeds. Doctors often had more in common with priests and exorcists than modern physicians, and their cures usually involved some component of magic.

For example, if a patient ground their teeth, the healer might suspect that the ghost of a deceased family member was trying to contact them as they slept. According to ancient necromantic texts, the doctor would recommend sleeping by a human skull for a week as a way of exorcising the spirit. To ensure this disturbing treatment worked, the tooth-grinder was also instructed to kiss and lick the skull seven times each night. Tags When bleeding was a treatment - latimes When bleeding was a treatment June 26, 2006 |Elena Conis For thousands of years, physicians relied heavily on a single treatment for hysteria, heart disease and just about every other malady: bloodletting. The theory behind the practice changed often over time, but the practice itself remained much the same -- with doctors often bleeding patients until they were weak, pale and, sometimes, unconscious. -- Elena Conis * In the beginning in Asia and the Mideast, patients were bled to release demons and bad energy. Later, in ancient Greece, they were bled to restore the body's balance of fluids, and even later, in medieval and Renaissance Europe, they were bled to reduce inflammation -- by then thought to be at the root of all disease.

In ancient times, leeches were sometimes used, but more often people used thorns or sharpened sticks, bones or shells to cut open a vein (a process known as venesection) or to make small incisions in capillaries just below the skin (known as scarification). Their successors used lancets and fleams -- small double-edged blades that came with pocket-sized, often tortoiseshell carrying cases. They used vacuum cups of varying dimensions to draw blood to the surface of the skin and bleeding bowls to catch the fluid, released in amounts from a few ounces to a quart at a time. By the time of the Renaissance, blood-letters (often barbers in Europe), had the practice down to a science of sorts. Zodiac charts determined the best times of year for letting blood from different parts of the body. Medical tomes distinguished between diverting blood flow (bleeding the right arm to staunch a bloody left nostril, for example) and encouraging it (bleeding the foot to draw menstrual blood down). Practitioners throughout Europe routinely bled patients who could afford it in efforts to prevent sickness brought on by excess food, weather changes and wounds.

By the late 1700s, bloodletting was the treatment of choice in America too -- thanks to the efforts of Declaration of Independence signer and physician Benjamin Rush. Rush, who believed that tension in blood vessels was at the root of disease, turned to bloodletting to treat victims of Philadelphia's devastating yellow fever outbreak in 1793. He favored a quart at a time, repeated several times over several days, and claimed the treatment sped his recovery when he contracted the disease. Later that same decade, George Washington fell ill with laryngitis, and his physicians bled him heavily, one after the other. The president gave up more than two liters of blood during the procedures and died a day later. Historians dispute whether it was the loss of blood or other complications that actually killed him. In the decades that followed, physicians began to realize that germs -- not an imbalance of fluids -- were at the root of cholera, flu and other illnesses. But bloodletting retained a few adherents into the 20th century, and even today some of its wisdom, however faint, is coming to light: Leeches are used to improve circulation and prevent clotting in some surgical patients.

In 2004, University of Chicago researchers found that some bacteria rely on iron in blood cells to survive -- leading some researchers to conclude that as an attempt to kill bacteria, letting blood out of the body may not have been such a bad idea after all. MORE: Are leeches being used in modern medicine? | HowStuffWorks Are leeches being used in modern medicine? Hemera/ Thinkstock "Leeches!!" Anyone who remembers the scene in the 1986 classic movie "Stand by Me" -- in which the young River Phoenix, Corey Feldman and Jerry O'Connell flail and screech in the mud, flinging the blood-sucking creatures from their arms, backs, legs and...other places -- is justified in believing that these slimy, segmented worms' sole reason for existing is to make people recoil in disgust at the very sight of them. But believe it or not, leeches also serve an important purpose in the medical field.

In ancient Greece and 19th-century Europe, leeches were the predominant medical device for bloodletting, a procedure by which practitioners sought to help balance the body's "humors" (phlegm, blood and bile) by simply allowing the subject to bleed for a bit. Bloodletting was prescribed to treat a variety of conditions, from a black eye, headache and fever to obesity and melancholia, and in 1883, French medical professionals imported more than 40 million leeches for this purpose [sources: Rubin , Mestel ]. Related Links 10 Bizarre Treatments Doctors Used to Think Were Legit These days, leeches are used to help heal skin grafts -- the process for treating burns in which blood tissue is transferred from one part of the body to another -- by removing blood pooled under the graft and restoring blood circulation in blocked veins. They've also been used in reattaching fingers and other body parts [sources: MSNBC , PBS ]. To feed, a leech attaches itself to a human or animal through suckers at each end of its body and then eats its host's blood.

Leeches can eat six to eight times their body weight, but rather than sinking to the bottom of the body of water they live in because of such a fully belly, leeches produce a natural anticoagulant or blood thinner, which keeps the blood in them from thickening and clotting and allows them to stay mobile [source: PBS ]. The anticoagulant is also useful to patients in a grafting or reattachment procedure. A doctor attaches a leech to the skin near the graft or reconnected digit. As the leech feeds, it releases the blood thinner into the patient's soft tissue, preventing clotting and allowing for continuous blood circulation, which is necessary for the procedure to be successful. When the leech fills with blood, it eventually falls off, but the patient continues to bleed, allowing for continued circulation and new vein growth. Depending on the nature of the procedure, leeches are typically used constantly (replaced as they drop off every 20 minutes or so) for up to two days and then often intermittently for a few days following the procedure [sources: PBS , Rubin ].

1 Antique Bloodletting and Leeching Instruments BLOODLETTING ANTIQUES DOUGLAS ARBITTIER, M.D. The practice of bloodletting, or phlebotomy, dates back to antiquity. The followers of Hippocrates in the fifth century B.C. strongly believed in bleeding patients, and it is likely that this was done in Egyptian times and probably even before that. Early civilizations may have been inspired by seeing bats remove blood from animals, hippos scratching on trees until they bled, and other animals scratching at diseased body parts for relief. Additionally, there were many human examples of bleeding such as spontaneous nosebleeds and menstruation that had to be explained. It is perhaps these signs in nature that led early civilizations to put it all together: bleeding must have some beneficial value! From these simple observations came increasingly complex theories as to why bloodletting was necessary and how it worked. An early theory was that there were four main bodily humors: blood, phlegm, black bile, and yellow bile. An imbalance in these humors was postulated as the need for bloodletting, purging, vomiting, etc.

Virtually every known medical condition at one time or another was treated by these methods. Bloodletting was used to treat everything from fever and madness to anemia and debility. As one can imagine, treating an anemic patient by removing even more blood was not the best of ideas. The popular belief that George Washington was bled to death proves that even "nobility" was not spared. Through the Middle Ages and into the 18th and 19th century there were many strides in medical knowledge with regards to disease states, and anatomy. However, there was not much that could be done in terms of treatment. There were no antibiotics and surgery was in its infancy (in large part due to the lack of quality anesthesia). One of the only therapeutic modalities was to get out the old lancet and let some blood. It can safely be said that this almost never benefited the patient. Perhaps the biggest benefit was to the physician and family, who felt that at least they were doing something, and if the patient died anyway, it was meant to be. Much detail is known about the history of bloodletting but an in depth study is beyond the scope of this summary.

Instead, I will look at some of the artifacts that help to demonstrate how phlebotomy was carried out, both on humans and animals. Some of these items are still readily available on the antique market. Others are harder to find but do turn up from time to time. Most of these items are from the 18th and 19th centuries. Earlier items are essentially known only from illustrations. THE LANCET The earliest bloodletters probably used sharpened pieces of wood and stone to "breath a vein." There are many steel lancets with flat ebony or ivory handles that exist today (figure 1). There is some controversy surrounding these items. Firstly, though they are called lancets, they are thought by some to be ink erasers. Indeed, many have the signatures of stationers or cutlers that did not make surgical instruments. Some are unsigned. There are those who think that they were used for both purposes. Some feel that as bloodletting went out of favor in the late 19th and early 20th century the many leftover lancets were sold as "leftover stock" to stationary stores and sold as ink erasers.

While Im not sure of the truth, I feel that the commonly seen ebony-handled steel pointed instruments with clover leaf shaped blades were not used for phlebotomy. I just havent seen much evidence for their use in bloodletting. Fig. 1 Fig. 4 A lancet that no doubt was used for bloodletting is seen in (figure 2). This is a standard 19th century thumb lancet in tortoise shell covers, or scales. These must have been made by the millions, mainly in England, but also in France, the US, and other countries. Some are signed with the makers name but many are either unsigned or just have a cutlers stamp. These items were standard equipment for physicians who made house calls. More decorative covers, in ivory and mother of pearl, can be seen in figure 3. Thumb lancets were no doubt sometimes carried individually, but more commonly in a lancet case. These varied in form from simple leather boxes (figure 4) to beautiful engraved cases made of silver, mother of pearl, tortoise shell, and even gold (figure 5-7). Fig. 5 Fig. 7 Fig.

8 Figure 7 shows three unusual cases made in the orient for export to England around 1800. They have oriental scenes in relief, one made of silver, the others tortoise shell and mother of pearl. Often these cases had elaborate dedications from one physician to another, or perhaps from a patient who enjoyed being bled! THE FLEAM The fleam is perhaps easiest-to-find bloodletting antique. These devices have one or more blades at right angles to the handle. The most common form is a brass case containing 2 or 3 steel blades, often stamped with a makers name (figure 8). The blades were usually of various sizes to offer a selection to the phlebotomist. Many of these fleams were likely used on animals but the ones with small blades no doubt were used at times on humans as well. Imagine the farming family that used their fleam for both purposes! Figure 9 shows several fleams in horn casing. Some of these came with a removable thumb lancet inserted into the horn case. Fig. 9 Fig. 11 Fig. 12 Figure 10 shows 3 multi-bladed fleams in silver casing. These are unusual.

One pictures a man walking over a bridge to a millhouse. This is French. The one on the left has the initials and family crest of Roger Manwaring of England and dates to the 1730s. Figure 11 shows some crude fleams, probably of American manufacture and dating to the18th century. The fleams used for veterinary purposes were placed over the jugular vein of the neck most commonly and inserted with the help of a fleam stick. This was a heavy wooden club used to drive the blade in with a quick motion (so the horse didnt know what hit him). Figure 12 shows a variety of fleam sticks. Often the bleeder would place a sheet over the animals head so they didnt see what was coming. Its a good thing they didnt bleed humans this way! THE SPRING LANCET A much more elegant bloodletting method was used for humans. While fleams were sometimes used it was more common to use a spring loaded device in the 18th and 19th centuries. This is when the spring lancet was developed (though its origins go back earlier than this).

Figure 13 shows a spring lancet in its simplest form. The case is brass and the blade is steel. The blade was cocked by the hook at end and released with the button on the side. Note the small size of the blade (for human use). Single blade spring lancets came in many sizes and shapes (figures 14-17). Most were brass and steel but some were made of iron or silver. Devices with larger blades were probably for veterinary use. Note the one with the depth adjuster. Figure 18 shows an unusual American hand-forged spring lancet that is signed "P.I.V. 1775." One wonders if the bleeder was anxious over the politics of the time as he bled his patients, whether human or animal! Fig. 13 Fig. 18 THE SCARIFICATOR Why bleed with one spring-loaded blade when you could have 4, 12, or even 20?! As long ago as the 17th century there were multi-bladed bleeders called scarificators. These became very popular in the late 18th and 19th centuries. Like spring lancets, they came in every size and description.

Figures 19 and 20 show a basic octagonal English scarificator. The case is brass and the mechanism and blades are steel. There is a depth adjuster for the blades on the top and the blades are cocked by the lever on top. The release switch is on the side. This allowed the blades to swing around, making multiple cuts at once. Scarificators with pointed V-shaped blades are probably pre-1820. Those with slightly rounded blades are later. Round scarificators are usually French in design and post-1860 (often around 1900!) Scarificators that have a mechanism allowing the blades to stay in the half-cocked position are probably post-1830. Figures 21-24 show a variety of scarificators. Note the example of Tiemanns patent 1846 scarificator with unusual horn handle in figure 23. This figure also show a rare solid silver scarificator made in England. Figure 24 shows the tremendous variation in sizes between these devices. Fig. 19 Fig.

24 CUPPING Once a scarificator was used to slice and dice the patient, a cup was often placed over the wound as a receptacle for the blood. Cups were made of tin, brass, rubber, horn, and most commonly glass. Figure 25 shows a selection of cups of various materials. There were often suction devices attached to the cup to allow the removal of blood. Human lips, rubber bulbs, and brass syringes were all used as sources for suction. Fig. 25 Fig. 26 The above methods were for "wet cupping." At times "dry cupping" was used. This technique entailed creating suction in a cup placed over the skin without cutting the skin. Often a wad of burning material or the end of a heat lamp (figure 26) was placed in the cup to heat it. The cup was placed on the skin and a suction was created as it cooled. The skin then became engorged, presumably with evil humors that could improve health by coming to the surface. Fig. 27 Fig. 29 Fig. 30 All of the elements of wet and/or dry cupping were often placed in a complete kit, or cupping set.

Figures 27, 28, and 29 show English (ca. 1860), American (ca. 1880), and French (ca. 1900) cupping sets respectively. These sets often had multiple cups, suction devices, scarificators, spare blades, etc. Figure 30 shows a very rare cupping set consisting of two matching scarificators and a heat lamp all in solid silver. Each is inscribed with the makers mark and owners initials. The pieces are hallmarked for 1832 and were obviously used by an important bloodletter! BLEEDING BOWLS From antiquity through the 19th century, there have been a large variety of vessels used to catch blood. These must originally have been made of stone or pottery. In the 18th and 19th centuries they were more commonly tin or pewter, though some rare silver examples are known. Figure 31 shows a variety of pewter bleeding bowls dating from about 1770 to 1850. These are of English manufacture. All of these bowls have inner concentric rings in ounce increments to measure the amount of blood.

One must be very careful in collecting these antiques as often they are confused with porringers. These are pewter and often have two handles instead of one. Unscrupulous individuals have been known to add inner rings to porringers. While this is usually obvious upon close inspection, let the buyer beware! Fig. 31 LEECHES A long-used alternative to the lancet or scarificator is the leech. Since antiquity in Greece, Rome and Syria, leeches have been used to suck blood from many sites on the body. Hirudinea Annelida was the favored European "strain" and Macrobetta decora was used in the US. Leeches have both male and female sex organs (fun fact of the day). They attach to the skin via 3 sharp teeth, inject an anticoagulant so the blood wont clot, and then "fill up." A European leech could ingest several times the amount of blood as an American leech, so the colonists often imported them. Leeches were carried in a variety of containers that are now sought after by collectors. Figure 32 shows two glass containers.

The small one was for several leeches while the bigger bowl may have been used to dish out the leeches in a pharmacy. Note the everted lip of both containers. These were used to attach a cloth to prevent escapees. Of note, there is some controversy as to whether the larger type of container was actually used as a fish bowl. Some were on pedestals and there is evidence for both types of use. Seeing as one cant be sure of its use, a safe approach in collecting is simply to not pay too much for a large glass leech container. Fig. 32 Fig. 33 Fig. 34 The two small pewter containers pictured in figure 33 are portable leech carriers. I call them "leech mailboxes" as the front door flips down to gain access to the leech. Note the holes in this door. This allowed the leeches to get enough air. Physicians may have put a few leeches in this pocket-sized container for house calls. Perhaps the most beautiful leech containers are the large decorative ceramic containers with multi-colored floral and other motifs. These often are inscribed "leeches" in decorative lettering.

They date to the mid-19th century for the most part. Figure 34 shows a fine example. Once again, one must be cautious in purchasing these as reproductions are now commonplace. The thousands of dollars that an original costs have made these repros very well done! Fig. 35 A variety of unusual "mechanical leeches" were made in the 19th century. These were spring loaded devices made to simulate a leechs bite in order to bleed a patient. Figure 35 shows a rare patent model for an artificial leech made by Frederick Wolf in 1866. The spring was tightened and by a turning motion the cuts were made just as a leech would. The top of the device is then pulled back to evacuate the blood by suction. Ingenious! These devices were cumbersome to use and not popular for very long. COLLECTING As with all antiques over the last 20 years, bloodletting antiques have become harder to find. They can range in price from $20 for a lancet/ink eraser up to many thousands for a fine leech jar or rare cupping set.

As mentioned several times, one must be very careful to avoid reproductions, which are becoming more commonplace. Some English dealers have gutted wooden boxes, relined them with old looking velvet, and made a "custom" cupping set which looks genuine and original. Its scary, when one realizes the costs of these items. There are specialty medical antique dealers and auction houses that have medical sales in the US and Europe. One can pay top dollar buying this way. A more reasonable way to get started is to scour country sales and local estate auctions. Cupping sets do appear from time to time as do spring lancets and scarificators. Often no one knows what these were used for and the price is quite low. There is nothing more exciting than finding a $200 item for $20 and this still can happen!! BIBLIOGRAPHY ANTIQUE MEDICAL INSTRUMENTS ANTIQUE MEDICAL INSTRUMENTS by C Keith Wilbur, MD., 1987. ANTIQUE MEDICAL INSTRUMENTS ANTIQUE MEDICAL INSTRUMENTS by Elisabeth Bennion, 1979. by Elisabeth Bennion, 1979.

BLOODLETTING INSTRUMENTS in the NATIONAL MUSEUM OF HISTORY AND TECHNOLOGY AND TECHNOLOGY by Audrey Davis and Toby Appel, 1979. by Audrey Davis and Toby Appel, 1979. !!!!!!! IMPORTANT NOTE !!!!!!! I am a very active collector of all sorts of pre-1900 bloodletting antiques in excellent condition. Over the years I have acquired most of the more common examples of the types things I reviewed in this paper. However, I am very seriously looking for unusual bloodletting devices, leeching items, and cased cupping sets. I purchase items individually or by the collection and am always eager to hear from other collectors. I do have some items for trade as well. If you have or know of any of these items for sale (I do pay finders fees) please contact me personally at any time via email . Thank you very much! Doug Arbittier, M.D.

A Brief History of Bloodletting - History in the Headlines A Brief History of Bloodletting May 30, 2012 By Jennie Cohen Share this: A Brief History of Bloodletting Author A Brief History of Bloodletting URL Google The ancient practice of bloodletting might offer cardiovascular benefits to obese people with metabolic syndrome, a new study published today in the journal BMC Medicine suggests. As the medical community contemplates its revival, explore this long-abandoned procedure’s age-old history, from its early roots to its use on figures such as George Washington and Marie-Antoinette. Several thousand years ago, whether you were an Egyptian with migraines or a feverish Greek, chances are your doctor would try one first-line treatment before all others: bloodletting. He or she would open a vein with a lancet or sharpened piece of wood, causing blood to flow out and into a waiting receptacle. If you got lucky, leeches might perform the gruesome task in place of crude instruments. Considered one of medicine’s oldest practices, bloodletting is thought to have originated in ancient Egypt.

It then spread to Greece, where physicians such as Erasistratus, who lived in the third century B.C., believed that all illnesses stemmed from an overabundance of blood, or plethora. (Erasistratus also thought arteries transported air rather than blood, so at least some of his patients’ blood vessels were spared his eager blade.) In the second century A.D., the influential Galen of Pergamum expanded on Hippocrates’ earlier theory that good health required a perfect balance of the four “humors”—blood, phlegm, yellow bile and black bile. His writings and teachings made bloodletting a common technique throughout the Roman empire. Before long it flourished in India and the Arab world as well. In medieval Europe, bloodletting became the standard treatment for various conditions, from plague and smallpox to epilepsy and gout. Practitioners typically nicked veins or arteries in the forearm or neck, sometimes using a special tool featuring a fixed blade and known as a fleam. In 1163 a church edict prohibited monks and priests, who often stood in as doctors, from performing bloodletting, stating that the church “abhorred” the procedure.

Partly in response to this injunction, barbers began offering a range of services that included bloodletting, cupping, tooth extractions, lancing and even amputations—along with, of course, trims and shaves. The modern striped barber’s pole harkens back to the bloodstained towels that would hang outside the offices of these “barber-surgeons.” As hairdressers lanced veins in an attempt to cure Europeans’ ailments, in pre-Columbian Mesoamerica bloodletting was believed to serve a very different purpose. Maya priests and rulers used stone implements to pierce their tongues, lips, genitals and other soft body parts, offering their blood in sacrifice to their gods. Blood loss also allowed individuals to enter trance-like states in which they reportedly experienced visions of deities or their ancestors. Bloodletting as a medical procedure became slightly less agonizing with the advent in the 18th century of spring-loaded lancets and the scarificator, a device featuring multiple blades that delivered a uniform set of parallel cuts. Respected physicians and surgeons extolled the practice, generously prescribing it to their most esteemed patients.

Marie-Antoinette, for instance, seemed to benefit from a healthy dose of bloodletting while giving birth to her first child, Marie-Thérèse, in 1778, 14 years before the guillotine would shed more of the queen’s blood. As an excited crowd thronged her bedchamber, hoping to witness a dauphin’s arrival, the mother-to-be fainted, prompting her surgeon to wield his lancet. Marie-Antoinette immediately revived after the bloodletting—perhaps because the windows were simultaneously opened to let in fresh air. America’s first president was less fortunate than France’s most infamous queen. On December 13, 1799, George Washington awoke with a bad sore throat and began to decline rapidly. A proponent of bloodletting, he asked to be bled the next day, and physicians drained an estimated 5 to 7 pints in less than 16 hours. Despite their best efforts, Washington died on December 17, leading to speculation that excessive blood loss contributed to his demise.

Bloodletting has also been implicated in the death of Charles II, who was bled from the arm and neck after suffering a seizure in 1685. By the late 1800s new treatments and technologies had largely edged out bloodletting, and studies by prominent physicians began to discredit the practice. Today it remains a conventional therapy for a very small number of conditions. The use of leeches, meanwhile, has experienced a renaissance in recent decades, particularly in the field of microsurgery. Tags 10 Excruciating Medical Treatments from the Middle Ages (medieval medicine) - ODDEE 10 Excruciating Medical Treatments from the Middle Ages 3/28/2009 Medieval medicine: from hot irons for hemorrhoids to bloodletting for almost any ailment; meet ten of the most horrible treatments of middle age's medicine, presented by our guest author David Morton. 1 Surgery: Crude, blunt and horribly painful Surgery in the Middle Ages was crude and blunt and … PAINFUL! Surgeons had a very poor understanding of human anatomy, anesthetics and antiseptic techniques to keep wounds and incisions from infection.

It was not a pleasant time to be a patient, but if you valued your life, there was no choice. To relieve the pain, you submitted to more pain, and with any luck, you might get better. Surgeons in the early part of the Middle Ages were often monks because they had access to the best medical literature – often written by Arab scholars. But in 1215, the Pope said monks had to stop practicing surgery, so they instructed peasants to perform various forms of surgery. Farmers, who had little experience other than castrating animals, came into demand to perform anything from removing painful tooth abscesses to performing eye cataract surgery. But there were some great successes. Archeologists in England found the skull of a peasant man from about 1100 who had been struck in the head by a heavy, blunt object. Close examination shows the man had been given life-saving surgery called trepanning, where a hole was drilled and a section of the skull was lifted, allowing smashed bone segments to be removed. The surgery alleviated pressure on the brain and the man recovered. We can only guess how painful it must have been!

2 Dwale: A crude anesthetic that could cause death in itself Surgery in the Middle Ages was really only used in life/death circumstances. One reason is that there was no reliable anesthetic to dull the excruciating pain caused by the rough cutting and procedures. Some potions used to relieve pain or induce sleep during surgery were potentially lethal. An example was a concoction of lettuce juice, gall from a castrated boar, briony, opium, henbane, hemlock juice and vinegar. This was mixed with wine before being given to the patient. The Middle English word used to describe an anesthetic potion was "dwale" (pronounced dwaluh). The hemlock juice alone could easily have caused death. While the anesthetic might induce a profound sleep, allowing a surgery to take place, it might be so strong that the patient would stop breathing. Paracelsus, a medieval Swiss physician, was the first to use ether for its anesthetic qualities. Ether did not gain wide acceptance and its use declined. It was rediscovered in America some 300 years later. Paracelsus also used laudanum, a tincture of opium, to alleviate pain.

3 Spells: Pagan rituals and religious penance as a form of cure Early medieval medicine was often a mix of the pagan, religious and scientific. As the church gained more control, pagan “rituals” were made punishable offences. One such punishable offence might have been the following: "When [the healer] approaches the house where the sick person lies, if [the healer] finds a stone lying nearby, [he turns] the stone over and looks in the place where the stone was lying [to see] if there anything living under it, and if [the healer] finds there a worm or a fly or an ant or anything that moves, they [the healer] avers that the sick person will recover." (From The Corrector & Physician). Patients who had contracted the bubonic plague were told to perform penance – the practice of confessing one’s sins, then performing a religious devotion prescribed by a priest – a common “treatment.” They were told they might be spared death if they correctly confessed their sins.

4 Eye Cataract Surgery: Painful procedure that rarely saved patients’ sight An early operation for removal of a cataract included inserting a sharp instrument, such a knife or large needle, through the cornea and forcing the lens of the eye out of its capsule and down to the bottom of the eye. Once Islamic medicine became more widely followed in medieval Europe, cataract surgery improved. The syringe was used for the extraction of cataracts by suction. A hollow metallic hypodermic syringe was inserted through the white part of the eye and successfully extracted the cataracts through suction. 5 Blocked Bladders: Metallic catheters inserted into the bladder Blockage of urine in the bladder, due to syphilis and other venereal diseases, was fairly common at a time when antibiotics were not available. The urinary catheter – a metal tube inserted through the urethra into the bladder – was first used in the mid-1300s. When a tube could not easily be passed into the bladder to relieve the obstruction, other procedures to enter the bladder were devised, some quite novel, though all probably as painful and dangerous as the condition itself.

Here is a description of the treatment of kidney stones: "If there is a stone in the bladder make sure of it as follows: have a strong person sit on a bench, his feet on a stool; the patient sits on his lap, legs bound to his neck with a bandage, or steadied on the shoulders of the assistants. The physician stands before the patient and inserts two fingers of his right hand into the anus, pressing with his left fist over the patient's pubes. With his fingers engaging the bladder from above, let him work over all of it. If he finds a hard, firm pellet it is a stone in the bladder... If you want to extract the stone, precede it with light diet and fasting for two days beforehand. On the third day, ... locate the stone, bring it to the neck of the bladder; there, at the entrance, with two fingers above the anus incise lengthwise with an instrument and extract the stone." 6 Surgeons on the Battlefield: Pulling of arrows was a nasty business Use of the longbow – a large powerful bow that could shoot arrows great distances – flourished in the Middle Ages. This created a real problem for battlefield surgeons: how to remove arrows from the bodies of soldiers.

The heads of war arrows weren’t necessarily glued onto the shafts, but attached with warm beeswax. After the wax set, they could be handled normally, but once shot into something if the shaft was pulled, the head would come off inside the body. One answer was the arrow spoon, based on a design by an Arab physician, named Albucasis. The spoon is inserted into the wound and attaches itself around the arrowhead to be drawn from a wound without causing further damage as the barbs rip out. Wounds such as these were also treated with cautery, where red hot irons were applied to the wound so that the tissue and veins sealed over, preventing blood loss and infection. Cautery was especially used in amputations. A famous illustration for surgeons was called, “The Wound Man,” which showed the various kinds of wounds a battlefield surgeon might expect to see. 7 Bloodletting: A cure-all for almost any ailment Physicians in the Middle Ages believed that most human illnesses were the result of excess fluid in the body (called humour). The cure was removing excess fluid by taking large amounts of blood out of the body. Two of the main methods of bloodletting were leeching and venesection.

In leeching, the physician attached a leech, a blood-sucking worm, to the patient, probably on that part of the body most severely affected by the patient's condition. The worms would suck off a quantity of blood before falling off. Venesection was the direct opening of a vein, generally on the inside of the arm, for the draining of a substantial quantity of blood. The tool used for venesection was the fleam, a narrow half-inch long blade, which penetrates the vein, and leaves a small wound. The blood ran into a bowl, which was used to measure the amount of blood taken. Monks in various monasteries had regular bloodletting treatments – whether they were sick or not – as a means of keeping good health. They had to be excused from regular duties for several days while they recovered. (Photo by: McKinney Collection and FM ) 8 Childbirth: Women told to prepare for their death Childbirth in the Middle Ages was considered so deadly that the Church told pregnant women to prepare their shrouds and confess their sins in case of death. Midwives were important to the Church due to their role in emergency baptisms and were regulated by Roman Catholic law.

A popular medieval saying was, "The better the witch; the better the midwife"; to guard against witchcraft, the Church required midwives to be licensed by a bishop and swear an oath not to use magic when assisting women through labour. In situations where a baby's abnormal birth position slowed its delivery, the birth attendant turned the infant inutero or shook the bed to attempt to reposition the fetus externally. A dead baby who failed to be delivered would be dismembered in the womb with sharp instruments and removed with a "squeezer." A retained placenta was delivered by means of counterweights, which pulled it out by force. 9 Clysters: A medieval method of injecting medicines into the anus The medieval version of the enema was known as the clyster, which is really an instrument for injecting fluids into the body through the anus. The clyster was a long metallic tube with a cupped end, into which the medicinal fluid was poured. The other end, a dull point, which was drilled with several small holes, was inserted into the anus. Fluids were poured in and a plunger was used to inject the fluids into the colon area, using a pumping action.

The most common fluid used was lukewarm water, though occasionally medical concoctions, such as thinned boar’s bile or vinegar, were used. In the 16th and 17th centuries, the medieval clyster was replaced by the more common bulb syringe. In France, the treatment became quite fashionable. King Louis XIV had over 2,000 enemas during his reign, sometimes holding court while the ceremony progressed. 10 Hemorrhoids: Agony of the anus treated with hot irons Treatment of many diseases in the Middle Ages included prayers to patron saints for possible divine intervention. A seventh century Irish monk, St. Fiacre, was the patron saint for hemorrhoid sufferers. He developed hemorrhoids from digging in his garden, one day, and sat on a stone which gave him a miraculous cure. The stone survives to this day with the imprint of his hemorrhoids and is visited by many hoping for a similar cure. The disease was often called “St. Fiacre’s curse” in the Middle Ages. In more extreme cases of hemorrhoids, medieval physicians used their cautery irons to treat the problem.

Others believed that simply pulling them out with their fingernails was a solution, a solution that the Greek physician, Hippocrates suggested. The 12th century Jewish physician Moses Maimonides wrote a seven-chapter treatise on hemorrhoids and disagreed with the use of surgery, instead prescribing the most common treatment used to this day: the sitz bath. (Photo by: McKinney Collection ) David Morton is a Vancouver-based blogger and writer, who is working on a novel about monasteries in the Middle Ages. He is also a teacher of English as a second language. You can read his blog at From the Web

Question: What creature was used for the medical treatment of bloodletting?
Answer: Leeches