For more than 3000 years, bloodletting has earned a surprisingly persistent place in medicine. Given its longevity, you may wonder how bloodletting started, if it was effective, and if it's still practiced today.
What Is Bloodletting?
Bloodletting is removing blood from a person with the goal of treating a medical condition. From ancient times to the early 20th century, bloodletting was believed to cure just about any ailment you can imagine.
The earliest bloodletting practices used sharp thorns or animal teeth, but this evolved into lancets that allowed easier access to veins. Whether using crude or highly specialized tools, blood was drained from the person while attempting to control the exact amount removed.
When Did Bloodletting Start?
Egyptians were among the first to perform bloodletting more than 3000 years ago. From there, the practice spread to the Greeks and Romans, then Asia, and beyond.
By the Middle Ages, bloodletting was widely practiced in Europe and barbers served as pseudo-medical providers. The familiar barber pole is a vestige of the profession’s historic association with bloodletting. The shape of a barber pole is similar to the pole customers gripped during a bloodletting procedure to increase blood flow. The red stripe represents blood and the white represents bandages or tourniquets used to stop the blood flow.
The practice of bloodletting as a cure-all didn't end with the Middle Ages. It was still the most popular medical treatment during the Enlightenment of the 17th and 18th centuries. With the Enlightenment came the scientific method. While most doctors still practiced bloodletting, more were questioning and studying its effectiveness.
Despite the increased scrutiny and questionable results, bloodletting persisted into the 20th century. As late as the 1940s, a popular textbook of internal medicine (William Osler’s 14th edition of Principles and Practice of Medicine) indicated pneumonia could be treated with bloodletting.
What Was the Purpose of Bloodletting?
The idea behind bloodletting is rooted in how people understood disease in ancient times. Hippocrates (460 – 370 B.C.) is often referred to as the “founder of modern medicine”. You might recognize his name from the Hippocratic Oath many medical students take today. Hippocrates was trying to understand illness well before anyone knew about germs or even fully understood anatomy. His views on the basic elements supported bloodletting as an effective treatment for illness.
Hippocrates believed there were four basic elements in existence:
- earth
- air
- fire
- water
In human beings, these four basic elements were basic “humors”. The four basic humors were:
- blood
- phlegm
- black bile
- yellow bile
If a person was ill, this meant there was an imbalance among the four humors.
Several centuries after Hippocrates, Galen of Pergamum (129 – 216) determined blood was the dominant humor. Galen’s ideas spread widely. His writings trained doctors (and barbers) for hundreds of years during the Middle Ages. As a result, the practice of bloodletting to bring humors into balance and cure illness became even more widespread.
Bloodletting was used to treat just about any condition you can imagine. Some examples include
Types of Bloodletting
Bloodletting was either generalized or local. Generalized bloodletting involved cutting a vein or artery.
Venesection. The most common type of generalized bloodletting was a venesection, which involved cutting into a vein such as the medial cubital vein at the elbow.
Scarification and cupping. Scarification was a local type of bloodletting. It involved scraping the skin with a special tool that looked like a small box with blades. After scrapping, the skin was then cupped to create suction. The practice of cupping involves placing a dome over the skin to create a vacuum with either suction or heat. The vacuum allows blood to be drawn into the cup.
Leeches. Parisian doctor Dr. François Broussais (1772 – 1838) made the practice of local bloodletting with leeches popular. He believed fevers were due to organ inflammation and placing leeches on the skin over the inflamed organ would resolve the fever. In Dr. Broussais’ practice, leeches were used for local bloodletting in addition to general venesection bloodletting.
Leeches were effective at removing blood and can eat 10 times their own weight. Leech therapy grew in popularity in France and all of Europe by the 1830s. At its height, more than 35 million leeches were used in medical practice per year in France alone.
Was Bloodletting Effective?
In the majority of cases, bloodletting wasn't just ineffective but could also be life-threatening. It probably isn’t surprising that one of the biggest risks of bloodletting is death due to blood loss. Bloodletting practices put people at great risk for infections and sepsis.
George Washington is one famous example of someone who likely died as a result of bloodletting. At the height of bloodletting’s popularity, on December 14, 1799, George Washington was ill. Upon his request, Washington's doctor bled him four times over the course of eight hours. Washington lost 40% of his blood, and ultimately his life.
Dr. Pierre Louis (1787 – 1872) was among the doctors that began questioning the practice. Louis studied the hospital records of 77 pneumonia patients and concluded that bloodletting wasn’t as effective as many claimed. As new methods of scientific inquiry and study were developed, anecdotal claims about the cure-all nature of bloodletting weren't as compelling. As medicine progressed, the concept of humor imbalance seemed unscientific and even dangerous.
Modern Bloodletting
The practice of bloodletting hasn't completely disappeared, but it’s no longer used to treat an endless list of conditions based on the idea of humor balance. Modern bloodletting exists in a safer and much more limited form.
Phlebotomy therapy is a modern type of bloodletting used for specific conditions:
- Hemochromatosis, a genetic disorder of excessive blood iron
- Polycythemia vera, a blood marrow disorder involving the overproduction of red blood cells
- Porphyria cutanea tarda, an iron metabolism disorder
In these instances, removing a certain amount of blood can prevent organ damage and dangerous blood clots.
Even leeches haven’t completely disappeared from modern medical science. Leeches excrete many substances useful in medicine, such as an anticoagulant. Leeches are sometimes used, for example, to remove pooled blood or to prevent tissue necrosis after a skin graft of reimplanted fingers and toes. To avoid bacteria contamination and other challenges that come with live leeches, a mechanical leech has been developed.
As history shows us, the pace of change in medicine can be very slow. Despite its lack of success and apparent dangers, the ancient practice of bloodletting endured for thousands of years. With improved research methods, we can be optimistic that future medical breakthroughs will improve healthcare at a much faster pace.