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Early Practices


Bloodletting drawing Phlebotomy, or bloodletting, is the longest-running tradition in medicine. It originated in the ancient civilizations of Egypt and Greece, persisted through the Medieval, Renaissance, and Enlightenment periods, flourished in Arabic and Indian medicine, and lasted through the second Industrial Revolution. The practice continued for 2,500 years until it was replaced by the techniques of modern medicine.

Doctors bled patients for every ailment imaginable. They bled for pneumonia and fevers, back pain and rheumatism, headaches and melancholia; even to treat bone fractures and other wounds. Yet there never was any evidence that phlebotomy did any good.

Bloodletting was based on an ancient system of medicine in which blood and other bodily fluid were considered to be "humors" whose proper balance maintained health. Sick patients were thought to have an imbalance of their humors, which bloodletting was thought to restore.

Video Clip.Most bloodletters would open a vein in the arm, leg or neck with small, fine knife called a lancet. They would tie off the area with a tourniquet and, holding the lancet delicately between thumb and forefinger, strike diagonally or lengthwise into the vein. (A perpendicular cut might sever the blood vessel.) They would collect the blood in measuring bowls, exquisitely wrought of fine Venetian glass.

Bleeding was as trusted and popular in ancient days as aspirin is today. The Talmudic authors laid out complex laws for bloodletting. Medieval monks bled each other several times a year for general maintenance of health. Doctors devised elaborate charts indicating the most favorable astrological conditions for bleeding.

It wasn't until well into the 19th century that people began to question the value of bloodletting. Scientists such as Louis Pasteur, Joseph Lister, and Robert Koch showed that germs, not humors, were responsible for disease. Furthermore, medical statisticians tracking case histories began to collect evidence that bloodletting was not effective. Eventually the practice died, although it continued in some parts of rural America into the 1920s.

Phlebotomy is almost never used anymore, except for certain rare conditions. One is hemachromatosis, a genetic condition affecting 600,000 to 1,000,000 Americans in which the body stores too much iron. One way to treat this is to periodically drain some of their iron-rich blood, which restores the mineral's proper balance.

-- Douglas Starr

Photo: Courtesy of the National Library of Medicine.

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