Bloodletting

Bloodletting therapy is defined as the practice of treating diseases through the removal of a small amount of blood from patients ¹. Bloodletting therapy has been widely used around the world since the time of Hippocrates in the West and primitive society in China ². In the United States, perhaps the most infamous use of bloodletting was when doctors reportedly bled as much as 5 units (2625 ml) of blood from George Washington before he died from what was probably either acute epiglottitis or streptococcal pharyngitis ³. Bloodletting therapy rationale was based on the belief that removing blood eliminated “impure” fluids. Bloodletting was considered a panacea, and it was the most common and versatile form of medical treatment. Not only was it believed to cure the sick, but also to promote vigor in the healthy. The instruments of bloodletting therapy include the triangle-edged needle, plum-blossom needle, injection needle, dermal needle, blades, vacuum blood sampling needle, etc., and cupping or leeches can often be used as an auxiliary method ⁴.

Bloodletting therapy originated thousands of years ago and has been used extensively in dermatosis (a general term used to describe any skin disease or lesion on the skin, especially one that does not cause inflammation) ⁵. Many clinical trials have reported the effect of bloodletting therapy in treating chronic urticaria in China ⁶.

Bloodletting procedure

Depending on the illness, bloodletting was done at different areas of the body, although it was traditionally performed at the elbows and knees using one of several different methods. The most common, called “general bloodletting”, involved cutting open a vein (phlebotomy) or artery with a tool ⁷. Among the earliest were naturally sharp thorns or animal teeth, or sharpened pieces of wood, stone or bone ⁸. Later, sharper instruments were developed, and since the time of Hippocrates surgeons frequently carried a variety of different sized lancets or scalpels. These small and extremely sharp double-bladed instruments were used for a variety of procedures, but as bloodletting became popular in the Roman Empire, flebotomes, a type of lancet known for its straight, sharp-pointed, doubleedged blade, became popular. The thumb lancet was introduced in the 15th century and consisted of a double-edged blade of iron or steel screwed together between two decorative covers, usually of horn or shell. It became the preferred tool for opening veins because it could be used at various angles, and the width of the blade could be varied depending on where the vein was located. In the 17th and 18th centuries, fleams became popular. These cutting implements utilized a pointed edge set at a right angle to the handle (Figure 1). Later, spring lancets were invented in Vienna, which allowed a physician to open a vein without applying manual pressure. The small blade was attached at a right angle to a spring-loaded lever in the handle that could be released with a lever or button (Figure 2). At the time, the spring lancet was a safer way to draw blood due to its small size and design. The lancet’s intricate construction made it harder to clean, however, and often resulted in a higher rate of infection ⁹.

Figure 1. Fleams

Other, more localized methods of bloodletting removed blood only from capillaries. Application of one or more leeches was a popular method, since a single leech can ingest 5-10mL of blood, and due to the anticoagulant effects of their bite, a total of 40-60mL of blood might be lost at once ¹⁰. Cupping was another popular method that is still practiced today in traditional Chinese medicine. It was favored if a patient was thought to be too young, too old, or too weak to undergo phlebotomy. Either dry or wet cupping was used. In the former, blood was not actually removed from the body, but a glass cup from which the air had been extracted by heating the glass or by vacuum-suction, was placed over the area. This process caused the skin to become swollen and bruised. For wet cupping, the skin was either scraped or cut open before the cups were applied, thus actually removing blood from the body.

Figure 3. Bloodletting cupping

Modern bloodletting

To the modern public, bloodletting may seem barbaric and archaic, but it continues to be used effectively for a small number of myeloproliferative disorders based on empirical evidence, not as in the past on superstition and faith ¹¹. Currently, bloodletting (phlebotomy) is used in the treatment of hemochromatosis and porphyria cutanea tarda to help prevent organ damage from the accumulation of iron. Polycythemia vera is also commonly treated with phlebotomy to reduce blood viscosity and prevent thrombotic events.

Recently, the use of leeches has also made a comeback, especially in plastic surgical settings. Hirudo medicinalis leeches, used in microsurgery and re-implantation operations to enhance blood flow by preventing venous congestion, secrete several biologically active substances such as hyaluronidase, fibrinase, vasodilators, and anticoagulants ¹².

Bloodletting continues to be used as an alternative therapy around the world. Cupping is used in traditional Chinese medicine to treat a variety of illnesses. Their popularity reflected the belief that dry cupping can improve blood flow, provide deep massage, relieve pain and inflammation, and accelerate recovery from strenuous exercise. None of these claims is substantiated by controlled studies, since it is impossible to eliminate the powerful placebo effect of such a tactile and visible intervention ⁸. Even as recently as 2008, Kashmiri hospitals in Pakistan were applying leeches to patients to treat a range of diseases including heart problems, arthritis, gout, headaches, and sinusitis ¹³. Overall, bloodletting has been a common medical practice for centuries and continues to remain relevant today in specific circumstances, despite modern technological advances.

References

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