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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. 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. Leeches used for bloodletting usually involved the medicinal leech, Hirudo medicinalis.
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At each feeding a leech can ingest about 5 to 10 ml of blood, almost 10 times its own weight. 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.
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By the late s, however, enthusiasm for leech therapy had waned, but leeches are still used today in select situations. Famous bleedings When Charles II — suffered a seizure he was immediately treated with 16 ounces of bloodletting from the left arm followed by another 8 ounces from cupping. 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 — 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. Warring physicians The practice of bloodletting aroused deep emotions in both practitioners and detractors, with intense argument about the benefit and harm of venesection. 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 and and devoted much time to the problem of mental illness. He was known to remove extraordinary amounts of blood and often bled patients several times. He aroused both extremely positive and negative reactions in those around him, including many physicians. However, Rush Medical College in Chicago was named in his honor and gained its charter in 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. Both were implacable in their point of view, thereby underlining the significant gap between their beliefs in empirical observation versus scientific verification. The tide turns In Paris Dr Pierre Louis — 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. 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.
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.
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. 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. 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 years from now? 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.
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The history of bloodletting
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