MEDICAL TIMES FROM THE PAST

Bloodletting Submitted by the Leon P. Fox Medical History Committee The practice of bloodletting dates back several thousand years. It was extremely popular in America in the nineteenth century. Two theories for the etiology of disease were responsible for its use: (1) There was an imbalance in one of the four humors (blood, phlegm, black bile, and yellow bile); (2) The circulatory system was in a state of excitability and needed to be relaxed. Benjamin Rush, MD, was the most influential proponent of bloodletting in the United States. He recommended it for treatment of convulsions, concussion, labor pain, hernia, smallpox, croup, pneumonia, and any other disease that produced a fever. The method used in bloodletting was straightforward. With the patient sitting upright, a tourniquet was applied to the upper arm. A single blade lancet or a multiple blade lancet (scarificator) was used to cut the vein in the arm. A cup,

usually made of glass, was heated and applied to the bleeding site. This added a small amount of suction to the procedure. The blood was collected in a volume marked bleeding bowl until the desired amount was obtained or the patient fainted. The process was often repeated several times over several days until the patient started to recover or died. It is thought that George Washington’s death was more directly related to bloodletting than to his respiratory infection. The following is a vivid firsthand account of bloodletting in the nineteenth century: The patient is the first wife of Salmon P. Chase, the future secretary of the treasury under Abraham Lincoln. The diagnosis was puerperal fever two weeks after delivery. The year was 1837. “ The next morning (she had already been bled three times the previous day), such was her condition, there was a fair prospect of her recovery. All the symptoms boded well. But Drs. Drake and Richards were of the opinion that she had not been bled sufficiently, and that the disease had not been subdued. They, accordingly, recommended

further bleeding; Dr. Colby opposed it, saying that all her symptoms were improved, and they ought to watch the result. The other physicians insisted, however. It was anticipated that the effect would be to reduce the frequency of the pulse and augment its volume. Kitty was told that the doctors thought of bleeding her again, and was asked if she was willing. She said “Yes, anything.” She was then raised up in bed and twenty ounces of blood were taken from her. The physicians seemed to entertain some hopes of her recovery, and agreed upon a course of treatment to be adopted. The (patient’s) father came into her room exclaiming, ‘Thank God, my child, the doctors say there is hope.’ She said nothing. All hope had vanished. Dr. Drake felt her pulse, and said she was dead.” Bloodletting retained its popularity until the latter half of the nineteenth century. Bacteriology, the germ theory, and the growing realization that bloodletting was detrimental to the patient, finally put its use to rest.

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MARCH / APRIL 2011 | THE BULLETIN | 19