Bleeding: a brief history of the bleeding up to the blood transfusion

Bloodletting, a practice of drawing blood from a person’s veins for therapeutic reasons, has been common for thousands of years. Also known as phlebotomy (from the Greek phlebos, which means “vein”, and temnein, which means “to cut”). Bloodletting is a therapeutic practice that began in antiquity. Today, however, the term phlebotomy refers to the removal of blood for transfusions or blood tests. Some sources suggest that the original practice of bloodletting dates back over 3,000 years and that the ancient Egyptians, Greeks and Romans, as well as many other ancient peoples, all used it for medical treatment.

But what is the origin of the notion of bleeding someone to help them get better?

The 4 humors theory

Hippocrates was an ancient Greek physician who lived in the fifth century BCE and was one of the most important figures in the history of medicine. He practiced medicine according to the theory of the four humors, or “humoral theory”. This theory posits that there are four key humors, or liquids, in the human body and that imbalances in these humors are responsible for many physical and mental illnesses. According to the most influential version of this theory, these humors were: black bile, yellow bile, phlegm and blood.

In the second century BCE, Galen, a famous Roman physician who also subscribed to humoral theory, promoted arteriotomy, a method of bloodletting, as a means of restoring balance to the four humors and treating various symptoms. According to Galen, a bloodletting incision in the veins behind the ears could treat vertigo and headaches. Letting blood flow through an incision in the temporal arteries, the veins located on the temples, could treat eye conditions.

The principle of bleeding is to eliminate part of the blood in a controlled manner without the patient bleeding profusely. However, as some of Galen’s contemporaries observed, the famous physician could sometimes lose his temper when administering this treatment.

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Galen was a staunch defender of bloodletting against those who doubted its effectiveness. Galen’s methods could be very messy: he let out so much blood from a patient that the other doctors present joked, comparing the patient to a slaughtered animal: “Man, you have brought down the fever”. Bloodletting continued to play a role in medicine throughout medieval Europe. It persisted as a common therapeutic method until the 19th century, when it began to gradually go out of fashion.

The instruments of bleeding

The instruments doctors commonly used for bloodletting ranged from the grotesque-looking scalpel to the tools and methods that some alternative medicine practitioners still use today. They included:

– kinds of “Swiss Army knives”, with several kinds of blades
– a knife with a single thin blade
– the “sacrificers”, who had multiple blades
– cups that the doctor could place over the incision to collect blood
– leeches, which some people still use today for therapeutic purposes

Bloodletting in the Middle Ages

Bloodletting was particularly popular in the Middle Ages. When doctors used it not only to treat diseases, but also to prevent them.

In the book “Medieval Bodies: Life, Death and Art in the Middle Ages,” Dr. Jack Hartnell describes some of the uses of bloodletting, as well as some of the ways doctors performed the procedure.

Dr. Hartnell writes that according to medieval medical practice:

“The purging of the moist and warm humor, which was the blood, cooled and ventilated the patient’s heart and served as prophylactic insurance against future illnesses. She could prepare the body for foreseeable future biological or seasonal changes that could cause her to become misaligned with the next menstruation at the start of a particularly hot summer.

In the Middle Ages, barbers and surgeons practiced it

As for the application of bloodletting as a treatment, Dr. Hartnell notes that medieval physicians could opt for one of two contrasting approaches. They would choose to make an incision either near the part of the body needing treatment or at an opposite location on the body that would correspond to the affected organ. Some medieval and Renaissance medical treatises presented detailed illustrations of the points on the body where it was appropriate to make incisions for bleeding. Each according to the part of the body affected by a disease. In medieval and Renaissance Europe, bloodletting had become such a common therapy that barber surgeons practiced it. These were men who could cut a person’s hair or beard, as well as pull out badly damaged teeth and draw blood.

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People were bled.. at their own request

In 18th century Europe, surgeons continued to use bloodletting as a treatment for fever, hypertension (high blood pressure), inflammation of the lungs, and pulmonary edema (excess fluid in the lungs ). Some doctors have even expanded the use of this supposedly therapeutic method. For example, John Hunter, one of the ancestors of modern surgery, described various other uses of bloodletting, notably in the treatment of smallpox or gonorrhea.

In the latter case, he advised bleeding by leeches, which a doctor had to affix to the patient’s testicles. Bloodletting was still fairly common in the 19th century. But at the beginning of the 20th century, it gradually became unpopular with the medical community and the general public. Speaking of the popularity of this practice in the mid-19th century, a consulting physician of the time wrote in his memoirs:

“When I started out, haemorrhage was very often used in this hospital. And people used to come and be bleed at their own request. Just like they are now asking to have their teeth pulled, and we thought that was good practice for the students.”

Bloodletting began to lose ground in part thanks to the work of French physician Pierre-Charles-Alexandre Louis. He began to question this therapeutic method in the 1820s. Louis’ approach was to look at the number of patients who had received this therapy. Taking into account the effect of other factors, such as age, then determining whether the bleeding had actually done more good than harm. His conclusion, again and again, was that there was not enough evidence to support the idea that bloodletting could improve health.

Although he does not totally reject bloodletting as a therapy, Louis writes that according to his observations: “the study of general and local symptoms, mortality and variations in the average duration of pneumonia, according to the period in which the bloodletting has been instituted, all set narrow limits to the usefulness of this mode of treatment”.

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A strange precursor to blood transfusion?

Although doctors no longer prescribe bloodletting, the practice has not entirely disappeared. In some communities around the world, there are still people who believe that this practice can help cure all kinds of ailments and diseases. The leech has also persisted in alternative medicine, with some claiming it can help improve blood circulation and may even have an antitumor effect.

But the most important legacy of bloodletting is, perhaps oddly, blood transfusion. Throughout history, bloodletting has been closely associated with an interest in the various functions of the human body. By examining how changing the volume of blood in the body can affect its health, doctors have come to understand more and more about blood circulation. The importance of blood for health and the characteristics of blood. In the 1200s, a Persian scholar called Ibn an-Nafīs had already understood that blood circulates in the veins that weave between the different organs. However, it took about 400 years for European researchers to learn more about blood circulation.

The discovery of blood groups

In Europe, doctors began performing blood transfusions as early as the 1400s. They were aware of the dangers of blood loss. However, for many centuries they did not know that there are different blood groups with different compatibilities. This greatly affects the success of blood transfusions.

It was the Austrian physician Karl Landsteiner who, in 1909, first discovered and described the different blood groups. Thus making blood transfusion a viable therapy. For his contribution to the field of medicine, Landsteiner received the Nobel Prize in Physiology or Medicine in 1930.

Today, every year, approximately 118.5 million blood donations are collected worldwide. These blood donations help save lives and improve people’s health.


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