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This aphorism, quoted in a 19th-century medical text, typified the
approach of many doctors to disease at that time. Essentially, the
message was to bleed, and bleed, and bleed again, for a wide variety of
illnesses and complaints, ranging from epilepsy and pneumonia, to
"bastard pleurisy" and hydrocephalus.1 Venesection was also
sometimes coordinated with astrological events, resulting in
complex "bleeding charts" being formulated based on celestial
cycles.2
Instruments for venesection consisted of peculiarly shaped lancets
called phlemes (Figure) which were wielded enthusiastically by
doctors. For example, one patient in France was bled over 64 times in
eight months,3 and sailors suffering from
fever in the West Indies had up to 70 ounces of blood taken at the first
sitting, with 250 ounces being drained off over three to four days. To
add to patients' misery, bleeding was often accompanied by "purging
and puking",2 with the use of medications
such as epsom salts, ipecacuanha and blue vitriol to induce diarrhoea
and vomiting.
If blood could not be drained directly from severed veins, leeches in
huge numbers were also applied, resulting in a lucrative trade in
these small creatures. In one year in 19th-century France, over 40
million leeches were applied to increasingly pallid
patients.4 So prevalent was the use of
leeching in medicine that the art of healing was, on occasion,
referred to as "leechcraft".5
Despite George IV being bled more than 100 times before his 30th
birthday,2 royal casualties were not
unknown. It is believed that both Emperor Leopold II of Austria and one
Prince Schwartzenberg were hurried off to early graves by excessive
venesecting.6
Although bleeding had been advocated by no less a figure than
Hippocrates, it was left to barbers to perform the task in the Middle
Ages, as it was deemed too menial for doctors. Subsequently, surgeons
evolved to perform these duties. Rows of patients were often bled at
the same time in special "bleeding houses".2
Early texts provide clear descriptions of how to perform
venesections, including the use of "a proper bandage of silk, linen,
or woollen cloth", and the provision of "wine or some other cordial" to
revive those who may have fainted.7 In addition, regional
venesections were also prescribed for particular conditions.
Recommended areas included under the tongue, the eyes, the penis and
the haemorrhoidal veins around the anus. In the event of poor blood
flow, presumably because of high levels of circulating adrenaline,
"immersing the parts in warm water was recommended".7
There is no doubt that doctors confidently and unquestioningly bled
patients and themselves for many centuries. The fact that bleeding
undoubtedly and obviously not only worsened some patients'
conditions, but also actually caused illness, serves as a salutary
reminder of the fallibility of our profession.
Roger W Byard
Forensic Pathologist
Forensic Science Centre, Adelaide, SA
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