The Long, Respected History of Bloodletting

A foundation stone of Western medicine

You can say this about bloodletting ‚ the practice of bleeding the ill patient to get his or her "humors" back in balance: it had a long and respected history. Dating back to at least fifth century B.C. and in practice across many cultures, bloodletting served as a foundation stone of Western medicine.

Unfortunately, you can also say this about bloodletting: It was at best a useless practice and at worse a dangerous one, causing more deaths than it could ever claim to save. Today, the idea seems barbaric, maybe equivalent to torture.

The story of bloodletting is told through several instruments housed in the History of Medicine Collections in the Medical Center Library at Duke. The collection has acquired through several sources tools that were standard equipment for physicians in the 1800s. These include a brass spring-loaded 12-blade lancet or scarificator; a folding, three-blade fleam with brass shield; four glass cups to draw blood to the skin surface; and an attractive and highly decorated brass bleeding cup used by a North Carolina surgeon in the 19th century. Most of the items were donated by Mrs. Emil C. Beyer.

"Blood letting has been a practice throughout a number of cultures," said Suzanne Porter, History of Medicine curator. "The particular devices we have are Western, specifically from England and the American colonies. Bloodletting was still being practiced late in the 19th century by some people. It was bound up in some folk practices, but it was also connected to Galen's theory of the four humors."

Galen was the ancient Greek who wrote the greatest of the Greek medical texts. His ideas on anatomy and medicine influenced Western medicine for centuries. He developed the concept of plethora, or an excess of humors, as the source of most disease. He believed that humans carried four bodily humors: blood, phlegm, yellow bile and black bile, and these had to be kept in balance to maintain health.

The recommended treatment was through purging, starving, vomiting or bloodletting to rid the patient of an overabundance of a particular humor. Bloodletting was flourishing in the Middle Ages in Europe. One reminder of its importance is the barber's red and white pole. The red advertised the bloodletting, and the white represented the tourniquet to stem the bleeding.

Porter says these early doctors really did try to make bloodletting be humane. The spring-loaded 12-blade scarificator was developed, she said, to provide narrow and quick punctures that would be the most painless.

"There are other sizes," she said, holding the scarificator on its side in her palms. Carefully she activated the spring-latch and the 12 blades rotated out. "There are also 16 blades ones; there are also six blade lancets. Less than six blades were not considered practical because you could do that by hand. The idea of the spring-loader was to make more cuts more swiftly, causing minimal discomfort."

The little glass cups came in different sizes and shapes, Porter said, and were used in two ways. They could be heated and used to dilate the blood vessels just under the skin in a practice called dry cupping. Or the dilated vessels could be lanced and heated cups used to draw the blood by means of a vacuum. This was called wet cupping.

When a large cut was needed, the fleam would be used, Porter said. "These don't look too sharp to me," she said. "Let's hope they were sharper when they were used. One advantage is it was easier to sharpen these blades than the fine blades of the lancet."

The brass bowl contains elegant images of birds, palm trees and women, belying the fact that its purpose was to collect large amounts of blood.

"It shows that so many utilitarian tools and items in medicine could be rendered in an artistic way," Porter said. "Now there are other examples of bleeding bowls that are less artistic, and there is some controversy as to whether household items like soup bowls were generally used to collect blood. There are some bleeding bowls with markings so you could see how much blood you had collected. Barber bowls, the kind that are cut out to fit under the chin, were also used."

Porter said the items are a treasured part of the collection, despite bloodletting's discredited reputation. "They document a belief system that was a big part of Western medicine at one point. If nothing else, they're artifacts that give you some insight into how medicine was practiced. It gets people talking about why this was believed, who did it, how long did it go on?

"For this particular practice, unlike so many other things of ancient medicine, there doesn't seem to be anything useful about it. The one exception is leeches, which were used in bloodletting and are now coming back in use. But they are used for a very different purpose now: to remove a buildup of blood in a particular place. They are often used now after surgery to reattach extremities. It has nothing to do with humors."