Bloodletting as Medical Care

From the Middle Ages until the early Nineteenth Century, many doctors felt that the bleeding of a patient might release the sickness that the poor individual was inflicted with. Various methods of cutting, leeches and blistering were all applied in the treatment of patients suffering from a variety of ailments. From a simple headache to a severe case of consumption, bleeding was usually prescribed. Although men dominated the profession from about 1700 on, there were still many women doctors and apothecaries that practiced their wares in villages and cities. For the most part, the women did not employ the bleeding cures as much as the male doctors did. This is interesting from a gender perspective. The female doctors chose not to bleed a patient, even when it was widely renowned as a cure for many, many problems. An examination of the development of bleeding as a practice, and a male invented cure, seems to be a factor in woman’s non-use of the method.

The first instances of bleeding, or phlebotmoy, as a medical cure are probably unrecorded. Not entirely a Western mode of practicing medicine, the first recorded instance that historians can locate occurs in both ancient Egypt and Greece. According to Henry Clutterbuck, M. D., “Like most other branches of the healing art, its [bloodletting] origin is involved in impenetrable darkness. It is certain, however, that the practice is of great antiquity, and was in general use long before the time of Hippocrates.” Phlebotomy flourished all over India and the Arabian countries and stands today as the longest consistently used form of medical treatment. Bloodletting was used for any and every ailment possible. Also very prevalent was the process of blistering. A caustic substance would be laid over the chest, arm or other inflicted part of the body and left there until blisters would rise. The blisters were then broken and drained, releasing the disease from the body.

In the Middle Ages, the Pope forbade clergymen and monks from the practice of bloodletting, and the physicians were just getting their first ideas about malpractice and could be sued by the feudal lords. The practice of bloodletting was then adopted by the barber surgeons, predominantly men, who would cut hair, shave, perform most small surgeries and bleed patients. As an interesting side note, the red and white spinning posts that signify a “barber” of today is a throwback to the bleeding barber surgeons of the middle ages. The blood-stained white towels were hung outside of the barber’s shop, allowing them to dry and telling passerby just who owned the store and what profession was practiced there.
Use of spring-loaded lancets, leeches, small vacuum tubes and even a device called a scarificator (a trigger released series of rotary blades that would cause shallow cuts) were implemented. Devices were being invented for the expressed purpose of bleeding a patient and releasing the “humours” that had invaded the body. The blood contained the “humours” which caused the disease so, in turn, by bleeding the patient the disease would be eradicated. And often times, the patient would be eradicated also. George Washington was bled in a treatment for a throat infection. He was drained of nine pints of blood in 24 hours and died.
The late 18th and early 19th centuries saw a great resurgence in the use of bloodletting. The process had once again come into vogue and doctors, most notably in the United States and Great Britain, were employing the methods. From their perspective, “Blood-letting may be considered in three points of view– as curative, as palliative, and as preventive and in all these respects important.” The resurgence of bloodletting as a prescribed medicinal cure came at a time when women were not allowed to practice medicine in general, and the physicians, in consequence, were mainly male. By 1900 the process was discarded and relegated to the rear of textbooks and deemed unsafe.

In every instance where the practitioner was a man, the idea that the blood held some sort of magical or mystical seemed to hold sway over their thinking. Blood was seen, for a very long time, as a magical substance. Blood was believed to hold the essence of a person, or animal. This belief came to be known as “vitalism.” Through vitalism, a calf’s blood was thought to contain tranquility and a dog’s blood thought to contain loyalty, and so on. Many professional women believed in the truth of vitalism, but more seemed to be skeptical about the process of bleeding to relieve the humours.

Another aspect of bloodletting that seemed to take predominance was the idea of timing, or the act of venesection. Venesection is more ritualized and pseudo-mystical than average leeching or cutting to relieve the inflicted patient. For example, from The Book of Anglo-Saxon Leechcraft, “Scarify the neck after the setting of the sun, pour in silence the blood into running water, after that spit three times, then say, ‘Have thou this unheal, and depart away with it’: go again on a clean way to the house, and go either way in silence.” The stylized ritual of the process is akin more to a voodoo rite than a practice of medicine, but it fits with the “magical” properties of the blood. Interestingly, the book does not tell what this is a cure for.

The roles of women were not that different from men in the Middle Ages. Only in the past three or four hundred years have the options for women been reduced to such a severe point. Women were allowed to be educated, hold non-governmental positions, own land and run their own businesses in medieval Europe. A great many women, not being able to afford the schooling that would of made them true physicians, came into the role of apothecaries. These apothecaries were, in essence, a blending of up-to-date medical science and homeopathic cures and remedies. Astrology and folklore was not uncommon but phlebotomy had not taken hold for the apothecary as it had for the doctor.

Women’s reluctance to see the mystical properties of blood or the total correctness of vitalism has been attributed to many factors. Men’s exposure to blood, for many years, has been solely through external or internal pain. Warfare and work related injuries, internal disease causing bleeding and animal husbandry. All instances of blood, to men, had been associated with pain. Women, on the other hand, did not share that view. Due in a large part to their menstrual cycle and childbirth, women did not associate the sight of blood with pain and disease immediately. The cures employed by the apothecaries tended to deal less with the aspect of all disease and pain being in the blood and more natural remedies dealing with the symptoms themselves. At a time when male physicians were prescribing leeches to cure a headache, women apothecaries prescribed the roots and herbs that folklore had taught them worked.

A common misconception by men in the medical fields in the Middle Ages were that occurrences of spontaneous bleeding being attributed to healing. They would view animals self-inflicting wounds, nosebleeds and even menstruation as forms medicinal practices. The jump to external bloodletting as a medicinal practice also was not a large one. The predominance of men in the medical community is a large part of the popularity of bloodletting. Men, throughout the centuries, have viewed bleeding in response to pain or injury. They assumed that the bleeding was a form of healing that the body would perform on it’s own, hence the extraction of the blood would further the body’s own healing process. Conversely, women involved in the medical profession did not wholly prescribe to this process. Women’s views of blood, although still magical in a sense, were related to menstruation and childbirth. The blood did not hold a “cure all” or a “harbors all disease and pain” for women in the Middle Ages. As women were phased out of the medical profession, bloodletting became more and more widely used as a functional cure for almost everything. Bloodletting in the 17th and 18th century has been equated to the proliferation of aspirin today, and was probably more popular and widespread.