Bleeding
Bleeding
Cure or Killer? In January 1765 twenty-six-year-old George III was suffering from fever, restlessness, nausea, and chest pains. On the thirteenth of the month his doctors, completely stumped, reported “a violent cold, a restless night, complained of [pains] in his breast.” They did the only thing they could agree on: “His Majesty was blooded 14 ounces.” His Majesty eventually recovered. Thirty-four years later, the king’s old nemesis, George Washington, lay sick with what may have been diphtheria. He had already been bled once by his plantation overseer, and two of his three doctors repeated the process three more times. Despite (or because of) their ministrations, Washington died the next night.
Approved Practice. What was good enough for a British king and an American president was considered good enough for everyone else. Exsanguination, or bleeding, was an almost universally approved treatment for a vast array of illnesses. The practice hearkened back to medieval Europe and was constructed on the belief that blood was one of the body’s four “humors”—blood, phlegm, bile, and black bile—which had to maintain proper balance within the body for good health. Like the other humors, blood could become excessive in the body, resulting in various symptoms, fever among them. The obvious remedy was to restore the humoral balance by drawing off the excess blood.
Applications. The theory made so much sense and the treatment was so simple that the practice was applied to all sorts of situations. While breathing deeply and coughing, a patient with pleurisy—a respiratory inflammation—could expect the doctor or surgeon to draw twelve ounces of blood from his or her jugular vein. If symptoms persisted after twenty-four hours, another bleeding followed. The particular place on the body from which the blood was drawn was often as important as the amount of blood taken. For rheumatic patients, for example, the bloodletter was supposed to draw ten ounces from the aching area. Patients submitted willingly to the procedure, many even considering regular bleeding part of a sensible health regimen; the lightheadedness that followed bloodletting was taken as a positive sign. For such all-purpose bleeding, the customary (and easiest) point of access was the inside of the patient’s arm. The great advantage of the practice of bleeding was that it could be per-formed almost anywhere, and with only a simple lancet. The disadvantage, of course, was that it almost never did any real good. By the time George Washington died in 1799, the practice was already being criticized by some doctors. After centuries of widespread use bleeding was virtually abandoned in the early nineteenth century.
LEECHES, LANCETS, AND SCARIFICATORS
Bleeding was one of the most common medical practices in the eighteenth-century western world, and the tools for the job ranged from the ancient to the most modern. Doctors and surgeons often kept jars of leeches ready for use. Using leeches for bleeding had advantages: the amount of blood taken could be easily controlled; they could be applied anywhere on the body; and no incision was required. But it was a slow process. Bleeding by incision required more skill and judgment but could remove blood more quickly, and for this the surgeon’s lancet was simple and effective. Indeed the lancet was undoubtedly the most used tool in a surgeon’s kit. Incisions were more painful, however, and doctors generally recommended leeches for children and the faint of heart. To overcome a patient’s fear of the lancet, doctors who could procure one used a “scarificator,” a handheld device that was pressed against the patient’s skin, and when a small trigger was released, a set of spring-loaded blades pierced the vein to a precise depth, making several incisions at once. The patient felt only a momentary pang.
Source: J. Worth Estes, “Therapeutic Practice in Colonial New England,” in Medicine in Colonial Massachusetts, 1620-1820 (Boston: Colonial Society of Massachusetts, 1980).
Sources
Don Cooke, The Long Fuse: How England Lost the American Colonies (New York: Atlantic Monthly Press, 1995);
James Thomas Flexner, Washington: The Indispensible Man (Boston: Little, Brown, 1974);
Harold L. Peterson, The Book of the Continental Soldier (Harrisburg, Penn.: Stackpole, 1968).