Bloodletting is Back, Baby!

Believe it or not, bloodletting is one of the oldest medical practices! It’s been done with everything from leaches to “sharpened sticks, shark’s teeth, and miniature bows and arrows”, writes Sharon Moalem in her terrific book, Survival of the Sickest. In fact, many medical books were written on how (and how much) to draw blood!

So what was the basis for this “treatment”? Siddhartha Mukherjee, in his masterpiece, The Emperor of All Maladies, tells about Hippocrates who came up with the theory of four bodily fluids termed “humors”: blood, black bile, yellow bile and phlegm. Any illness, he said, was due to the excess of one of those fluids. In AD 160, the physician Claudius Galen associated most of the known illnesses with specific “humors”. It followed that if certain illness were “caused” by the excess of blood, then the logical solution would be to… bleed the person!

But wait, it gets even better (or worse). You can’t just bleed a person anywhere, writes Mukherjee:

“If the patient was to be bled prophylactically (that is, to prevent disease), then the purging was to be performed far away from the possible disease site, so that the humors could be diverted from it. But if the patient was being bled therapeutically – to cure an established disease – then the bleeding had to be done from nearby vessels leading into the site.”

Though this be madness, yet there was method to it.

But this theory had a problem when it came to execution: nobody knew which vessels flowed into (or away from) which organs! Enter Andreas Vesalius in 1553. He decided to sketch the vessels in the body to create an “anatomical atlas for surgeons”. By the time he was done though, he realized there was no “black bile” anywhere in the body:

“Vesalius had started his anatomical project to save Galen’s theory, but, in the end, he quietly buried it.”

And yet, it was almost the beginning of the 20^th century before bloodletting stopped being used as a medical practice.

But in recent years, writes Moalem, bloodletting has risen from the ashes again. At least for hemochromatosis. That’s a disease which disrupts the way the body metabolizes iron. Normally, once the body detects it has enough iron, it stops absorbing any more iron. But for people with hemochromatosis, the check fails. The body thinks it is always short of iron, keeps absorbing more and more iron, whose accumulation then damages the organs and can eventually kill. The solution: bleeding!

“Regular bleeding of hemochromatosis patients reduces the iron in their systems to normal levels.”

Looks like the bleeding wheel has come full circle!