Bloodletting: Its Popularity in the 1700 and 1800s

Bloodletting is the withdrawal of blood from a patient to prevent illness or cure disease and could involve bloodletting performed by bloodletters or by applying leeches. Bloodletting began in ancient times to cure or prevent disease. It was based on ancient medicine and the idea “humors” — blood and other bodily fluids — needed to be in proper balance because when a person was ill, it was believed an imbalance in humors existed. People of the eighteenth and nineteenth century thought the best way to restore a humor imbalance was to draw blood. Additionally, curing illness was elusive, and, as doctors wanted to cure people, bloodletting was better than nothing because it worked in some cases, although that was likely due to a placebo effect.

Bloodletting - a surgeon bleeding the arm of a young woman

A surgeon bleeding the arm of a young woman as she is being comforted by another woman. Etching by Thomas Rowlandson, c. 1774. Courtesy of Wellcome Images.

Bloodletting was usually performed by bloodletters and involved the bloodletter searching for a vein in the patient’s arm, leg, or neck. The most common area they cut was the bend inside a patient’s elbow. The bloodletter would then draw no more than about four small teacups of blood by cutting into a vein using a small, two-edge knife, known as lancet. Cuts were made diagonally or lengthwise into the vein.

bloodletting - triple-bladed vaccination lancet

Triple-bladed vaccination lancet of 1822-1875 for bloodletting. Courtesy of Wellcome Images.

Bloodletting was extremely popular and used to treat nearly every disease imaginable. It was suggested in some cases that bloodletting be used before amputation or to resolve excessive menstruation. Bloodletting was also used in many cases where injury occurred. For example, in 1820, after the Duke of Berry, the youngest son of Charles X, was attacked by a assassin and had a dagger plunged into his side, his doctors, Dr. Guillaume Dupuytren and Monsieur Dubois, were called. The dagger was then pulled out and Dupuytren ordered exploration of the wound. The doctor also ordered the wound be bled, but when that didn’t help, the procedure was repeated a second and even a third time. Thus, it might not be any surprise to know that the Duke died.

Bloodletting also seems to have contributed to George Washington’s death. He awoke about 2:00am with an inflamed throat and breathing difficulties. His wife Martha sent for his aide-de-camp, who in turn sent for his doctors. They order bloodletting and in total it seems that that bloodletter took about “80 ounces of blood over 12 hours which is about 40 percent of an adult’s blood volume.”[1] Even if doctors did not make the situation worse, the bloodletting did not help and Washington died.

In the United States physician Benjamin Rush, who also happened to be one of the United States’ Founding Fathers, was a proponent of bloodletting. He thought arteries were key to curing diseases and believed the “excited” nervous state of life had two forms: healthy and morbid. So, when a patient was in the morbid state, relief could only be found by bloodletting, which Rush claimed would restore balance to the body. Of him it was reported in 1840:

“He considered hydrophobia as a variety of fever, calling it the hydrophobic state of malignant fever. It must be admitted, indeed, that the disease is characterized by many of the ordinary signs of proper or idiopathic fever, such as headache, flushing of the face and eyes, great restlessness, white tongue, and other febrile symptoms; and upon this ground Dr. Rush recommends the use of active bleeding in the cure.”[2]

Painting of Benjamin Rush by Charles Wilson Peale. Courtesy of Wikipedia.

Bloodletting could also be achieved with leeches. Doctors prescribed that the parasitic or predatory worms be placed everywhere on their patients. That meant they could be found from a patient’s anus to his or her tonsils to the mucous membranes. Doctors also recommended it for everything imaginable from acne and diabetes to indigestion and scurvy. One description on how to apply leeches follows:

“When leeches are ordered … wash the part to be operated on with soap and warm water, and then with plain cold water; dry well. Observe that leeches will not bite if the patient has been taking sulphur internally, or if there be any peculiar odour in the room, such as the vapour of hot vinegar, the smoke from burning brown paper, that from lighting a candle with a sulphur match, from blowing out a candle, or tobacco smoke. If the part be hot and inflamed, the leeches should be put, for a few minutes, into tepid water; and also when to be applied in the mouth or to any very warm part of the body. At all times, before applied, they should be dried between the folds of a fine towel. Place the number to be used in a hollow in a towel; then, so to turn the towel and the leeches upon the part that the towel will cover them. The hand must be kept over the towel until all bite. If this plan cannot be pursued, scratch the skin with a needle, and apply the leech to the spot. When they are to be applied within the mouth, put each leech into a large quill; apply the open end and retain until the leach is fixed, when the quill must be gently withdrawn. … A bread-and-water poultice, not to hot, should then be laid over the bites to encourage the bleeding. When a large quantity of blood is taken the invalid should be kept warm in bed. When the bleeding is too profuse, it may usually be stopped by pressing into the holes small pledgets of lint dipped in spirits of wine, or the muriated tincture of steel, or touching them lightly with a pointed piece of lunar caustic. If neither of these methods succeed, it will be requisite to pass a stitch, with a fine needle and silk, through each of the bleeding orifices. Bleeding must in every case be stopped before the patient is left for the night.”[3]

Hirudo medicinalis in the process of sucking blood. Courtesy of Wikipedia.

Leeches were also applied externally or internally. When attached externally they usually fell off on their own once they were satiated with blood. However, to reach that point, it might take twenty minutes to a few hours. Doctors were advised to count the number of leeches they used to ensure that all were removed. This was particularly important if used internally, but complications could sometimes result. For instance, if they were used inside the mouth or nose, it was reported:

“Leeches … have been occasionally swallowed, and have given rise to very unpleasant symptoms. The best treatment in case of this kind is to prescribe wine – half a glass, or even a glass, every quarter of an hours – which will speedily destroy the leech. A moderately strong solution of common salt would probably exert a similar fatal action on the animal.”[4]

Both external and internal applications sometimes required removal of the leech. This was accomplished carefully by a doctor using a fingernail or some sort of flat, blunt object that could break the seal of a sucking leech. Generally, nothing else (such as salt or vinegar) was applied to loosen the leech because there was always a danger that the leech would regurgitate its stomach contents into a wound, which could then become infected.

Mouthpart and sucker of a leech. Courtesy of Wikipedia.

Leeches for bloodletting was a popular medical treatment in both Europe and the United States. In fact, both France and England imported millions of blood-sucking leeches from leech collectors who obtained them for medicinal purposes and doctors prescribed them for everyone who suffered from illness. For instance, in the late 1790s when Eliza de Feuillide (Jane Austen’s cousin) found painful swelling in her breast, her doctor prescribed a leech application. The idea of leeches on her breasts terrified her, but she overcame her aversion and applied them. In fact, she did it more than once even though she claimed the leeches did not help reduce the swelling.

Leeches were also used by the French royal household in the late 1780s. The Princesse de Lamballe, Marie Antoinette’s friend and superintendent of her household, was once reported to have visited the Queen when her 15-month-old son, Louis-Charles, was having leeches applied. The princess was so shocked at the sight and fainted. Of course, that was something that happened frequently as the smell of violets or the sight of a lobster also made her faint.

Although leeches and bloodletting continued to be used into the 1800s, by the 1870s, bloodletting lost much of its popularity with the medical community. Doctors deemed it worthless in curing illness and disease. However, bloodletting remained popular with patients to such a degree many patients had to be convinced bloodletting would do them no good. A newspaper in Wichita, Kansas, reported in 1893 some interesting details on bloodletting and leeches:

“Several devices were invented to take the place of the leech before the doctors quit the business of blood-letting at every turn. Now it is a rare thing to see a bottle of leeches in a doctor’s office, and they are seldom called for at the druggists. As to the barbers, none of them dares justify the red streak in his pole by applying leech to the empimpled face of full-habited customer, lest the laws come down up him for practicing surgery without a license.”[5]

Bloodletting - the pharmacy leech jar

Pharmacy leech jar to hold leeches for bloodletting. Courtesy of Wikipedia.

References:

  • [1] “Bloodletting and Blisters,” in PBS News Hours.
  • [2] Clutterbuck, Henry, On the Proper Administration of Blood-letting, 1840, p. 105.
  • [3] Philp, Robert Kemp, Take My Advice, 1872. p. 150.
  • [4] Chambers’s Encyclopedia, 1889, p. 83.
  • [5] “A Dead Trade,” in The Wichita Daily Eagle, 20 June 1893, p. 3.

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