THE HUMORAL MANAGEMENT OF BLOOD: BLOODLETTING
by Karen Howell
In August, Science Gallery London teamed up with the Old Operating Theatre to exhibit the work of Helen Pynor and Peter Clancy with the installation The Body is a Big Place. Here Karen Howell, curator at the Old Operating Theatre shares some historical insights around bleeding in medicine.
Blood and heart health is a central aspect of the normal monitoring and maintenance of our body function. Via medical analysis we know that a unit of blood is taken to be approximately one pint, that an average adult male can be estimated to have within their body about twelve pints of blood, a female nine pints. A healthy donor's blood has been analysed to replenish in about 24 hours, and red blood cells that are lost take longer and are totally replaced in a few weeks. Whole blood can be donated every eight weeks and we are aware that blood types must be matched in order to safely transfuse blood. Our blood is accepted as the body’s replenishing life force.
But until the late nineteenth century the body’s humours were seen as central to a patients’ health and medical practitioners had to identify dis-ease of the patient’s body and attempt to rebalance four humours: blood, yellow bile, black bile and phlegm. The humoral system was based on the works of the Greek physicians Hippocrates (ca. 460 BCE–370 BCE) and Aelius Galen (c. 129-c. 216/17 CE) and was core to the whole of Western medical practice for nearly two thousand years. The Hippocratic Oath morally obliged a qualified medical practitioner to "nil nocere" (do no harm) but instead examine, monitor and restore the patients’ humoral balance. Blood as the bearer of life was seen as the prime humour and could be managed simply: any surplus of blood could be reduced by simply removing meat from the diet, or by controlled bleeding by phlebotomy – taken from the Greek words phlebo, meaning “pertaining to a blood vessel” – and tomia – meaning "cutting of" – and by venesection – to open a vein – not to analyse the blood but to simply release it to remove bad humours.
Bloodletting was undertaken via use of various designs of lancet, scarificators, sometimes also with the addition of small glass cups, but it was the medical Leech which remained the old world’s natural choice of bloodletting.
Parisian Leech Therapy - A course of 200 for Fever, 60 for Rheumatism
It was reported that the dynamic Napoleonic field-surgeon Joseph Victor Broussais (1772-1838) had no reserve for bleeding a patient. He notoriously directed his pupils and staff to '"Bleed ad finitum!...Bleed in an upright posture to fainting!". British physician James Clark (1788-1870) who, while in Rome had attended the frail poet John Keats (1795-1821) observed finer details of Broussais’ use of leeches at the Val de Grace Military Hospital in Paris.
Within his book Medical Notes, 1820, Clark reported of Broussais “…his treatment of fever…consists in the application of leeches to the abdomen” The number of leeches Broussai applied varied between twenty five and fifty!
Clark continues, “In one of his wards a soldier was pointed out to me who had lately come into the hospital with acute rheumatism of both knee and ankle joints, accompanied with the usual symptoms of redness, heat, and swelling. Sixty leeches were distributed on these joints, which bled freely; next day the patient was free from pain and the swelling of the joints gone. By this prompt abstraction of blood from the affected parts I was informed [that] his success in the treatment of acute rheumatism is very great."
We found out that leeches are still being used today, although their uses are limited to plastic and reconstructive surgeries, and relieving symptoms of osteoarthritis. The Body is a Big Place will be pumping in Peckham once again from the 3rd of October. Keep an eye on our events programme to find out what’s happening, when, and where.
August 31, 2017