Editing Bloodletting

{{Short description|Therapy, now rarely used in medicine}}
{{Other uses}}
{{Infobox medical intervention
| Name        = Bloodletting
| image       = BloodlettingPhoto (cropped).jpg
| Caption     = Bloodletting in 1860
| ICD10       =
| ICD9        =
| MeshID      = D001815
| OPS301      =
| OtherCodes  =
| HCPCSlevel2 =
}}
[[Image:Iatros.jpg|right|framed|Ancient Greek painting on a vase, showing a physician (''iatros'') bleeding a patient]]
'''Bloodletting''' (or '''blood-letting''') was the deliberate withdrawal of [[blood]] from a patient to prevent or cure illness and disease.  Bloodletting, whether by a physician or by [[leech]]es, was based on an ancient system of [[medicine]] in which blood and other bodily fluids were regarded as "[[Humorism|humours]]" that had to remain in proper balance to maintain health. It was the most common medical practice performed by surgeons from [[Ancient history|antiquity]] until the late 19th century, a span of over 2,000 years.<ref name="British Science Museum">{{cite web|url=http://www.sciencemuseum.org.uk/broughttolife/techniques/bloodletting.aspx|title=Bloodletting|access-date=2009-07-12|publisher=British Science Museum|year=2009|archive-url=https://web.archive.org/web/20090415024002/http://www.sciencemuseum.org.uk/broughttolife/techniques/bloodletting.aspx|archive-date=2009-04-15|url-status=dead}}</ref> In Europe, the practice continued to be relatively common until the end of the 19th century.<ref name="Anderson, Julie 2013">B.) Anderson, Julie, Emm Barnes, and Enna Shackleton. "The Art of Medicine: Over 2,000&nbsp;Years of Images and Imagination [Hardcover]." The Art of Medicine: Over 2,000&nbsp;Years of Images and Imagination: Julie Anderson, Emm Barnes, Emma Shackleton: {{ISBN|978-0226749365}}: The Ilex Press Limited, 2013.</ref> The practice has now been abandoned by modern-style medicine for all except a few very specific [[medical condition]]s.<ref name="leech">{{cite news|url=https://www.latimes.com/archives/la-xpm-2001-aug-06-he-31093-story.html|title=Modern Bloodletting and Leeches|access-date=2009-07-12|newspaper=Los Angeles Times |date=6 August 2001 | first=Rosie | last=Mestel}}</ref> In the beginning of the 19th century, studies had begun to show the harmful effects of bloodletting.<ref name="harmful">{{cite web|url=http://www.jameslindlibrary.org/essays/fair_tests/why-fair-tests-are-needed.html|title=Why fair tests are needed|year=2009|website=jameslindlibrary.org|archive-url=https://web.archive.org/web/20070102144950/http://www.jameslindlibrary.org/essays/fair_tests/why-fair-tests-are-needed.html|url-status=dead |archive-date=2 January 2007 |access-date=8 January 2017}}</ref>

Today, the term ''[[phlebotomy (modern)|phlebotomy]]'' refers to the drawing of blood for laboratory analysis or [[blood transfusion]].<ref name="phlebotomy">{{cite book|url=https://books.google.com/books?id=IbseP_cgy3gC&q=phlebotomy&pg=PA7 |title=Phlebotomy (book)|access-date=2009-07-12|publisher=Bonnie K. Davis |year=2001|isbn=978-0-7668-2518-5}}</ref> ''Therapeutic phlebotomy'' refers to the drawing of a unit of blood in specific cases like [[hemochromatosis]], [[polycythemia vera]], [[porphyria cutanea tarda]], etc., to reduce the number of red blood cells.<ref name="theraputic">{{cite web|url=http://www.hemochromatosis.co.uk/tp.html|title=The Basis of Therapeutic Phlebotomy|access-date=2009-07-12|publisher=James C. Barton, M.D|year=2009|archive-date=8 April 2011|archive-url=https://web.archive.org/web/20110408183020/http://www.hemochromatosis.co.uk/tp.html|url-status=dead}}</ref><ref name="therapy">{{cite web|url=http://www.ccgh.org/patient_ed/therapeutic_phlebotomy.shtml|title=Therapeutic Phlebotomy|access-date=2009-07-12|publisher=Carteret General Hospital|year=2009|archive-url=https://web.archive.org/web/20090707035400/http://www.ccgh.org/patient_ed/therapeutic_phlebotomy.shtml|archive-date=2009-07-07|url-status=dead}}</ref> The traditional medical practice of bloodletting is today considered to be a [[pseudoscience]],<ref name="Pseudoscience">{{cite book|last=Williams|first=William F.|title=Encyclopedia of Pseudoscience: From Alien Abductions to Zone Therapy|url=https://books.google.com/books?id=vH1EAgAAQBAJ&q=bloodletting+pseudoscience&pg=PT293|date=2013|publisher=Routledge|isbn=978-1135955298}}</ref> though the method is still commonly used in forms of [[alternative medicine]].{{cn|date=May 2025}}

==In the ancient world==
[[File:P. 11 a chart showing the parts of the body to be bled for different diseases.jpg|thumb|A chart showing the parts of the body to be bled for different diseases, {{circa|1310–1320}}]]
[[Image:Gersdorff Feldbuch s16.jpg|thumb|Points for bloodletting, [[Hans von Gersdorff (surgeon)|Hans von Gersdorff]], ''Field book of wound medicine'', 1517]]
Passages from the [[Ebers Papyrus]] may indicate that bloodletting by scarification  was an accepted practice in [[Ancient Egypt]].<ref name="Papavramidou">{{cite journal |last1=Papavramidou |first1=Niki |last2=Thomaidis |first2=Vassilios |last3=Fiska |first3=Aliki |title=The ancient surgical bloodletting method of arteriotomy |journal=Journal of Vascular Surgery |date=December 2011 |volume=54 |issue=6 |pages=1842–44 |doi=10.1016/j.jvs.2011.05.100 |pmid=21908152 |doi-access=free}}</ref><ref name="Parapia">{{cite journal |last1=Parapia |first1=Liakat Ali |title=History of bloodletting by phlebotomy |journal=British Journal of Haematology |volume=143 |issue=4 |pages=490–95 |date=September 2008 |doi=10.1111/j.1365-2141.2008.07361.x |pmid=18783398 |s2cid=9589933|doi-access=free }}</ref><ref name="Schneeberg">{{cite journal |last1=Schneeberg |first1=NG |title=A twenty-first century perspective on the ancient art of bloodletting. |journal=Transactions & Studies of the College of Physicians of Philadelphia |date=December 2002 |volume=24 |pages=157–85 |pmid=12800324}}</ref>
Egyptian burials have been reported to contain bloodletting instruments.<ref name="Stern">{{cite book |last1=Stern |first1=Heinrich |title=Theory and Practice of Bloodletting |date=1915 |publisher=Rebman Company |location=New York |page=[https://archive.org/details/theorypracticeof00ster/page/9 9] |url=https://archive.org/details/theorypracticeof00ster |access-date=20 August 2018}}</ref>
According to some accounts, the Egyptians based the idea on their observations of the [[hippopotamus]],<ref name="Davis">{{cite book |last1=Davis |first1=Audrey |last2=Appel |first2=Toby |title=Bloodletting Instruments in the National Museum of History and Technology |url=https://archive.org/details/bloodlettinginst0000davi |url-access=registration |date=1979 |publisher=Smithsonian Institution Press |location=Washington, DC |page=[https://archive.org/details/bloodlettinginst0000davi/page/1 1] |hdl=10088/2440}}</ref> confusing its [[Hippopotamus#Characteristics|red secretions]] with blood and believing that it scratched itself to relieve distress.<ref name="Distillations">{{cite journal |last1=Kean |first1=Sam |title=Sweating blood |url=https://www.sciencehistory.org/distillations/magazine/sweating-blood |journal=Distillations |date=2018|volume=4 |issue=2 |page=5 |access-date=20 August 2018}}</ref><ref name="Mikhail">{{cite book |last1=Mikhail |first1=Alan |title=The Animal in Ottoman Egypt |date=2014 |publisher=Oxford University Press |location=Oxford |isbn=978-0190655228 |page=169 |url=https://books.google.com/books?id=hfMEAQAAQBAJ&pg=PA169 |access-date=20 August 2018}}</ref>

In Greece, bloodletting was in use in the 5th century BC during the lifetime of [[Hippocrates]], who mentions this practice but generally relied on [[Dieting|dietary techniques]].<ref name="Hippo">{{cite web|url=https://www.bbc.co.uk/dna/mb6music/A896664|title=Degeneration of Medicine and the Grisly Art of Slicing Open Arms|access-date=2009-07-12|publisher=BBC |date=29 November 2002}}</ref> [[Erasistratus]], however, theorized that many diseases were caused by plethoras, or overabundances, in the blood and advised that these plethoras be treated, initially, by [[exercise]], [[Perspiration|sweating]], reduced food intake, and vomiting.<ref name="Erasistratus">{{cite book|url=https://books.google.com/books?id=-aFtPdh6-2QC&q=Erasistratus%2Bbloodletting&pg=PA269|title=Encyclopedia of ancient Greece|access-date=2009-07-12|publisher=Nigel Guy Wilson |year=2006|isbn=978-0-415-97334-2}}</ref> But his student [[Herophilus]] supported bloodletting.<ref>{{Cite book |last=Bynum |first=W. F. |url=https://www.google.co.il/books/edition/Companion_Encyclopedia_of_the_History_of/gyidO-ZLdiYC?hl=iw&gbpv=1&pg=PA943&printsec=frontcover |title=Companion Encyclopedia of the History of Medicine |last2=Porter |first2=Roy |date=2013-06-20 |publisher=Routledge |isbn=978-1-136-11036-8 |language=en}}</ref> A contemporary Greek physician, Archagathus, one of the first to practice in Rome, also believed in the value of bloodletting.{{cn|date=August 2022}}

"Bleeding" a patient to health was modeled on the process of [[menstruation]]. Hippocrates believed that menstruation functioned to "purge women of bad humours". During the [[Roman Empire]], the Greek physician [[Galen]], who subscribed to the teachings of Hippocrates, advocated [[Surgery in Ancient Rome|physician-initiated bloodletting]].<ref name="1iqDX">{{cite book |first=Elsimar M. |last=Coutinho |title=Is Menstruation Obsolete? |publisher=Oxford University Press |year=1999 |isbn=0-19-513021-9}}</ref>

The popularity of bloodletting in the classical Mediterranean world was reinforced by the ideas of Galen, after he discovered that not only [[vein]]s but also [[artery|arteries]] were filled with blood, not air as was commonly believed at the time.<ref>{{Cite book|url=https://www.worldcat.org/oclc/39257545|title=Western medical thought from antiquity to the Middle Ages|date=1998|publisher=Harvard University Press|others=Mirko D. Grmek, Bernardino Fantini, Antony Shugaar|isbn=0-674-40355-X|location=Cambridge, Ma.|oclc=39257545}}</ref><ref>{{Cite book|url=https://www.worldcat.org/oclc/31077045|title=The Western medical tradition : 800 B.C.–1800 A.D.|date=1995|publisher=Cambridge University Press|others=Lawrence I. Conrad, Wellcome Institute for the History of Medicine|isbn=0-521-38135-5|location=Cambridge, Eng.|oclc=31077045}}</ref> There were two key concepts in his system of bloodletting. The first was that blood was created and then used up; it did not [[Circulation (physiology)|circulate]], and so it could "stagnate" in the extremities. The second was that [[Humorism|humoral]] balance was the basis of illness or health, the four humours being blood, phlegm, black bile, and yellow bile, relating to the four Greek [[classical element]]s of air, water, earth, and fire respectively. Galen believed that blood was the dominant humour and the one in most need of control. In order to balance the humours, a physician would either remove "excess" blood (plethora) from the patient or give them an [[emetic]] to induce vomiting, or a [[diuretic]] to induce urination.

Galen created a complex system of how much blood should be removed based on the patient's age, constitution, the season, the weather and the place. "Do-it-yourself" bleeding instructions following these systems were developed.<ref name="Western Medical Tradition">{{cite book |last=Conrad |first=Lawrence I. |title=The Western Medical Tradition: 800&nbsp;B.C.–1800&nbsp;A.D. |location=Cambridge, Eng. |publisher=Cambridge UP |year=1995 |isbn=0-521-38135-5}}</ref> Symptoms of plethora were believed to include fever, [[apoplexy]], and headache. The blood to be let was of a specific nature determined by the disease: either arterial or [[venous blood|venous]], and distant or close to the area of the body affected. He linked different [[blood vessel]]s with different [[Organ (anatomy)|organs]], according to their supposed drainage. For example, the vein in the right hand would be let for [[liver]] problems and the vein in the left hand for problems with the [[spleen]]. The more severe the disease, the more blood would be let. Fevers required copious amounts of bloodletting.

== Middle Ages ==
{{Multiple image
<!--image 1-->| image1            = Psalter 1340.jpg
| width1            = 150
| caption1          = 1335-1340, England. Physician or barber bleeding a patient
<!--image 2-->| image2            = Middleages.jpg
| width2            = 200
| caption2          = Circa 1300 A.D., Germany. A physician holds the patient's arm straight, while blood streams into a bowl. The knife used to cut the wound is on the table, a tourniquet on the floor. The caption refers to sanguineus blood.
}}

The [[Talmud]] recommended a specific day of the week and days of the month for bloodletting in the [[Shabbat (Talmud)|Shabbat tractate]],<ref>{{Cite Talmud|b|Shabbat|18|129b}}</ref> and similar rules, though less codified, can be found among [[Christianity|Christian]] writings advising which [[saint's day|saints' days]] were favourable for bloodletting.{{Citation needed|date=January 2022}} During medieval times bleeding charts were common, showing specific bleeding sites on the body in alignment with the planets and zodiacs.<ref name="Western Medical Tradition" /> [[Islamic medicine|Islamic medical authors]] also advised bloodletting, particularly for fevers. It was practised according to seasons and certain phases of the [[Moon]] in the [[lunar calendar]]. The practice was probably passed by the Greeks with the translation of ancient texts to [[Arabic language|Arabic]] and is different than [[Hijama|bloodletting by cupping]] [[Hadith|mentioned]] in the [[Sunnah|traditions]] of [[Muhammad]]. When Muslim theories became known in the [[Latin]]-speaking countries of [[Europe]], bloodletting became more widespread. Together with [[cautery]], it was central to [[Arab]]ic surgery; the key texts ''[[The Canon of Medicine|Kitab al-Qanun]]'' and especially ''{{lang|ar-Latn|[[Al-Tasrif|Al-Tasrif li-man 'ajaza 'an al-ta'lif]]}}'' both recommended it. It was also known in [[Ayurveda|Ayurvedic]] medicine, described in the ''Susruta Samhita''.
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The practice continued throughout the [[Middle Ages]] but began to be questioned in the 16th century, particularly in northern Europe and the [[Netherlands]]. In [[France]], the court and university physicians advocated frequent phlebotomy. In [[England]], the efficacy of bloodletting was hotly debated,<ref name="British Medical Journal" /> declining throughout the 18th century, and briefly revived for treating [[tropical fever]]s in the 19th century.
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==Use in the 1600s through the 19th century==
[[File:4 transfusion.jpg|thumb|{{ill|Johannes Scultetus|de|Johannes Scultetus (Mediziner, 1595)}} ''Armamentarium Chirurgicum'', 1693 – diagrammed transfusion of dog's blood]]Bloodletting became a main technique of [[heroic medicine]], a traumatic and destructive collection of medical practices that emerged in the 18th century.<ref name="Ehrenreich 2005" />

Even after the humoral system fell into disuse, the practice was continued by [[surgery|surgeons]] and [[Barber surgeon|barber-surgeons]]. Though the bloodletting was often ''recommended'' by physicians, it was carried out by barbers. This led to the distinction between physicians and surgeons. The [[Barber's pole|red-and-white-striped pole]] of the [[Barbershop (hair)|barbershop]], still in use today, is derived from this practice: the red symbolizes blood while the white symbolizes the bandages. Bloodletting was used to "treat" a wide range of diseases, becoming a standard treatment for almost every ailment, and was practiced [[prophylaxis|prophylactically]] as well as therapeutically.
[[File:Blood letting machine.jpg|thumb|Scarificator]]
[[File:Blood letting machine mechanism.jpg|thumb|Scarificator mechanism]]
[[File:Bloodletting showing depth adjustment.jpg|thumb|Scarificator, showing depth adjustment bar]]
[[File:Bloodletting depth adjustment 2.jpg|thumb|Diagram of scarificator, showing depth adjustment]]

A number of different methods were employed. The most common was ''phlebotomy'', or ''venesection'' (often called "breathing a vein"), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. In ''arteriotomy'', an artery was punctured, although generally only in the temples. In ''scarification'' (not to be confused with [[scarification]], a method of body modification), the "superficial" vessels were attacked, often using a syringe, a spring-loaded [[Scalpel|lancet]], or a glass cup that contained heated air, producing a [[vacuum]] within (see [[fire cupping]]). There was also a specific bloodletting tool called a ''scarificator'', used primarily in 19th century medicine. It has a spring-loaded mechanism with gears that snaps the blades out through slits in the front cover and back in, in a circular motion. The case is cast brass, and the mechanism and blades steel. One knife bar gear has slipped teeth, turning the blades in a different direction than those on the other bars. The last photo and the diagram show the depth adjustment bar at the back and sides.

[[Leech]]es could also be used. The withdrawal of so much blood as to induce [[Vasovagal episode|syncope]] (fainting) was considered beneficial, and many sessions would only end when the patient began to swoon.

[[William Harvey]] disproved the basis of the practice in 1628,<ref name="Anderson, Julie 2013" />  and the introduction of [[Evidence-based medicine|scientific medicine]], ''la méthode numérique'', allowed [[Pierre Charles Alexandre Louis]] to demonstrate that phlebotomy was entirely ineffective in the treatment of [[pneumonia]] and various fevers in the 1830s. Nevertheless, in 1838, a lecturer at the [[Royal College of Physicians]] would still state that "blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly",<ref name="r0f58">{{cite book|last=Clutterbuck|first=Henry|title=Dr Clutterbuck's Lectures On Bloodletting: Lecture 1|year=1838|publisher=The London Medical Gazette|url=https://books.google.com/books?id=rs9bDPounQwC&q=%22blood-letting+is+a+remedy+which%2C+when+judiciously+employed%22&pg=PA9}}</ref> and Louis was dogged by the sanguinary [[François-Joseph-Victor Broussais|Broussais]], who could recommend leeches fifty at a time. Some physicians resisted Louis' work because they "were not prepared to discard therapies 'validated by both tradition and their own experience on account of somebody else's numbers'."<ref name="ZTTNU">{{cite journal |first=P. K. |last=Rangachari |pmc=1296268 |title=Evidence-based medicine: old French wine with a new Canadian label? |journal=J R Soc Med |year=1997 |volume=90 |issue=5 |pages=280–84 |doi=10.1177/014107689709000516 |pmid=9204029}}</ref>

During this era, bloodletting was used to treat almost every disease. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed.<ref name="qePBx">Carter (2005) p. 6</ref>

There were also theories that bloodletting would cure "heartsickness" and "heartbreak". A French physician, [[Jacques Ferrand]] wrote a book in 1623 on the uses of bloodletting to cure a broken heart. He recommended bloodletting to the point of heart failure (literal).<ref name="quackery">Lydia Kang MD & Nate Pederson, ''Quackery: A Brief History of the Worst Ways to Cure Everything'' "Bleed Yourself to Bliss" (Workman Publishing Company; 2017)</ref>

Leeches became especially popular in the early 19th century. In the 1830s, the French imported about 40 million leeches a year for medical purposes, and in the next decade, England imported 6 million leeches a year from France alone. Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe.<ref name="fnula">Carter (2005) p. 7</ref>

{{quote|One typical course of medical treatment began the morning of 13 July 1824. A French sergeant was stabbed through the chest while engaged in single combat; within minutes, he fainted from loss of blood. Arriving at the local hospital he was immediately bled twenty ounces (570&nbsp;ml) "to prevent inflammation". During the night he was bled another 24&nbsp;ounces (680&nbsp;ml). Early the next morning, the chief surgeon bled the patient another 10&nbsp;ounces (285&nbsp;ml); during the next 14&nbsp;hours, he was bled five more times. Medical attendants thus intentionally removed more than half of the patient's normal blood supply—in addition to the initial blood loss which caused the sergeant to faint. Bleedings continued over the next several days. By 29 July, the wound had become inflamed. The physician applied 32 leeches to the most sensitive part of the wound. Over the next three days, there were more bleedings and a total of 40 more leeches. The sergeant recovered and was discharged on 3 October. His physician wrote that "by the large quantity of blood lost, amounting to 170&nbsp;ounces [nearly eleven pints] (4.8&nbsp;liters), besides that drawn by the application of leeches [perhaps another two pints] (1.1&nbsp;liters), the life of the patient was preserved". By nineteenth-century standards, thirteen pints of blood taken over the space of a month was a large but not an exceptional quantity. The medical literature of the period contains many similar accounts-some successful, some not.<ref name="kBzOf">During the Yellow Fever this practice was also used by Dr. Rush. Read the book Fever 1793 for more info of look up Yellow Fever or Dr. Ben Rush {{cite journal | last = Delpech | first = M | title = Case of a Wound of the Right Carotid Artery | journal = Lancet | volume = 6 | issue =73 | pages = 210–13 | year = 1825 | doi =10.1016/S0140-6736(02)83521-8}} quoted in Carter (2005):7–8</ref>}}

Bloodletting was also popular in the young United States of America, where [[Benjamin Rush]] (a signatory of the [[United States Declaration of Independence|Declaration of Independence]]) saw the state of the arteries as the key to disease, recommending levels of bloodletting that were high even for the time. [[George Washington]] asked to be bled heavily after he developed a throat infection from weather exposure. Within a ten-hour period, a total of 124–126 [[ounces]] (3.75&nbsp;liters) of blood was withdrawn prior to his death from a throat infection in 1799.<ref name="jUoPd">[http://www.thepermanentejournal.org/files/Spring2004/time.pdf The Permanente Journal Volume 8 No. 2: The asphyxiating and exsanguinating death of president george washington] {{Webarchive|url=https://web.archive.org/web/20171022142641/http://www.thepermanentejournal.org/files/Spring2004/time.pdf |date=22 October 2017 }}, p. 79, Spring, 2004, retrieved on 11 November 2012</ref>
[[File:Bloodstick2.jpg|thumb|upright|Bloodsticks for use when bleeding animals]]
One reason for the continued popularity of bloodletting (and purging) was that, while [[anatomy|anatomical]] knowledge, surgical and diagnostic skills increased tremendously in Europe from the 17th century, the key to curing disease remained elusive, and the underlying belief was that it was better to give any treatment than nothing at all. The psychological benefit of bloodletting to the patient (a [[placebo effect]]) may sometimes have outweighed the physiological problems it caused. Bloodletting slowly lost favour during the 19th century, after French physician Dr. Pierre Louis conducted an experiment in which he studied the effect of bloodletting on pneumonia patients.<ref name="British Columbia Medical Journal" /> A number of other ineffective or harmful treatments were available as placebos—[[mesmerism]], various processes involving the new technology of electricity, many potions, tonics, and elixirs. Yet, bloodletting persisted during the 19th century partly because it was readily available to people of any socioeconomic status.<ref name="bCVnM">{{Cite journal|last=Upshaw|first=John|year=2000|title=The medicinal leech: Past and present|journal=The American Surgeon|volume=66 |issue=3|pages=313–14|doi=10.1177/000313480006600318 |pmid=10759207|s2cid=2028394 }}</ref>

[[Barbara Ehrenreich]] and [[Deirdre English]] write that the popularity of bloodletting and heroic medicine in general was because of a need to justify medical billing. Traditional healing techniques had been mostly practiced by women within a non-commercial family or village setting. As male doctors suppressed these techniques, they found it difficult to quantify various "amounts" of healing  to charge for, and difficult to convince patients to pay for it. Because bloodletting seemed active and dramatic, it helped convince patients the doctor had something tangible to sell.<ref name="Ehrenreich 2005">{{cite book |pages=49–52 |title=For her Own Good |author1-first=Barbara |author1-last=Ehrenreich |author2-first=Deirdre |author2-last=English |year=2005 |publisher=Anchor Books |author1-link=Barbara Ehrenreich |author2-link=Deirdre English |isbn=1400078008 }}</ref>

==Controversy and use into the 20th century==
Bloodletting gradually declined in popularity over the course of the 19th century, becoming rather uncommon in most places, before its validity was thoroughly debated. In the medical community of [[Edinburgh]], bloodletting was abandoned in practice before it was challenged in theory, a contradiction highlighted by physician-physiologist [[John Hughes Bennett]].<ref name="FN3jl">{{cite journal |last1=Warner |first1=John Harley |title=Therapeutic explanation and the Edinburgh bloodletting controversy: Two perspectives on the medical meaning of science in the mid-nineteenth century |journal=Medical History |date=July 1980 |volume=24 |issue=3 |pages=241–58 |doi=10.1017/s0025727300040308 |pmid=6997652 |pmc=1082653}}</ref> Authorities such as [[Austin Flint I]], Hiram Corson, and [[William Osler]] became prominent supporters of bloodletting in the 1880s and onwards, disputing Bennett's premise that bloodletting had fallen into disuse because it did not work. These advocates framed bloodletting as an orthodox medical practice, to be used in spite of its general unpopularity.<ref name="Anders">{{cite journal |first=Eli Osterweil |last=Anders |title='A Plea for the Lancet': Bloodletting, Therapeutic Epistemology, and Professional Identity in Late Nineteenth-century American Medicine |journal=Social History of Medicine |volume=29 |issue=4 |year=2016 |pages=781–801 |doi=10.1093/shm/hkw026 |quote=Arguing that it was the physician's obligation to be active and to intervene when necessary, bloodletting proponents explicitly contrasted themselves with advocates of expectant treatment, whom they portrayed as passive, timid, and unwilling to do what was necessary to save their patients.}}</ref> Some physicians considered bloodletting useful for a more limited range of purposes, such as to "clear out" infected or weakened blood or its ability to "cause [[hæmorrhage]]s to cease"—as evidenced in a call for a "fair trial for blood-letting as a remedy" in 1871.<ref name="British Medical Journal">{{cite journal |title=Bloodletting |journal=British Medical Journal |date=18 March 1871 |volume=1 |issue=533 |pages=283–91 |pmc=2260507 |doi=10.1136/bmj.1.533.283}}</ref>

Some researchers used [[evidence-based medicine|statistical methods for evaluating treatment effectiveness]] to discourage bloodletting.<ref name="British Columbia Medical Journal">{{Cite journal|url=http://www.bcmj.org/premise/history-bloodletting#4|title=The history of bloodletting |journal=British Columbia Medical Journal |volume=52|issue=1|date=January–February 2010|first=Gerry|last=Greenstone|access-date=2017-02-17}}</ref> But at the same time, publications by [[Philip Pye-Smith]] and others defended bloodletting on scientific grounds.<ref name="Anders" />

Bloodletting persisted into the 20th century and was recommended in the 1923 edition of the textbook ''[[The Principles and Practice of Medicine]]''.<ref name="rKVqc">{{Cite web|url=http://www.library.ucla.edu/specialcollections/biomedicallibrary/12193.cfm|title=Bloodletting|date=12 January 2012|website=UCLA Library: Biomedical Library History and Special Collections for the Sciences|archive-url=https://web.archive.org/web/20120313034620/http://www.library.ucla.edu/specialcollections/biomedicallibrary/12193.cfm|archive-date=13 March 2012 |url-status=dead|access-date=5 January 2012}}</ref> The textbook was originally written by Sir William Osler and continued to be published in new editions under new authors following Osler's death in 1919.<ref name="Postgraduate Medical Journal">{{Cite journal|doi=10.1136/postgradmedj-2015-133677|pmid=26404786|title=Osler and his teaching: relevant today|journal=Postgraduate Medical Journal|volume=91|issue=1080|pages=540–41|year=2015|last1=Ryan|first1=Terence J|s2cid=41284621}}</ref>

Bloodletting was once thought to reduce inflammation, boost immunity, and improve circulation by aiding in the detoxification of the blood circulating throughout the body.<ref>{{Cite web |title=Bloodletting: Causes, Symptoms, Treatment and Cost |url=https://www.lybrate.com/topic/bloodletting |access-date=2025-04-07 |website=Lybrate |language=en}}</ref> Over time, however, bloodletting's harmful impacts made the practice a less preferable form of medicine. Not only was bloodletting generally ineffective it commonly led to significant blood loss. High loss of blood made patients highly susceptible to infection/[[sepsis]] or the formation of a [[hematoma]].<ref>{{Cite web |last=Nicola |first=Stephanie |title=What to Know About the History of Bloodletting |url=https://www.webmd.com/a-to-z-guides/what-to-know-history-bloodletting |access-date=2025-04-02 |website=WebMD |language=en}}</ref> Additionally, bloodletting also caused [[anemia]], leading the patient to feel weak, tired, or even go unconscious. The harmful effects did not stop there, in severe cases bloodletting had to the potential to cause deadly [[hypovolemic shock]].<ref>{{Cite web |title=Bloodletting: Causes, Symptoms, Treatment and Cost |url=https://www.lybrate.com/topic/bloodletting |access-date=2025-04-02 |website=Lybrate |language=en}}</ref> As the medical world advanced these deadly effects made the practice of bloodletting fade in popularity.

==Therapeutic phlebotomy==
Therapeutic phlebotomy is used today in the treatment of a few diseases, including [[hemochromatosis]], [[sickle cell disease]], [[porphyria cutanea tarda]], [[Metabolic dysfunction–associated steatotic liver disease|nonalcoholic fatty liver disease]], and [[polycythemia]].<ref name="Tuttle">{{cite journal |last1=Tuttle |first1=Kelly |title=Let it bleed |url=https://www.sciencehistory.org/distillations/magazine/let-it-bleed |journal=Science History Magazine |date=2012|volume=30 |issue=2 |page=17 |access-date=20 August 2018}}</ref><ref>{{Cite journal |last1=Kim |first1=Kyung Hee |last2=Oh |first2=Ki Young |date=2016-07-18 |title=Clinical applications of therapeutic phlebotomy |journal=Journal of Blood Medicine |language=English |volume=7 |pages=139–144 |doi=10.2147/JBM.S108479 |doi-access=free |pmc=4957680 |pmid=27486346}}</ref> It is practiced by specifically trained practitioners in hospitals using modern techniques and a relatively safe procedure that depletes iron stores in the body. <ref name=":1" /> In most cases, [[phlebotomy]] now refers to the removal of ''small'' quantities of blood for [[blood tests|diagnostic purposes]] and is an important procedure in the U.S.. According to an academic article posted in the ''Journal of Infusion Nursing'' with data published in 2010, the primary use of phlebotomy is to take blood that would be reinfused back into a person ([[blood donation]]).<ref name="Lhfsg">{{Cite journal |last=Cook |first=Lynda S. |year=2010 |title=Therapeutic Phlebotomy |journal=Journal of Infusion Nursing |volume=33 |issue=2 |pages=81–88 |doi=10.1097/nan.0b013e3181d00010 |pmid=20228645}}</ref>  However, in the case of [[hemochromatosis]], bloodletting (by [[venipuncture]]) has become the mainstay treatment option.<ref name="jtx9F">{{cite journal|last1=Merryweather-Clarke|first1=Alison T.|last2=Worwood|first2=Mark|last3=Parkinson|first3=Lisa|last4=Mattock|first4=Chris|last5=Pointon|first5=Jennifer J.|last6=Shearman|first6=Jeremy D.|last7=Robson|first7=Kathryn J. H.|title=The effect of HFE mutations on serum ferritin and transferrin saturation in the Jersey population|journal=British Journal of Haematology|date=May 1998|volume=101|issue=2|pages=369–73|doi=10.1046/j.1365-2141.1998.00736.x|pmid=9609537|s2cid=19683918}}</ref><ref name="oSPil">{{cite journal|last1=Powell|first1=Lawrie W|last2=Seckington|first2=Rebecca C|last3=Deugnier|first3=Yves|title=Haemochromatosis|journal=The Lancet|volume=388|issue=10045|pages=706–16|doi=10.1016/s0140-6736(15)01315-x|pmid=26975792|year=2016|s2cid=208791894}}</ref> Therapeutic phlebotomy is a cost effective way to remove excess iron in blood for patients that have [[hemochromatosis]].<ref name=":1">{{Cite journal |last=Zubair |first=Abba |date=December 9, 2014 |title=Therapeutic Phlebotomy |journal=Clinical Liver Disease |volume=4 |issue=5 |pages=102–106 |doi=10.1002/cld.408 |pmid=30992932 |pmc=6448745 }}</ref>  

==Cross-cultural bloodletting==
Therapeutic uses of bloodletting were reported in 60 distinct cultures/ethnic groups in the [[Human Relations Area Files|HRAF]] database, present in all inhabited continents. Bloodletting has also been reported in 15 of the 60 cultures in the [https://hraf.yale.edu/resources/reference/probability-sample-files-psf/ probability sample files (PSF)] list.<ref name=":0">{{Cite journal |last1=Miton |first1=Helena |last2=Claidière |first2=Nicolas |last3=Mercier |first3=Hugo |date=August 2015 |title=Universal cognitive mechanisms explain the cultural success of bloodletting |url=https://linkinghub.elsevier.com/retrieve/pii/S1090513815000136 |journal=Evolution and Human Behavior |language=en |volume=36 |issue=4 |pages=303–312 |bibcode=2015EHumB..36..303M |doi=10.1016/j.evolhumbehav.2015.01.003|url-access=subscription }}</ref> The PSF is a subset of [[Human Relations Area Files|eHRAF]] data that includes only one culture from each of 60 macro-culture areas around the world.  The prevalence of bloodletting in PSF controls for pseudo-replication linked to common ancestry, suggesting that bloodletting has independently emerged many times. Bloodletting is varied in its practices cross-culturally, for example, in native Alaskan culture bloodletting was practiced for different indications, using different tools, on different body areas, by different people, and it was explained by different medical theories.<ref>{{Cite journal |last=Fortuine |first=R. |date=1985 |title=Lancets of stone: traditional methods of surgery among the Alaska natives |url=https://pubmed.ncbi.nlm.nih.gov/11616622/ |journal=Arctic Anthropology |volume=22 |issue=1 |pages=23–45 |issn=0066-6939 |pmid=11616622}}</ref>

According to Helena Miton et al.'s <ref name=":0" /> analysis of the [[Human Relations Area Files|HRAF]] database and other sources, there are several cross-cultural patterns in bloodletting.

* Bloodletting is not self-administered. Out of 14 cultures in which the bloodletting practitioner was mentioned, the practitioner was always a third party. 13 out of 14 of the cultures had practitioners with roles related to medicine, while one culture had a practitioner whose role was not related to medicine.
* The idea of bloodletting removing "bad blood" that needs to be taken out was common, and was explicitly mentioned in 10 out of 14 cultures studied with detailed descriptions of bloodletting.
* Bloodletting is not thought to be effective against illness caused supernaturally by humans (e.g., witchcraft). This is surprising, because in most cultures witchcraft and sorcery can be blamed for ailments.<ref>{{Cite journal |last1=Murdock |first1=George P. |last2=Wilson |first2=Suzanne F. |last3=Frederick |first3=Violetta |date=October 1978 |title=World Distribution of Theories of Illness |url=http://dx.doi.org/10.2307/3773194 |journal=Ethnology |volume=17 |issue=4 |pages=449 |doi=10.2307/3773194 |issn=0014-1828 |jstor=3773194|url-access=subscription }}</ref> But out of 14 cultures with detailed bloodletting descriptions, there was no evidence of bloodletting being used to cure witchcraft-related ailments, while bloodletting was recorded as a cure for ailments of other origins. The [[Azande people|Azande]] culture has been recorded to believe that bloodletting does not work to cure human-related witchcraft ailments. <ref>{{Citation |last=Schmitt |first=Rüdiger |title=Edward Evan Evans-Pritchard: Witchcraft, Oracles and Magic among the Azande (1937) |date=2019 |work=Schlüsselwerke der Religionssoziologie |pages=167–171 |url=http://dx.doi.org/10.1007/978-3-658-15250-5_20 |access-date=2023-07-17 |place=Wiesbaden |publisher=Springer Fachmedien Wiesbaden |doi=10.1007/978-3-658-15250-5_20 |isbn=978-3-658-15249-9 |s2cid=201473885|url-access=subscription }}</ref>
* Bloodletting is usually administered directly to the affected area, e.g. if the patient has a headache, a cut is made on the forehead. Out of 14 cultures with information on the localization of bloodletting, 11 at least sometimes removed blood from the affected area, while 3 specifically removed blood from a different area from the area in pain. Europe is the only continent with more instances of non-colocalized than colocalized bloodletting.

In a [[transmission chain experiment]] done on people living in the US through [[Amazon Mechanical Turk]], stories about bloodletting in a non-affected area were much more likely to transition into stories about bloodletting being administered near the area in pain than vice versa.<ref name=":0" /> This suggests that colocalized bloodletting could be a [[Cultural attractor theory|cultural attractor]] and is more likely to be culturally transmitted, even among people in the US who are likely more familiar with non-colocalized bloodletting. 

Bloodletting as a concept is thought to be a cultural attractor, or an intrinsically attractive / culturally transmissible concept. This could explain bloodletting's independent cross-cultural emergence and common cross-cultural traits.<ref name=":0" />

==See also==
{{Div col|colwidth=20em}}
* [[Blood donation]]
* [[Bloodstopping]]
* [[Cupping therapy]]
* [[Fleams]]
* [[Hematology]]
* [[History of medicine]]
* [[Humorism]]
* [[Leech]]
* [[Panacea (medicine)|Panacea]]
* [[Phlebotomy]]
* [[Trepanation]]
{{Div col end}}

==References==
{{reflist}}

==Books cited==
* {{cite book
 | last = Carter | first = K. Codell
 |author2=Barbara R. Carter
 | title = Childbed fever. A scientific biography of Ignaz Semmelweis
 | publisher = Transaction Publishers
 | date = 2005
 | isbn = 978-1-4128-0467-7 }}
*  Carter, K. Codell (2012). ''The Decline of Therapeutic Bloodletting and the Collapse of Traditional Medicine''. New Brunswick & London: Transaction Publishers. {{ISBN|978-1-4128-4604-2}}.
* {{cite book
|last= Kang |first=Lydia
|author2=Nate Pederson
| title= Quackery: A Brief History of the Worst Ways to Cure Everything
|publisher = Workman Publishing Company
|date = 2017 }}{{ISBN?}}

==Further reading==
* McGrew, Roderick. ''Encyclopedia of Medical History'' (1985), brief history pp.&nbsp;32–34{{ISBN?}}

==External links==
{{Commons category|Bloodletting}}
* [https://web.archive.org/web/20120902212357/http://www.medtech.edu/blog/the-history-progression-and-modern-stance-on-bloodletting The History and Progression of Bloodletting]
* [http://www.medicalantiques.com/medical/Scarifications_and_Bleeder_Medical_Antiques.htm Medical Antiques: Scarification and Bleeding]
* {{usurped|1=[https://web.archive.org/web/20120502183602/http://www.phisick.com/zphleb.htm Pictures of antique bloodletting instruments]}}
* [https://www.pbs.org/wnet/redgold/basics/bloodletting.html PBS's ''Red Gold: The Story of Blood'']
* [http://www.alllancets.com Huge collection of antique bloodletting instruments]
* {{usurped|1=[https://web.archive.org/web/20150914190515/http://phisick.com/article/breathing-a-vein/ "Breathing a Vein"]}} phisick.com 14 Nov 2011

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{{Use dmy dates|date=January 2021}}

[[Category:Blood]]
[[Category:Bleeding]]
[[Category:Medical tests]]
[[Category:Medical treatments]]
[[Category:Obsolete medical procedures]]
[[Category:Traditional medicine]]
[[Category:Pseudoscience]]
[[Category:Phlebotomy]]
[[Category:Blood in culture]]