| 
  • If you are citizen of an European Union member nation, you may not use this service unless you are at least 16 years old.

  • You already know Dokkio is an AI-powered assistant to organize & manage your digital files & messages. Very soon, Dokkio will support Outlook as well as One Drive. Check it out today!

View
 

Bloodletting

Page history last edited by A.E.Stevens@warwick.ac.uk 6 years, 2 months ago

 

BLOODLETTING

 

 

 Figure 1: Entry for bloodletting in Samuel Johnson’s Dictionary (1785)

 

 

OED: The action or process of extracting blood (from a person, animal, vein, or part of the body) for (supposed) therapeutic purposes;

 

 

HISTORY  
 
For well over 3000 years, bloodletting was steadfast in its popularity for the treatment of almost any ailment imaginable. First seen as early as with the ancient Egyptians, bloodletting was a popular treatment within the medical field well into the eighteenth century, and slightly beyond. However, since the nineteenth century it has come to be considered a pseudoscience and often may have been the thing which led people to the grave, and not away. And yet, however, we are seeing an increase in its relevance today with a select few ailments still being resolved with cupping etc. and a huge influx in the number of modern celebrities taking up cupping, and yet in the eighteenth century it was very much the answer to every medical issue imaginable.  
The practice of letting blood stems from the Hippocratic Theory; the concept that illness was based upon the excess of one of the four humours, their being, yellow bile, blood, phlegm and black bile. Treating an illness required that the offending humour be removed, hence the idea of bloodletting with people believing that the balancing of these fluids within the body would lead to the relief of the offending disease or other medical afflictions. This was seen most within the treatment of both the fever and Syphilis although was in no way limited to such illnesses, being relied upon to alleviate anything from the common cold, to cancer and even to hysteria. Those who devoutly believed in utilising bloodletting as a form of treatment very much saw the concept as being interlinked with the idea of natural forms of purging, such as in Menstruation, with the idea that women's bodies naturally purged themselves of excess blood, therefore it was only logical to emulate this process within medicine making bloodletting a positive and natural thing.  
 
Figure 2: A surgeon bleeding the arm of a young woman: she is being comforted by another woman. Coloured etching by T. Rowlandson (?), 1784.  
 
METHODS
 
In order to let the blood and allow for the purging and rebalancing of the four humours, a range of different methods were used depending on the issues involved, but mainly split into two different techniques, differentiating between a general cleanse of the blood, which fell under the bracket of phlebotomy, and targeting of specific places which involved scarification through the use of leeches and cupping.  
 
FLEAMS AND LANCETS
 
  In the practice of phlebotomy, tools such as lancets (Figure 3) and fleams (Figure 4) were used and involved an incision into a main artery or vein, often in the elbow, and the blood being drained until a satisfactory amount of blood was let. The amount of blood let was very much dependent on the ailment and the persons health etc. however often, the first letting would be to a level that the patient became faint and would pass out. Following that, the amount of blood extracted on each occasion was usually enough to fill a pint basin (Figure 5 and 6) often the equivalent to 20 ounces. Occasionally, this was increased to 35 ounces in the case of more violent examples as with hypertension and epidemic fevers.  
    
  
 Figure 3: Lancet owned by Edward Jenner, England, 1701-1718                           Figure 4: Three spring fleam/lancets, cased, possibly Germany,  1720-1800                             
  

Figure 5: Bleeding bowl, England, 1671-1730                                                               Figure 6: Pewter bleeding bowl, Europe, 1701-1900.   

 

 

 In the examples of the bleeding bowls alone, we are afforded a sense of how widespread and classless the method of bloodletting was. In the juxtaposition of the ornamental bleeding bowl as opposed to the pewter one, we can see how both the lower and upper classes relied on bleeding as a form of medical treatment. In the eighteenth century, the majority of personal possessions were marked by class and wealth in both functionality but also, in decorativeness and bloodletting and it's apparatus were not exempt from this. The concept and practice was so wide spread, the upper classes had to separate their experience from peasants simply through aesthetics. This is reaffirmed in the example of the lancet in Figure 3, with the expensive and seemingly exotic tortoiseshell handle, in an entirely materialistic effort to prove wealth through an object in no way designed to decorate. This reinforces the idea of eighteenth century society and its growing materialism, with the creation of new capitalist ideals, people were beginning to really invest in material and foreign objects in a display of wealth but also of imperialism. The lancet is an entirely practical and surgical item, and so this almost perpetrates this commodified ideal more than something which was designed to be aesthetically beautiful, everyday objects were being transformed into displays of grandeur for no other purpose than to prove they could.

 

CUPPING AND LEECHES  

 

Conversely, in the practice of scarification, the blood was let in a less invasive way and involved the scratching of the skin in order to raise the blood to the surface as with cupping and leeching. Cupping took place in both wet and dry forms, though dry was far more popular and wide spread, simply from ease, as the wet technique took an increased level of skill and was far less available. For wet cupping, the skin and cups were warmed in water before a lighted torch was held against the gap between cup and skin, with the heat causing a vacuum and the skin filling part of the cup. After around a minute, the cup was released, and the scarificator used to pierce the now raised and blood-filled area, the cups having been reapplied in order to catch the streaming blood. The dry cupping technique was far simpler as a blister was created purely from the application of the cup against skin alone, with the scarificator then used on this blister in order to draw blood and rebalance and treat the body. Though there was a sharp decline in the popularity of this treatment, it continued to be crucial in the treatment of pneumonia and other rheumatic conditions. (Turk and Allen 130-131)

 

Leeches were also used in this localised manner, and were an incredibly popular way of letting blood during the eighteenth century, as shown by accounts such as that of Hannah Springthorpe who was treated for a headache alongside what seems to be rabies, with leeches to the temple, (Figure 7.) The use of leeches for something as trivial as a headache shows just how central bloodletting and more specifically, leeches were in the eighteenth century.  

 

Figure 7: The medical case of Hannah Springthorpe and her treatment for “Hydrophobia”.  

 

Again, in Figure 8, we see the gentrification of such a medical practice, with a leech jar being highly ornamental with leeches playing an important enough role in order to have specially designed and designated earthenware. Leeches were too a very much favoured technique, as they did not require the presence of a surgeon, unlike with phlebotomy and could very much be undertaken and performed by everyone at home.

 

 However, due to their reputation for being safer and less invasive, leeches were often used for head injuries, which does indeed seem incredibly counterproductive, with excessive bleeding of the head being detrimental to a patients health. 

In an Old Bailey Proceeding where a man was found guilty of murdering his son, not hours before his death, leeches were recommended to stem the head injury. 

 

     I was at his house within a quarter of an hour of the child's death, we had all the assistance that could be got from a Doctor; there came a

     Doctor, and we got leeches, and set to the child's temples but all to no purpose.

     Who did you see there? - Nobody but his wife, the Doctor had been there about a quarter of an hour before, and had ordered leeches to be 

     set to his forehead; his wife went and fetched them, and she and I put them to; and it was by her husband's desire we went for assistance.

Old Bailey Proceedings in the trail against William Higson for murder.

 https://www.oldbaileyonline.org/browse.jsp?id=t17850406-1&div=t17850406-1&terms=leeches#highlight  

 

This reiterates the significance of leeches in medical proceedings as their use on such a serious head injury at a crucial time and last treatment of a dying boy, shows that eighteenth century society truly depended upon the technique, and believed it to be effective. And yet it also calls into question the dangers of bloodletting, as it was the last procedure to be enacted upon the patient, and he did die within a day. The injury was also an historical one, and did seem to be more controlled before the leeching took place, further pointing to the futility of the treatment, and how it was very much a gamble rather than a foolproof method. 

 

 

   

Figure 8: Green earthenware leech jar                                   Figure 9: Scarificator 1769.  with gilt decoration, grid top 18th to 19th Century.  

 

PRACTITIONERS

 

 For the most part, the majority of bloodletting was performed by barber surgeons, who were well versed in many different procedures, and were seen as a one stop shop for resolving medical issues. Unlike today, surgeons were very much looked down upon, as opposed to their medicinal counterparts, and were viewed in a rudimentary and skill-less way. The practice of bloodletting was so common that low level surgeons and even their apprentices were trusted to perform the surgery. (Lane, Joan. Pg. 20.) furthering this idea that it was an incredibly common and trusted procedure, with very little required in the way of qualifications to perform the act itself.

 

We see this play out in John O’Keeffe’s play The Prisoner at Large - “He was a farrier---call'd himself a surgeon, tho' he was a  farrier; for the fellow out with a fleam, up with my leg, and swore he'd bleed me” (O’Keeffe 11) perpetrating the fear of the time of “quacks” a colloquial term for fraudulent practitioners. Due to the fact that there was little to no regulation of medicines and those administering them, it was very easy for a person to pose as a surgeon and perform bloodlettings for financial gain, often doing little to help, and causing more damage than good or simply not alleviating them. The farrier – a smith who shoes horses, clearly has not had the training required to administer such a procedure, and yet he is able to convince otherwise.    

 

Figure 10: A pamphlet detailing the dangers of quacks  

 

William Jackson takes a strong stance against the existence of quacks and argues for the people to become more aware of their practitioners and the malice of those fraudulent surgeons. This very much reinforces the idea of bloodletting as an entirely commonplace occurrence, so much that eighteenth century society believed it acceptable to have the procedure enacted by inexperienced people. Again this draws class into question, as quacks naturally would cost far less than a legitimate surgeon would, and therefore it was the lower classes who were susceptible to this fraudulent healthcare, and not the upper classes who would afford better treatment. 

 

IN LITERATURE  

 

Bloodletting was often mentioned and alluded to within literature during the eighteenth century, often on the peripherals of the narrative, solidifying the idea that it was simply an everyday fact of life, which was always present but not focused on all that much because of its banality. 

 

In John Murdocks’ play The Politicians, (1798) not only are we given an example in which bloodletting was the agreed treatment for hysteria, but also seems to be alluding to the ways in which bloodletting was beginning to be questioned and challenged. The analogy of having to ‘let’ a country and administer relief to its seemingly deranged state could allude to the fact that the play was written at the end of the eighteenth century and could be evidence of the newly changing ideas towards bloodletting and its relevance, “[Hasty] Mr. Conciliate's opinion is, that France is deranged, and that we must permit her to act as she thinks fit, that it would be a still greater act of madness in us, to administer that relief, which is commonly given to people in a state of insanity, such as bloodletting, &c.” Even if France is indeed seemingly acting in a deranged manner, the opinion that this behaviour should be left in the perpetrators hands and played out, instead of being let, furthers this cynical sentiment as to the necessity of bloodletting. As well as this, the simple satirical voice in which France is mocked as an hysterical woman treats the entire issue and situation as unimportant and excessive. 

 

In another example of the absurdities of bloodletting, Tobias George Smollett’s The Adventures of Peregrine Pickle (1751) follows a physical fight where a character in the novel has been knocked out, and is let there and then. “Among these was a blacksmith and farrier, who took cognizance of his carcase, every limb of which having examined, he declared there was no bone broke, and taking out his fleam, blooded him plentifully as he lay.” (Smollett 135). The idea of releasing blood from an already weak and injured person points to the sheer illogical nature of letting, and again reinforces the idea of quackery with another farrier taking the place of a surgeon, using his own personal fleam, and letting a young boy's blood on the side of the road, performed upon by someone who we can safely assume is not an expert in the procedure nor in surgeries more widely.  

 

And yet we also see how people truly believed bloodletting to be effective and of huge relief, in Daniel Defoes’ The Life and Adventures of Robinson Crusoe (1719), an analogy of a man upon death row being allowed a reprieve, is described in relation to the relief felt after a letting of blood, coupled with the idea that bloodletting was effective in the stabilising of one’s temperament. The image of “Animal Spirits” being released through the purging of blood evokes an idea that the procedure in some way ensured a human and sedated temperament. One not affected by a passionate loss of control, but calm and collected, a sense that bloodletting rebalanced and reinstated an emotional equilibrium.    

 

  Figure 11: Robinson Crusoe pg 52-53.  

 

Samuel Jackson Pratt devotes an entire poem to leeches, and does so in a highly erotic manner. In The Two Leeches to Mrs. Clutterbuck, (1785) a woman suffering from cholera is described as having "not one drop of promis'd comfort" (13) until two leeches are applied to her face and become "Cholra's cure" (34). The descriptions are heavy with sexualised imagery, with their lips being described as luxuriously steeping (21) her blood as they creep into the "confines of her bosom" (22). This then prompts an entirely different view of leeching as opposed to every other method as there is very little sexualisation to be found with regards to the other techniques, where as the living leeches feeding from the female body evokes an erotic image. "Lovesick and blind at last they yield their breath / Drank deep, look'd long, and tasted certain death;" (31-32) the personification of the leech instead reads as though a the poem is watching two lovers consume each other, with a sense of the forbidden and the alien. This is made even more explicit in the image of the "presumptuous grown" (27) leeches having decidedly phallic and erectile imagery.

 

However, on the most part, bloodletting is mentioned in passing, in Laurence Sterne’s The Life and Opinions of Tristram Shandy (1759), bloodletting is listed within a number of instances that are a daily occurrence for human beings, further reiterating the prominence of the procedure in eighteenth century society. “May he be cursed in eating and drinking, in being hungry, in being thirsty, in fasting, in sleeping, in slumbering, in walking, in standing, in sitting, in lying, in working, in resting, in pissing, in shitting, and in bloodletting” (Sterne 116). The entirety of this list is compiled with essential acts therefore equating bloodletting with sleeping and eating, placing the concept into a place of centrality within the lives of those in the eighteenth century.              

 

------------------------------------------------------------------------------------------------------------------------------------------------

 

 Bibliography:

 

"bloodletting, n." OED Online. Oxford University Press, January 2018. Web. 03 March 2018.

- a good place to start in order to fully understand the term, and to look for other possible terms

 

Defoe, Daniel. The Life and Strange Surprising Adventures of Robinson Crusoe. For W. Taylor, 1719.

- having an eighteenth century classic novel mention blood-letting was crucial to showing how important the method was

 

Jackson, William. Cautions and advice to the public, respecting some abuses in medicine, through the malpractices of quacks or pretenders to the medical and chirurgical arts. 1787.

- exemplified the cautious and disapproving tone taken by those against and fighting quacks

 

Johnson, Samuel. A Dictionary of the English Language. London: J. F And C. Rivington, 1785. Open Library.

- a good place to start for comparing what we understand by the term, and what those of the time believed it to be - its accepted definition 

 

 Lane, Joan. “Provincial Medical Apprentices and Masters in Early Modern England.” Eighteenth Century Life 12.3. 1988.

---. Eighteenth-Century Medical Practice: A Case Study of Bradford Wilmer, Surgeon of Coventry 1737-1813. The Society for Social History of Medicine, 1990. 

- evidence to support the claim that inexperienced and uneducated people were performing the surgeries

 

Lettsom, John Coakley. History of the Origin of Medicine. J. Phillips, 1778.     

- generally useful with understand the procedures of the time and the contexts surrounding 

 

Murdock, John. The Politicians. 1798. O'Keeffe, John. 

-useful in linking hysteria with letting blood

 

The Prisoner at Large: A Comedy in Two Acts. GGJ and J. Robinson, 1788

-evidence of quackery in literature, and its penetration into daily lives

 

Old Bailey Proceedings Online (www.oldbaileyonline.org, version 8.0, 20 March 2018), April 1785, trial of WILLIAM HIGSON (t17850406-1).   

- an incredibly interesting and real life account of the negative impacts blood letting could have had, not to say that the young boy died simply from having blood let, but the timing etc. further my argument against the dangers 

 

Pratt, Samuel Johnson. The Two Leeches to Mrs. Clutterbuck, 1785. 

- a unique take on letting blood and afford a new viewpoint on the erotic notions of the procedure

 

Smith, Hugh. Essays Physiological and Practical, on the Nature and Circulation of the Blood: And the Effects and Uses of Blood-letting. W. Johnston, 1761.

- Knowledge on the histories and relevance of blood-letting

 

Sterne, Laurence. The Life and Opinions of Tristram Shandy, Gentleman. Kindle Edition, 2012.

- Evidence of the everyday relevance of the blood-letting and its inclusion in popular literature furthers its centrality 

 

Thomas, Arnold. A Case of Hydrophobia, commonly called canine madness from the bite of a mad dog, successfully treated. T. Chapman for C. Dilly, 1793.   

- A real-life medical account of someone being regularly let in the treatment of a range of suspected issues      

 

Turk, J. L., and Elizabeth Allen. "Bleeding and cupping." Annals of the Royal College of Surgeons of England 65.2 (1983): 128

- Further factual evidence for the actual procedures

 

Images:  

'Bleeding bowl, England, 1671-1730' by Science Museum, London. Credit: Science Museum, LondonCC BY 

'Lancet owned by Edward Jenner, England, 1720-1800' by Science Museum, London. Credit: Science Museum, LondonCC BY

'Leech jar, 18th-19th century.' . Credit: Wellcome CollectionCC BY

'Pewter bleeding bowl, Europe, 1701-1900' by Science Museum, London. Credit: Science Museum, LondonCC BY

Scarificator, circa 1769.' . Credit: Wellcome CollectionCC BY 

'Surgeon bleeding the arm of a young woman: she is being comforted by another woman. Coloured etching by T. Rowlandson (?), 1784.' by Thomas Rowlandson. Credit: Wellcome CollectionCC BY

 'Three spring fleam/lancets, cased, possibly Germany, 1701-18' by Science Museum, London. Credit: Science Museum, LondonCC BY    

 

 

Comments (0)

You don't have permission to comment on this page.