Editing Bloodletting (section)

==Use in the 1600's 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>