Thursday, August 28, 2008

Question from Christy - Effectiveness of bleeding patients

I am wondering if bleeding people, a common 16th century cure for almost anything, was an effective procedure for helping treat patients. It seems like this would not help a person, only make them more suspectible to infection. However, because it was practiced so widely, I am wondering if physicans during this time era saw positive results to bleeding their patients.


Kathy said...

The only disease I know of that bloodletting is used for today is hemochromatosis (too much iron in the blood). I suppose if that were the problem, the patient would improve. Otherwise, it's hard to think of anything positive about bloodletting.

Lara said...

You beat me to it Kathy! We have hemochromatosis in my family and I currently have one relative that we jokingly say has to 'go to the leech to be bled'. :)

Yeah, other than that, I can't think of many conditions that would benefit from bloodletting. I'm not even sure how much blood was typically lost during that procedure, which would also play a part in the outcome.

Foose said...

I've read that it might have been effective for people with hypertension. The book I read this in was referring to the 18th century in England, when the upper classes indulged in large meals and lots of drinking, but the same effect might have pertained in Tudor England.

I would think that anyone already in a weakened condition, or with loss of blood, would be finished off by bleeding. But there are historical accounts where people in these conditions are bled and do survive and contemporaries solemnly attribute the miraculous recovery to the efficacy of bloodletting. The most famous case I can think of is Marie Antoinette's first childbirth; she was in a very weakened state from prolonged labor, suffering from loss of blood, and probably suffocating from all the people packed into the room; bleeding was administered and the Queen immediately came around from her swoon. (I would think that her husband breaking open the windows might have helped more ...)

Mary Queen of Scots was frequently bled, to help with her mysterious bouts of illness; it doesn't seem to have helped. I have read that some fashionable Elizabethan ladies had themselves bled to achieve an elegant pallor, but I don't know if this is true.

Bearded Lady said...

Bloodletting did work to some degree. Remember that old wives tale - feed a cold, starve a fever. Well, there is some truth to it.

When a person is sick with an infection, such as pneumonia, Staphylococcus aurerus (Staph) starts looking for lunch inside your body. Staph feeds on a specific type of iron found in blood called Heme iron. If it cannot find Heme iron, it starves. When doctors bled patients with illnesses such as pneumonia, they temporarily starved the Staph bacteria. If bloodletting was done at the onset of sickness then it could help a patient recover quicker. And the patients actually felt better (at first) after bloodletting because it lowered the body’s temperature.

Now I am not recommending anyone start slicing veins or wading out into leech infested waters (despite its new popularity with Hollywood). Bloodletting also weakened the patient to the point of fainting and if too much blood was taken it could even kill you.

Obviously, doctors at the time did not know bacteria existed. They only saw that sometimes bloodletting worked. And when faced with the other option of doing nothing, bloodlettings seemed like a perfectly logical treatment.

Also, keep in mind the accepted belief of the four humours. To 16th century doctors, patients simply had too much blood and getting rid of some seemed the only way to balance the humours.

PhD Historian said...

On the whole, bleeding was counter-productive and certainly contributed to the high mortality rate and short life expectancy during the period when it was used. If only from a purely physiological standpoint, bleeding reduced the total number of red blood cells, which in turn reduced the blood's ability to distribute oxygen to the various regions of the body. Adequate oxygenation is absolutely vital to combating disease and infection and to the healing of tissues. Indeed, some disease-causing organisms, called anaerobes, actually thrive when oxygen levels are reduced, so that bleeding could worsen conditions caused by anaerobic bacteria. Bleeding resulted in reduced blood volume, which in turn resulted in reduced oxygen carrying capacity, which led to reduced ability to heal (and sometime to increased spread of infection).

"Positive results" were not really a consideration in assessing the usefulness of treatments during the Tudor era, as difficult as that may be to imagine. It was a pre-scientific era, and the kind of deductive scientific reasoning used today in evaluating after-the-fact whether or not a treatment was beneficial or harmful was not yet commonly in use among physicians and surgeons. Instead, they relied entirely and literally on the "wisdom of the ancients." Since the days of ancient Greece and Rome, bleeding had been considered the definitive treatment for an excess of bodily heat, which corresponded with the bodily "humour" of blood (as well as with yellow bile). For any condition in which an excess of heat was considered to be the culprit ... and there were many ... balance between hot/cold and wet/dry must be restored by removing the excess of heat. The patient must be bled, period. If the patient died, it was because the bleeding had not been done quickly enough, or the volume bled was not large enough, or was too much, or from the wrong region of the body (arm vs leg) or something similar. Failure of treatment and death of the patient was usually attributed to how the treatment was employed, not to the treatment itself. Bleeding as a treatment was not critically evaluated until the 18th century.

Bleeding is used today in the treatment of several diseases, in addition to hemachromatosis. It is today called by the less gruesome name phlebotomy and is used to treat polycythemia vera (an excess number of red blood cells, resulting in thickened blood), porphyria cuntanea tarda (similar to hemachromatosis), and intractable acute pulmonary edema (swelling within the lungs that fails to respond rapidly enough to other treatments).