Bloodletting: A Historical Medical Practice

The Death of George Washington

• December 14, 1799: George Washington died from a suspected infected epiglottis.
• He was prescribed treatments common at the time: enema, steam therapy, and bloodletting.
• Bloodletting involved four sessions where Washington lost about 2 liters (~40% of his blood).

Historical Context of Bloodletting

• Originated in ancient Greece with physicians like Hippocrates.
• Belief in the four humors: yellow bile, black bile, phlegm, and blood needed balance for good health.
• Treatments included purging, peeing, enemas, and bloodletting.

Methods of Bloodletting

• Variably performed with sharp tools, leeches, or wet cupping.
• Prolific physician Galen in the 2nd century favored bloodletting for most ailments.
• Remained popular in medieval Islamic and European medical practices.

Notable Historical Bloodletting Practices

• King Richard the Lionheart delayed negotiations for bloodletting treatment.
• King Charles II underwent extensive bloodletting and other extreme treatments for convulsions.
• Poet Lord Byron criticized his physicians as "butchers" due to excessive bloodletting.

Risks and Perceptions

• Placebo effect might have led to perceived benefits.
• Some studies today suggest moderate bloodletting may have cardiovascular benefits.
• Excessive or poorly executed bloodletting caused infections, notably with the spring lancet in the 1700s.

The Decline of Bloodletting

• By the late 1700s, physicians like Benjamin Rush advocated for large-scale bloodletting.
• Debate and data scrutiny began questioning the practice’s efficacy.
• Use declined in the 20th century with the rise of germ theory replacing humoral theory.

Modern Use

• Currently, bloodletting treats specific conditions like hemochromatosis, allowing for controlled iron levels.
• Bloodletting's historical medical practice is considered outdated and largely misapplied.