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Bleeding healthy

For thousands of years, and in many different cultures, people have practised bloodletting for health and medical reasons. Julia Nurse explains where and when bleeding was used, how it was done, and why.

Words by Julia Nurse

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A photograph of an 18th century oil painting in a rusted gold metal frame displayed on a marble grey background. 

A woman patient, looking very pale, sits on a chair, left. Behind her, a doctor, wearing a wig, leans over her to take the pulse of her left hand with his left hand. Her left foot is placed in a tub of water and a young surgeon, kneeling on the right, lets blood from her left foot while holding a tourniquet around her ankle. The woman is obviously wealthy from her surroundings. She sits on an elaborately embroidered chair, a luxurious carpet covers the floor and silken drapes hang over her bed

Bleeding was thought to treat a myriad of conditions, including asthma, cancer, gout, convulsions, indigestion, smallpox, consumption, insanity, jaundice, the plague and even heavy menstruation, nosebleeds and heartbreak. It was used in lots of places around the world through history.

Historians believe that bloodletting was first practised in ancient Egypt. The ‘Book of Knowledge and Ingenious Mechanical Devices’ by Al-Jazari (1136–1206) described a device believed to have been used by the ancient Egyptians to bleed patients: it featured two scribes sitting on top to measure the patient’s blood, which flowed into a basin below.

In ancient Greece, physicians like Hippocrates and Erasistratus believed blood formed one of the four humours (blood, phlegm, yellow bile and black bile), which had to be balanced for good health, sometimes by letting blood.

The practice of letting blood continued in Europe in the Middle Ages, following ancient Greek theories and guides. It formed the backbone of Western medicine for centuries, despite its sometimes fatal results.

Coloured medieval drawing showing a person dressed in red pulling their sleeve aside and looking away as a person dressed in black cuts their arm with a scalpel and blood drips down. To the right, someone wearing green stands with a bowl and cloth.

Bloodletting was also used in many other places too, including by the Chippewa in North America, the Mayans in Mesoamerica, in Uganda, from the eighth century in Tibet, in traditional Chinese medicine practices, as part of a long history of being used in Ayurvedic medicine in India, and was even performed on animals in veterinary medicine.

Why did people think that letting blood would make them healthier?

Bloodletting went hand in hand with purging, starving and vomiting techniques to rid the body of nasties and maintain a healthy equilibrium. ‘Bleeding’ a patient was modelled on the process of menstruation, based on Hippocrates’ belief that it functioned to “purge women of bad humours”. Since many bodily complaints were thought to be caused by imbalances, bleeding was used a lot as a treatment.

Bloodletting was popular among patients of all social standing. People believed poor circulation was caused by stagnated blood, which needed to be removed to restore flow, and that some people had too much blood, which also needed removing.

When would people be bled?

In one so-called “leech book” (a physician’s manual) from the 15th century, instructions for good health include bloodletting alongside a healthy balanced diet and urine-colour diagnosis. According to this guide, bloodletting could be done any time of the year, though here we see a warning that it is perilous to bleed on the 21st day – this would have been for astrological reasons, which were used as guides for many health-related things at this time.

Such guidelines continued to be adhered to in the early modern period, by which time bloodletting was commonly practised in the home, usually before and after the cold months, which was thought to help avoid the accumulation of corrupt and waste matter.

Who bled people?

Monks, who were traditional practitioners of medicine, were forbidden from letting blood. This meant that bloodletting had to be done by other people.

Where on the body were people bled?

Where to bleed depended on where someone was hurt or diseased. Guides on bloodletting points in the body were printed in medieval medical manuals such as Hans von Gersdorff's Feldtbuch der Wundartzney (1517), which was aimed at military field surgeons.

Most early modern bloodletters followed the Persian polymath Ibn Sina’s 11th-century ‘Canon of Medicine’, which stated that the bloodletting was to be administered from the side of the body opposite to the disease’s location. Jacobus Sylvius believed in this opposite-side or “revulsive” bleeding. But others argued otherwise: Pierre Brissot (1478–1522) challenged centuries of tradition by making a case for “derivative” bloodletting, to be done on the same side as the illness. A fierce battle between “revulsive” bleeders and “derivative” bleeders ensued and can be seen in medical texts from the time. Gersdorff's guide offers a compromise by illustrating both.

Black-and-white woodcut on a slightly yellowed page showing a naked male body, covered with lines labelled with letters and pointing to different body parts where someone could be bled. The body is cut open on the trunk to reveal some of the major organs.

This woodcut shows the appropriate places to draw blood. It is from Hans von Gersdorff’s ‘Feldtbuch der Wundartzney’, a portable manual for military field surgeons, first published in Strasbourg in 1517. The Bloodletting Man illustration was drawn from observations of a dissection performed in Strasbourg on the body of a hanged criminal.

Bloodletting was even performed from the head. This may have been to alleviate ailments that were associated with the head, notably seizures, which were often described as “falling sickness”, but now believed to be epilepsy.

What tools did people use for bloodletting?

Phlebotomy is used today to describe the ubiquitous blood test. The name is derived from the original ancient Greek phlebos for blood vessel and tome, meaning to cut. Various tools have been used to cut and bleed patients across cultures.

The dangers of bloodletting

Not surprisingly, sometimes there were fatal results from bloodletting. It required careful attention and the dangers of inattentive physicians were shown in illustrations.

The decline of bloodletting

Other systems began to rival bloodletting. Brunonianism, the theory of John Brown (1735–88), regarded most illnesses as due to a deficit of stimulation, requiring treatment with medicines based on opium or alcohol. François Joseph Victor Broussais (1772–1838) believed in bloodletting and tried to ridicule Brown and his followers.

Pen-and-ink drawing showing people wearing 18th-century clothes in a battle between the rival partisans of Brown (on the left, believed in using opium and alcohol to treat patients and therefore surrounded by bottles) and Broussais (on the right, believed in bleeding patients and purging so are carrying enema canisters): they are identified by military standards (flags) inscribed “Brown” (left) and “Broussai”. Various foul play is happening, including a forced enema in the centre, and someone being grabbed around the head by some forceps, centre left.

This drawing, probably by a French or German artist, shows a battle between the rivals of Brown (on the left) and Broussais (on the right).

By the 19th century, bleeding was considered dangerous and no longer deemed ‘heroic’ cure-all medicine. Some patients, who had grown to expect it, may even have been disappointed.

Black-and-white print showing a sad-looking man seated in an armchair wearing a housecoat with his hands clasped in his lap. To the left, a smartly dressed doctor leans over him, smiling. The lettering at the bottom has the doctor saying “No sir, it is nearly obsolete in practice. We don’t bleed now as they used to do formerly. The “atrabilious” patient replies “Ah!? Not with the lancet, you mean!”

Drawing blood today

Although inherently dangerous, traditional bloodletting might not have been as totally unhelpful as it might sound. Researchers found that letting blood may have been an effective mechanism for starving bacterial pathogens of iron and slowing bacterial growth, which would have been one of the only ways to achieve this in the pre-antibiotic era.

In the 21st century, we mostly only take blood in the form of phlebotomy, the ubiquitous diagnostic blood test, or from donors to enable blood transfusions. Leeches are still used to treat some nervous-system abnormalities, dental problems, skin diseases and infections. Leeches are also used in surgery because they secrete peptides and proteins that help prevent blood clots. So you may find that even today you could be “bleeding healthy”.

About the author

Black and white photograph of Julia Nurse, a white woman with brown hair, smiling. She wears an animal-print dress and the corners of paintings are visible in the background.

Julia Nurse

(she/her)

Julia is a collections research specialist at Wellcome Collection with a background in Art History and Museum Studies. She currently runs the Exploring Research programme, and has a particular interest in the medieval and early modern periods, especially the interaction of medicine, science and art within print culture.