Origins of Phlebotomy

Phlebotomy is translated from the Greek work Phlebos, vein, and the word tome, incision into. While many believe the origins of phlebotomy were developed by Hippocrates in the 400’s B.C., some references point as far back as the Stone Age, when veins were punctured by crude tools to allow for bloodletting.The act of bloodletting is one of the oldest medical practices in the world, used for over 2000 years until the evolution of modern medicine. One of the first Greek physicians to use bloodletting frequently was Archagathus, after which it became quite popular. Bloodletting was practiced in ancient Greece and Egypt, continued down through the Renaissance period, when bloodletting calendars were available to remind people to frequently ‘breathe a vein’. Used in both Indian and Arabic medicine, the practice of bloodletting continued until after the second Industrial Revolution.

The body was believed to contain four humors, or fluids: black bile, yellow bile, phlegm and blood. The four humors, responsible for a persons’ health, were modeled after the four classic Greek elements – earth, air, fire, and water. If one or more of the ‘humors’ became imbalanced, that person would become ill or diseased. The treatment was to purge the body of these humor imbalances by bloodletting, vomiting and purging. Additionally, if there was too much blood in the patient’s body, called plethoras or an overabundance, the treatment prescribed included bloodletting, sweating, vomiting and dieting. Hippocrates also believed that women had menstruation to automatically ‘purge’ them of harmful humors. A student of his, Galen, further examined the four humors and determined of the four, blood was the most dominant and in need of control. In addition to purging by bloodletting and vomiting, Galen recommended diarrhetics to induce urination.

Bloodletting or ‘breathing a vein,’ was believed to cure stroke, infections, inflammation and even mental disorders such as psychosis. Patients were bled for fevers, arthritis and depression. There is even evidence that bloodletting was used to cure broken bones. Physicians advised people of the best astrological charts for which to ‘let blood.’ Strict and complex laws were written by the Talmudic authors for the practice of bloodletting. Monks performed bloodletting every few months to maintain their good health. Draining the body of blood could frequently lead to syncope, a patient fainting. This was considered a good sign, that the bloodletting was successful, and typically signaled the end of the bloodletting session.

Bloodletting was a cure-all, heavily advertised and recommended for a myriad of symptoms. Perhaps the most positive benefit of bloodletting was never advertised – its ability to offer patients hope. As a panacea, bleeding the patient was something that could be done by a physician, rather than leave the patient in hopeless despair. In an age when medicine offered little hope or understanding of serious disease and illness, bloodletting allowed the patient to focus on returning to health. For some, bloodletting was inadvertently able to help their symptoms. Very little was understood about the human body at that time. For a patient with frequent headaches and dizziness, bloodletting most like would have been ordered. While actually suffering from high blood pressure, the bloodletting may have actually cured the symptoms by creating anemia, which can lower pressure. For most, however, bloodletting either did not help or was harmful. For those debilitated and ill, regular bloodletting further weakening them, resulting in death.George Washington was repeatedly exposed to cold weather, giving him a rather serious throat infection. He then requested bloodletting. Unfortunately, an astounding four pounds of blood, totaling 1.7 liters, was bled from his body. He died of the throat infection in 1799.

There were several techniques for bloodletting. The first was for the Phlebotomist to simply open a vein using a knife called a lancet, a small steel blade with an ivory or ebony handle. Nicking a vein diagonally or lengthwise in the arm, leg or even neck of the patient, blood was then drained and collected. A perpendicular cut into the vein was not chosen so the vein could not accidentally be severed. Thumb lancets were also developed, designed to be attractive as well as functional. Many were made using tortoise shell, pearl or ivory. Thumb lancet cases were made in mother of pearl, tortoise shell and even gold engraved cases, for the physician of stature who performed house calls.

Another technique was called the fleam. Containing one or more blades that are placed at right angles to the handle, fleams were used on humans, as well as the jugular vein of animals such as horses. The phlebotomist had their choice of two or three steel blades of various sizes to perform the bloodletting. As with lancets, fleams were decorative and frequently had the family crest engraved on them. The scarificator was used as a bloodletting device in the 17th century. Containing many blades, these bleeders were usually octagon shaped with steel blades. On top of the case, an adjuster allowed the Phlebotomist to change the blade depth. Blades were cocked using a lever, released by a switch on the side of the case. As time progressed, many small design changes were made to the scarificator such as size, v-shaped blades and rounded shape. The mechanisms allowed the blades to swing around, and make multiple cuts at the same time.

Perhaps one of the most well known tools that Phlebotomists used to bleed patients was leeches. During bloodletting, one or several leeches, depending on the need, were placed on the patient’s body. The leech, sensing blood, attach to the patient with three teeth. Once the leech has attached, an anticoagulant contained in its blood is injected into the site much as a mosquito does. This blood thinner prevents coagulation, clotting, and allows the leech to continue draining blood. Otherwise, the body would begin to coagulate, slowing the rate of bleeding until it stopped. There are several types of leech that were used for bleeding. Te Macrobetta decora was used in the United States, while a favored European type was Hirudinea Annelida, which could drain several times the amount of an American leech.

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