In the early nineteenth century adults with good health from the country districts of England were bled as regularly as they went to market;3 this was considered to be preventive medicine. In earlier times specific veins were described as heart veins, breast veins, and head veins. Buchan's4 DOMESTIC MEDICINE discussed this in the 1784 edition. Buchan realized that since systemic blood made a full circuit, little significance should be placed on the site chosen for venesection. The median basilic vein was the site most frequently used.
The term antiphlogistic means to counteract inflammation. Redness, heat, and swelling were considered the abnormal responses to be treated. With infection, the formation of laudable pus was thought to be an essential part of healing. It was not appreciated that these responses represented an attempt by the body to counteract bacterial infection; this discovery came later. Our current efforts to treat cancer without understanding the underlying etiologic factors will someday no doubt appear just as illogical. Bloodletting counteracted the redness, heat, and swelling by relieving the vascular congestion. The following quotation comes from Watson and Condie's5 PRACTICE OF PHYSIC in 1858.
The main object of general blood letting is to diminish the whole quantity of blood in the system, and thus to lessen the force of the heart's action. The object of local bleeding is, in most instances, that of emptying the gorged and loaded capillaries of the inflammed part. Sometimes the blood is thus taken directly from the turgid vessels themselves; more often, I fancy, topical bloodletting produces its effect by diverting the flow of blood from the affected part, and giving it a new direction, and so indirectly relieving the inflammatory congestion.
Watson goes on to state, "I cannot too strongly
inculcate the precept that in order to extinguish or check
acute inflammation, you must above all bleed early." An
indication for bleeding in acute inflammation was a hard
pulse of 90 to 120 beats per minute, which was measured by
the resistance that the pulse of the artery made to the
pressure of the examiner's fingers. Rapid bleeding by
venesection with the patient standing was advised. It was
surmised that the early onset of faintness and softness of
pulse was beneficial. Slow bleeding with the patient supine
led to more blood loss before the soft pulse and faintness
developed, which was thought to be undesirable. Blood losses
averaged 16 to 30 oz. Sufficient bleeding had occurred when
the fever subsided, the pulse had become soft, or
suppuration had developed.
Variations of
the concept of
body balance
persisted until
the end of the
nineteenth
century. Most
physicians of
that century
believed that
illness was due
to either an
excess or
deficiency of
some body
product.
Cathartics were
used to reduce
an over-excited
nervous system
by cleansing the
bowels.
Diuretics were
used to restore
systemic
balance. Tonics
were used to
stimulate a
depressed
nervous system.
Bloodletting
allowed the
physician to
reduce body
fluids and
decrease body
temperature. The
febrile patient
with a full
pulse, red skin,
and agitated
state could be
rendered pale
and cool. The
physician
concluded that
this represented
clinical
improvement
