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| title | chunk | source | category | tags | date_saved | instance |
|---|---|---|---|---|---|---|
| Bloodletting | 3/4 | https://en.wikipedia.org/wiki/Bloodletting | reference | science, encyclopedia | 2026-05-05T09:17:33.324303+00:00 | kb-cron |
One reason for the continued popularity of bloodletting (and purging) was that, while anatomical knowledge, surgical and diagnostic skills increased tremendously in Europe from the 17th century, the key to curing disease remained elusive, and the underlying belief was that it was better to give any treatment than nothing at all. The psychological benefit of bloodletting to the patient (a placebo effect) may sometimes have outweighed the physiological problems it caused. Bloodletting slowly lost favour during the 19th century, after French physician Dr. Pierre Louis conducted an experiment in which he studied the effect of bloodletting on pneumonia patients. A number of other ineffective or harmful treatments were available as placebos—mesmerism, various processes involving the new technology of electricity, many potions, tonics, and elixirs. Yet, bloodletting persisted during the 19th century partly because it was readily available to people of any socioeconomic status. Barbara Ehrenreich and Deirdre English write that the popularity of bloodletting and heroic medicine in general was because of a need to justify medical billing. Traditional healing techniques had been mostly practiced by women within a non-commercial family or village setting. As male doctors suppressed these techniques, they found it difficult to quantify various "amounts" of healing to charge for, and difficult to convince patients to pay for it. Because bloodletting seemed active and dramatic, it helped convince patients the doctor had something tangible to sell.
== Controversy and use into the 20th century == Bloodletting gradually declined in popularity over the course of the 19th century, becoming rather uncommon in most places, before its validity was thoroughly debated. In the medical community of Edinburgh, bloodletting was abandoned in practice before it was challenged in theory, a contradiction highlighted by physician-physiologist John Hughes Bennett. Authorities such as Austin Flint I, Hiram Corson, and William Osler became prominent supporters of bloodletting in the 1880s and onwards, disputing Bennett's premise that bloodletting had fallen into disuse because it did not work. These advocates framed bloodletting as an orthodox medical practice, to be used in spite of its general unpopularity. Some physicians considered bloodletting useful for a more limited range of purposes, such as to "clear out" infected or weakened blood or its ability to "cause hæmorrhages to cease"—as evidenced in a call for a "fair trial for blood-letting as a remedy" in 1871. Some researchers used statistical methods for evaluating treatment effectiveness to discourage bloodletting. But at the same time, publications by Philip Pye-Smith and others defended bloodletting on scientific grounds. Bloodletting persisted into the 20th century and was recommended in the 1923 edition of the textbook The Principles and Practice of Medicine. The textbook was originally written by Sir William Osler and continued to be published in new editions under new authors following Osler's death in 1919. Bloodletting was once thought to reduce inflammation, boost immunity, and improve circulation by aiding in the detoxification of the blood circulating throughout the body. Over time, however, bloodletting's harmful impacts made the practice a less preferable form of medicine. Not only was bloodletting generally ineffective, it also commonly led to significant blood loss. High loss of blood made patients highly susceptible to infection/sepsis or the formation of a hematoma. Additionally, bloodletting also caused anemia, leading the patient to feel weak, tired, or even go unconscious. The harmful effects did not stop there; in severe cases, bloodletting had the potential to cause deadly hypovolemic shock. As the medical world advanced, these deadly effects made the practice of bloodletting fade in popularity.
== Therapeutic phlebotomy == Therapeutic phlebotomy is used today in the treatment of a few diseases, including hemochromatosis, sickle cell disease, porphyria cutanea tarda, nonalcoholic fatty liver disease, and polycythemia. It is practiced by specifically trained practitioners in hospitals using modern techniques and a relatively safe procedure that depletes iron stores in the body. In most cases, phlebotomy now refers to the removal of small quantities of blood for diagnostic purposes and is an important procedure in the US. According to an academic article posted in the Journal of Infusion Nursing with data published in 2010, the primary use of phlebotomy is to take blood that would be reinfused back into a person (blood donation). However, in the case of hemochromatosis, bloodletting (by venipuncture) has become the mainstay treatment option. Therapeutic phlebotomy is a cost effective way to remove excess iron in blood for patients that have hemochromatosis.
== Cross-cultural bloodletting == Therapeutic uses of bloodletting were reported in 60 distinct cultures/ethnic groups in the HRAF database, present in all inhabited continents. Bloodletting has also been reported in 15 of the 60 cultures in the probability sample files (PSF) list. The PSF is a subset of eHRAF data that includes only one culture from each of 60 macro-culture areas around the world. The prevalence of bloodletting in PSF controls for pseudo-replication linked to common ancestry, suggesting that bloodletting has independently emerged many times. Bloodletting is varied in its practices cross-culturally, for example, in native Alaskan culture bloodletting was practiced for different indications, using different tools, on different body areas, by different people, and it was explained by different medical theories. According to Helena Miton et al.'s analysis of the HRAF database and other sources, there are several cross-cultural patterns in bloodletting.