Bloodletting: an early treatment used by barbers, surgeons

Some bloodletting procedures are still in practice today in reconstructive and plastic surgery.

Issue: February 2008

Bloodletting was used for hundreds of years to help cure illness and restore health, and its popularity thrived in the 19th century. Although its effectiveness was routinely questioned, the procedure was used for cardiac problems into the 1920s.

Bloodletting has been employed since ancient times as a method to keep the body’s so-called four humors in balance. By the second millennium, the belief in the four humors began to decline, but bloodletting remained popular. Because surgery was still a crude practice, many physicians avoided it. Instead, people turned to the church for medical help. However, in 1163 a church edict by the Council of Tours forbade monks and priests to practice bloodletting.

This series of events led to the rise of the barber-surgeon.

Advent of barber surgeons

Barbers performed a wide variety of functions at that time. In addition to cutting hair, a barber might pull teeth, perform surgery on minor wounds, amputate limbs or administer leeches.

A woman sitting in a chair is being bled by two physicians while a third physician kneels at her side holding a clyster; in the background an autopsy is taking place.

Source: National Library of Medicine

Already prepared with the tools needed to perform venesection, barbers developed a thriving bloodletting practice from 1100 to 1500. This included the development of barber organizations, entrance into schools to learn the trade and a distinguishing symbol, the barber pole.

As more was learned about surgery, a transition began from barbers to more experienced physicians performing bloodletting. By the 1800s, the popularity of bloodletting had reached an all-time high. Multiple methods of administration were detailed in medical books, including dry cupping, scarification, venesection and arteriotomy.

In areas considered too constricted or in patients too weak for the usual methods of bloodletting, leeches were considered useful. Rubbing the skin with sugar-water, milk or blood would persuade the leech to bite after which it would suck blood until gorged.

Leeches could be applied to the anus and rectum for relief of abdominal inflammations such as hepatitis, enteritis and puerperal fever; to the mucous membrane of the nose to relieve chronic nose bleeds; and sometimes to the vagina to stimulate menstrual flow. Detailed methods were developed for the administration of leeches to almost any body part. For example, a physician might tie a string to a leech to avoid suffocation when attaching a leech to a patient’s tonsils.

At the end of the 1700s leeches were a low-priced commodity. However, by the turn of the century the growing medicinal use of leeches – and their scarcity due to overuse – drove the cost up 300%.

The cultivation of leeches by leech farmers or medical facilities became a thriving industry, and the import of leeches also increased rapidly during this time. Some research suggests that France imported about 42 million leeches in one year.

When they were in short supply, techniques were developed to extend the use of a single leech. Immersing the leech in vinegar or applying salt to its mouth would cause the animals to disgorge, allowing them to be reused. Bdellatomy, or cutting open a leech’s digestive tract, would allow leeches to continuously consume blood without limit.

Multiple leeches were used; early records show that over 100 leeches were sometimes applied to a single patient over a few days.

In 1828, Pierre Charles Alexandre Louis was one of the first physicians to openly criticize bloodletting for the treatment of diseases. His research found that in patients with pneumonia, 44% of those who were bled within the first four days died, compared with 25% of those patients who were bled later in their illness. He deduced that those patients bled later had already passed through the worst phases of the disease and that bloodletting was thus useless in the treatment of pneumonia.

By the 1870s, bloodletting was so popular among patients that, although medical use of the practice was declining, many patients had to be convinced not to be bled when they fell ill.

In June 2004, the FDA cleared the first application for leeches to be used in modern medicine as medical devices.

Surgeons who do plastic and reconstructive surgery find leeches valuable when regrafting amputated appendages. Once found beneficial for the amount of blood they could withdraw, leeches are useful now for the anticlotting agent hirudin, contained in their saliva, which keeps blood flowing freely during these procedures. – by Leah Lawrence

For more information:

Berry D. History of cardiology: the use of bloodletting. Circulation. 2007;115:f8.

Best M, Neuhauser D. Pierre Charles Alexandre Louis: master of the spirit of mathematical clinical science. Qual Saf Health Care. 2005;14:462-464.

Codell Carter K. Leechcraft in nineteenth century British medicine. J R Soc Med. 2001;94:38-42.

Roman F. Notes from ophthalmic practice in the eighteenth century. Br J Ophthalmol. 1994;78:338.

Seigwroth GR. Bloodletting over the centuries. N Y State J of Med. 1980;80:2022-2028.

Warner JH. Therapeutic explanation and the Edinburgh bloodletting controversy: two perspectives on the medical meaning of science in the mid-nineteenth century. Medical History. 1980;24:241-258.