In the ancient world
A chart showing the parts of the body to be bled for different diseases, c. 1310–1320
Points for blood-letting, Hans von Gersdorff (surgeon), Field book of wound medicine, 1517
Passages from the Ebers Papyrus may indicate that bloodletting by scarification was an accepted practice in Ancient Egypt.[10][11][12] Egyptian burials have been reported to contain bloodletting instruments.[13] According to some accounts, the Egyptians based the idea on their observations of the Hippopotamus,[14] confusing its red sweat with blood, and believing that it scratched itself to relieve distress.[15][16]
In Greece, bloodletting was in use in the fifth century BC during the lifetime of Hippocrates, who mentions this practice but generally relied on dietary techniques.[17] Erasistratus, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood and advised that these plethoras be treated, initially, by exercise, sweating, reduced food intake, and vomiting.[18] Herophilus advocated bloodletting. Archagathus, one of the first Greek physicians to practice in Rome, also believed in the value of bloodletting.
"Bleeding" a patient to health was modeled on the process of menstruation. Hippocrates believed that menstruation functioned to "purge women of bad humours". During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting.[19]
The popularity of bloodletting in the classical Mediterranean world was reinforced by the ideas of Galen, after he discovered that not only veins but also arteries were filled with blood, not air as was commonly believed at the time.[citation needed] There were two key concepts in his system of bloodletting. The first was that blood was created and then used up; it did not circulate, and so it could "stagnate" in the extremities. The second was that humoral balance was the basis of illness or health, the four humours being blood, phlegm, black bile, and yellow bile, relating to the four Greek classical elements of air, water, earth, and fire respectively. Galen believed that blood was the dominant humour and the one in most need of control. In order to balance the humours, a physician would either remove "excess" blood (plethora) from the patient or give them an emetic to induce vomiting, or a diuretic to induce urination.
Galen created a complex system of how much blood should be removed based on the patient's age, constitution, the season, the weather and the place. "Do-it-yourself" bleeding instructions following these systems were developed.[20] Symptoms of plethora were believed to include fever, apoplexy, and headache. The blood to be let was of a specific nature determined by the disease: either arterial or venous, and distant or close to the area of the body affected. He linked different blood vessels with different organs, according to their supposed drainage. For example, the vein in the right hand would be let for liver problems and the vein in the left hand for problems with the spleen. The more severe the disease, the more blood would be let. Fevers required copious amounts of bloodletting.
