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The Humoral Management of Blood: Cupping, Bloodletting and Staunching- PART 1

Blood and heart health is a central aspect of the normal monitoring and maintenance of our body function. Via medical analysis we know that a unit of blood is taken to be approximately one pint; that an average adult male can be estimated to have within their body about twelve pints of blood, a female nine pints; a healthy donor's blood has been analysed to replenish in about 24 hours, that red blood cells that are lost take longer and are totally replaced in a few weeks. Whole blood can be donated every eight weeks and we are aware that blood types must be matched in order to safely transfuse blood.

Our blood is accepted as the body’s replenishing life force.
Woodcut from Physiognomische Fragmente zur Beförderung der Menschenkenntnis und Menschenliebe (1775-1778) by Johann Kaspar Lavater. Phlegmatic and choleric (above), sanguine and melancholic (below).

Until the late nineteenth century the body’s humours were seen as central to a patients’ health and medical practitioners had to identify disease of the patient’s body and attempt to rebalance four humours: blood, yellow bile, black bile and phlegm. The humoral system was based on the works of the Greek physicians Hippocrates (ca. 460 BCE–370 BCE) and Aelius Galen (c. 129-c. 216/17 CE) and was core to the whole of Western medical practice for nearly two thousand years. Following the Hippocratic Oath morally obliged a qualified medical practitioner to ‘nil nocere’ / do no harm’ but instead examine, monitor and restore the patients’ humoral balance. Blood as the bearer of life was seen as the prime humour and could be managed simply: Any surplus of blood could be reduced by simply removing meat from the diet, or by controlled bleeding by phlebotomy (- taken the Greek words phlebo - meaning “pertaining to a blood vessel"  and - tomia, meaning " cutting of" ) and by venesection (- to open a vein not to analyse the blood but to simply release it to remove bad humours).

Bloodletting was undertaken via use of various designs of lancet, scarificators, sometimes also with the addition of small glass cups, but it was the medical Leech, hirudo officinalis which remained the old world’s natural choice of bloodletting.

Leech supply was a lucrative business but perhaps it waned toward the mid nineteenth century. The Apothecary and Surgery Bills for St Thomas’ Hospital 1791-1845 for 1852-53 show for “500 beds average 455 occupied” treatment was provided for “4,160 In patients” and “30,606 O.p [Out Patients]”. Not all patients were leeched but purchase was made for the year for “leeches £73.17.6” with a similar matching cost having been used on the wards. A larger leech use was seen for year 1823 again via “Apothecary Bills” where payment was made to [D] “Roberts for 37,000 leeches £169. 6s [shillings]”. For the same year underSurgical Bills” again “Roberts 17,650 leeches £82, 3s 6d” amassing a much higher total of 44,650 leeches for 1823, purchased and most likely used on patients.

Parisian Leech Therapy - A course of 200 for Fever, 60 for Rheumatism

It was reported that the dynamic Napoleonic field-surgeon Joseph Victor Broussais (1772-1838) had no reserve for bleeding a patient. He notoriously directed his pupils and staff to 'Bleed ad finitum!'... 'Bleed in an upright posture to fainting!’. British physician James Clark (1788-1870)*, who had while in Rome had attended the frail poet John Keats (1795-1821) observed finer details of Broussais’ use of leeches at the Val de Grace Military Hospital in Paris. Within his book Medical Notes, 1820, Clark reported of Broussais “… his treatment of fever, founded on this view of the cause, consists in the application of leeches to the abdomen, in numbers proportioned to the strength of the patient and severity of the disease. The number of leeches applied varies from twenty-five to sixty” however Clark continued “One patient was pointed out to me in the hospital, to whom two hundred had been applied in the course of the fever: he was convalescent.” Clark on the doctor’s preference “Dr Broussais does not employ general blood-letting [via lancets etc.], as he thinks it little useful in inflammation of the mucous membranes …

ln one of his wards a soldier was pointed out to me who had lately come into the hospital with acute rheumatism of, both knee and ankle joints, accompanied with the usual symptoms of redness, heat, and swelling. Sixty leeches were distributed on these joints, which bled freely; next day the patient was free from pain and the swelling of the joints gone. Both thumb joints were afterwards affected in the same way, and a large number of leeches.... By this prompt abstraction of blood from the affected parts I was informed his success in the treatment of acute rheumatism is very great.”

To be continued...


* Physician James Clark (1788-1870) was later knighted as Physician to Queen.


References

Apothecary and Surgery Bills for St Thomas’ Hospital 1791-1845. London Metropolitan Archives.

Clark, James. 1822.  Medical Notes on Climate, Diseases, Hospitals, and Medical Schools in France, Italy, and Switzerland, comprising an Inquiry into the Effects of a Residence in the South of Europe in Cases of Pulmonary Consumption.


To cite this post : Karen Howell, “The Humoral Management of Blood: Cupping, Bloodletting and Staunching- PART I”, Museum Highlights (blog on oldoperatingtheatre.com), September 14th, 2017. [On line] http://www.oldoperatingtheatre...


Karen Howell was trained at Chelsea College of Art as a video and installation artist and undertook postgraduate work at Central St Martins School of Art, London. Throughout her training she has always had the history of medicine as a core interest. It was only after joining the museum that she undertook her museum studies training at Leicester University becoming then the Curator of the Old Operating Theatre Museum and Herb Garret. 

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