Blood Letting In The Heart Disease
( Originally Published 1921 )
THE history of blood letting is quite interesting, and has become more so of late, because some things have been made clear by the frightful influenza epidemic that has been prevalent.
During the eighteenth century blood letting was common and universal in the treatment of disease. During the nineteenth century it fell into disrepute, and a source of amazement to physicians and others was that during the previous century it had been so commonly used. During the early part of the nineteenth century, when it was being put out of business by public clamor and professional opinion, harsh things were said of the men of the eighteenth century.
The world has just been through a frightful plague that has killed more people in the world than are found in all the territory included in Greater New York, Long Island, Westchester County, and Newark, N. J. in other words, over six million people. This epidemic was similar to epidemics that occurred only three times during the Nineteenth century, but the disease was common during the eighteenth century, occurring every three to five years. The people who died of influenza were young, strong, and healthy, and they died in a short time sometimes twenty four hours, sometimes three or four days of terrible congestion of the lungs. It took the medical profession and the public by surprise, and at first the treatment was rather by waiting for nature to do something. Later on, the doctors woke up to their duties, and treated the disease vigorously and no doubt saved many lives.
The point is, that the whole practise of the eighteenth century was tinctured with this. frightful disease that killed people by acute congestion of the lungs, and there is no doubt that many of those who suffered during the eighteenth century were saved by taking a large quantity of blood out of the circulation and forcing the lungs to empty themselves into the rest of the body. Blood-letting was used successfully by some of those who treated sufferers during the recent epidemic, but as a rule other methods have been used to accomplish the same result.
In heart disease, when through a defect in the heart there is a great accumulation of blood in the veins which the heart is unable to take care of, and when a person is in danger of death, bleeding is a correct method of treatment and has often resulted, in saving life. Public opinion is rather against it, and it is not likely to be used often at the present time; but many really eminent physicians feel that a wonderful remedy was lost when bleeding was discountenanced. Should the recent plague repeat it. self, I would be willing to predict that in time blood letting would come into its own again. Of course, there are objections to taking blood from the human body. It does result in weakness if too much is taken. But it would seem better to have at the end of a few days a weak person who is alive than that he should be no longer there at all.
Bleeding, to be of much value, ought to bear some definite relation to the amount of blood in the body, because the effect of its removal is in a great measure mechanical. If you were driving a wagon with a barrel of water in it, and the barrel was too full, you would not do any good by taking out one one-hundredth of the water. You would have to take out at least one-tenth before you could drive your wagon safely without the water spilling. In the same way, there is no use in taking one one hundreth of the bulk of the blood out of the body and expecting to get a beneficial result. The body contains about twenty pounds of blood, depending of course upon the size of the person. A pint of blood weighs about a pound, and a pound is sixteen ounces. Two pints make a quart; so, in order to get enough blood really to count, from an average person, we ought to take at least from sixteen to thirty-two ounces.
Sixteen ounces of blood doesn't look like very much when it is contained in a bottle, but if it is scattered round the way it usually is when blood-letting is done by the average person who is not trained in the operation, it looks as ,if there had been a terrific battle of some kind. The only way to bleed a sufficient quantity is to make up your mind beforehand how much to take, and then take it no matter how things look.
People with high blood pressure, whose blood is thick because of an increase in the number of red cells, are greatly benefited by blood letting, and after it has been done, they are apt to come back later and want it done again.
One-tenth of the blood in the body can be taken without serious effect on the condition of the person. The blood should be tested, of course, beforehand, to be sure that it is not thin blood that is being taken, because that would not be judicious. A simple method of determining whether the blood is thin or not is to take an ordinary piece of blotting-paper and prick a healthy person, putting a drop of blood on the blotting-paper; then prick the person whose blood you want to test and put his along side of the other's. In this way you can compare the color and if they are alike, you can feel sure that the person's blood which you are testing is not extraordinarily thin.
Blood-letting is not easy to accomplish, particularly in sick people who really need it. The veins are apt to be more or less empty and hard to get at. The blood is usually taken from the vein at the elbow. The procedure is about as follows: The arm above the elbow is bound up just tight enough to shut off the flow back through the veins, but not tight enough to shut off the flow of the blood into the arm through the arteries. This causes the veins to be distended and stand out. A prominent vein is selected, and a lancet is thrust into it, allowing the blood to flow. If the person who is being bled will hold a stick in his hand and squeeze it firmly, he will assist the flow of blood. In ancient times it was the custom to bleed people until they fainted. That is seldom done in these days. The trouble was that in the eighteenth century bleeding was found to be so extremely beneficial in people who were threatened with death from congestion that it was empirically used in many other conditions, and perhaps not with good judgment. So, instead of allowing the continued use of this splendid remedy in a sensible way, public clamor caused it to be completely abandoned, and it has never regained its proper place as a remedy for congestion.
Of course it is for the medical profession to decide whether they will use a remedy or not, but I hope this popular explanation of what really happens and what blood-letting amounts to will remove part of the prejudice against it. Then if it be suggested in any emergency, the knowledge will be more widely diffused that it is a useful means and is not attended by any particular danger or disadvantage.
In modern practise the blood is often drawn into a bottle through a hollow needle, as shown in the illustration.