Blood-letting and Tears (From The Pain and Gain Chronicle, 2016)
Bloodletting goes back to Hippocrates and his humors (circa 400BC). He posited, ‘Four is a square number, the product of equals and therefore just and fair, so there is: 1. Choler – from the spleen, 2. phlegm - from the lungs, 3. blood - from the liver, and 4. melancholy – from the soul. A balance between them makes for a healthy human’.
Hippocrates claimed that the pheuma is pumped from the lungs to the heart, and the blood carries the breath of life to the other humors. The mechanism had to wait for Harvey (1643) to discover, but the ancient Greek’s claim, bar the humors, held up: the body is a tidal wave of blood and oxygen.
The ancients thought a plethora of pheuma inflames the vital organs and too little disturbs the spirits. When fever and/or derangement was observed a blood vessel was cut to let blood, and once the patient turned blue it was ligatured (‘to tie in the soul’). As Galen (129 – 216 AD) considered that surgery was an insult to the body, blood-sucking leeches replaced sectioning veins. It became such a routine treatment for so many ailments that doctors were sometimes called leeches (over two thousand years the meaning has changed).
When medicine became less philosophic the rationale offered was an analogy: as too much food weighs heavily on the constitution, too much blood upsets it. However, science still was abstract, and the third finger of the left hand was targeted for leeching as it was believed it had a vein that went straight to the heart. This view prevailed until the 17th century when human dissection became accepted practice in Holland (religious objections were waived).
Bloodletting left you pale and interesting,
but not in better health. If you had an anemia or a compromised immune system,
it could kill. And yet it lingered on as a treatment into the 19th century. Pre-modern
medicine was based on custom rather than science and it in the absence of
proven alternatives perpetuated itself with myths. For example, leeching is
most effective in the spring and autumn; monasteries made it part of their spiritual
renewal in recalcitrant sinners (the emphasis being the tying in of the soul);
bloodletting was reputed to give a rush of euphoria, and was used by gay dogs
on the decline. And it’s true letting a pint of blood can give a young person a
sense of well-being. Though in my student days it was the prospect of the pint
of Guinness gave me the lift.
The heart’s pre-eminence in love poetry could be attributed to Hippocrates. The humors reflect our deepest feelings and the heart moved the blood to them. He also inspired what to say to a sneeze. A nasal discharge meant a loss of pheuma and he advised invoking the god of the sky, Jupiter, and taking a deep breath. The Romans simplified it, ‘To your good health’, cutting out the deity and inhalation. This continues to this day but with the godly ‘bless you’ (dia duit, Gaelic) and ‘make a wish’ (a te souhait, French) still common. The scientific ‘why don’t you use a hanky?’ is reserved for harassed mothers. Though a Kleenex would be more hygienetic.
The sneeze that evicts staphylococci aureus from its natural habitat in nostrils into poorly ventilated hospital wards closed more hospitals in Britain in the 1990s than Thatcher, and still kills now antibiotic resistance is reaching crisis point. Picking the nose also spreads it. But that’s something people do in isolation – passing the time in traffic jams – and it does not spread, particularly if you eat the harvest. It is not known if patients waiting for beds in trollies similarly pick and when they shake hands eventually with the intern, since staphylococci survive in the skin, they pass it on (it’s not for nothing it’s call ‘staff’ infection).
Hospital cross-infection control is considerably better than in the days of Sir Almoth Wright’s Anti-Catarrh Vaccine originally drawn from pus in George V’s chest. It did not work but patriotic sales helped to fund the department in St Marys Hospital where Alexander Fleming discovered penicillin in 1928, a mixed blessing. As antibiotics destroys the cell linings of normal flora from the nose to the bowels, ‘asylum’ dysentry, for instance, could yet return to the disaster it was a hundred years ago. This regression has been to some extent prevented by care in the community and the closure of mental institutions. But that has opened up new sewers for the less fortunate to infect one another. History does not need to repeat itself to manifest its ignorance of consequences. Moving on can be sure of finding new ways of not making things better for humanity.
As a student in the early 1970s I tried to give my blood for a pint of stout. But the London Hospital transfusion service found I had a plethora of platelets and certain blood cells due to exposure to radioactive ions in a Scottish biomedical laboratory the previous year. It would regulate itself in time, I was assured, but it was blithely speculated that I had a hormonal imbalance which could make me infertile. The blood condition did not prevent me playing manic squash. But I recalled after games my high color made Moira Latham, the college champion, call me the Red Indian. I, who only wanted to be her cowboy. Foolish, as she turned out to be ‘not interested in men’, or so I realized when her butch female flat mates slammed the door on me. But the flush was perhaps simply a blush, I decided, and not without reason. Moira invariably beat me, though I sometimes took her to tie-breaks. As for the radio-active spill, a lawyer friend told me that since I’d never been acknowledged in a paternity suite before it, I couldn’t sue Dundee University (the accident was kept hush-hush).
In the early 18th century London
Hospitals consumed an estimated seven million leeches a year. Technicians
topped and tailed the leeches with a cutting machine so the blood spurted into
the worm. Their main source tropical rain forests were drying up, and, as
Horace Walpole’s proposal that fleas be used as an alternative was considered
infra dig, leach breeding farms proliferated in the swamps of East Anglia. Professor
Meyer, my mentor in epidemiology, estimated that between 1740 and 1755 the
leech boom resulted in more casualties than the sum of the War of Jenkins’ Ear,
Frederick the Greats War of the Austrian Succession, the Jacobite Rebellion,
Culloden and the Lisbon Earthquake, and remarked ‘The three-point star on the
flesh of the leech jaws was the mark of death’.
Bloodletting lasted for two thousand years for four reasons. Firstly, as a dramatic procedure it made you feel that ‘something was being done’ (Christianity went into a political and social decline when ‘not doing things’ became the mark of virtue). Secondly, most illnesses go away with time (or death) and bloodletting took the glory when patients survived. And thirdly, doctors were deceived by appearances: put a drop of blood in a petri dish, the red cells sink and turn crimson and a yellowy green slime surfaces. Under it a chicken fat clot forms that looks like phlegm. Then the lees blacken. And so you have bile, snot, and crimson, black dog dregs - a perfect picture of what Hippocrates described. Fourthly, as Doctor Johnson says, it continued because it began.
Medical science in the mid-19th
century finally discredited the humor theory. Virchow and others proved that
pathologies were due to body cells not the movement of fluids. Fair to say blood-letting still has a
scientific use with some rare blood diseases. One is to be found in the
environs of Transylvania, vampire country. Hubert Grace, my Polish pastry
artist, had his blood drained every month and replaced by a transfusion. But
the ebb and flow of blood made life difficult and Madame complained about his
foul moods (almost as bad as hers’). He caught septicemia due to hospital
infection and died as she was divorcing him. Other usages include letting blood
in patients with heredity iron excess, and as an emergency in certain cases of
congestive heart failure. Needless to say, performed by venesection rather than
leeches. Now methicillin-resistant staphylococci
aureus (MRSA) is common a return to blood-letting to prevent gangrene is
being used as a last resort but with mixed results.
Ben Johnson in the 16th century took the humors as a given but Shakespeare was less deceived. He played mood music with their received characteristics – blood, phlegm, black and yellow slimes– but also lightened the idea with suggestions of a whim, a caprice or a fancy and thus coined the word for the cultivation of mirth. He was in more than one way ahead of his time and its language.
Recently I had experimental treatment for recurrent polyps in my bladder and my platelet count shot up to twice the average level. I tried to make the case for blood-letting rather than wait for the chemical to be absorbed. The doctor gave me a strange look.