Years have passed since first we met,
Pliant and ever-faithful-slave!
Nobly thou standest by me yet,
Watchful as ever and as brave.
O, were the power of language thine,
To tell all thou hast seen and done,
Methinks the curious would incline,
Their ears to dwell they tales upon!
I love thee, bloodstain'd, faithful friend!
As warrior loves his sword or shield;
For how on thee did I depend
When foes of Life were in the field!
Those blood spots on thy visage, tell
That thou, thro horrid scenes, hast past.
O, thou hast served me long and well;
And I shall love thee to the Last!
A thousand mem'ries cluster round thee
In all their freshness! thou dost speak
Of friends far distant-friends who found thee
Aye with thy master, prompt to wreak
Vengeance on foes who strove to kill
With blows well aim'd at heart or head--
Thieves that, with demon heart and will,
Would fain have on they vials fed.
O, They have blessed thee for thy aid,
When grateful eyes, thy presence, spoke;
Thou, anguish'd bosoms, glad hast made,
And miser's tyrant sceptre broke.
Now, when 'mong strangers, is our sphere,
Thou, to my heart, are but the more
Endear'd--as many a woe-wring tear
Would plainly tell, if from me tore!
There was little change in the mechanism of the spring lancet during the
nineteenth century, despite the efforts of inventors to improve it.
Approximately five American patents on variations of the spring lancet
were granted in the nineteenth century. One patent model survives in the
Smithsonian collection. Joseph Gordon of Catonsville, Maryland, in 1857
received patent No. 16479 for a spring lancet constructed so that three
different positions of the ratchet could be set by the sliding shield. The
position of the ratchet regulated the force with which the blade entered
the vein. This also had the advantage of allowing the blade to enter the
vein at the same angle irrespective of the depth to which it
penetrated.[71]
_The Decline of Bleeding_
Throughout the seventeenth, eighteenth, and nineteenth centuries, most
physicians of note, regardless of their explanations of disease, including
Hermann Boerhaave, Gerard Van Swieten, Georg Ernst Stahl (phlogiston),
John Brown and Friedrich Hoffmann (mechanistic theories), Johann Peter
Frank, Albrecht von Haller, Percival Pott, John Pringle, William Cullen,
and Francois Broussais, recommended bloodletting and adjusted their
theories to provide an explanation for its value. At the end of the
eighteenth century and in the early nineteenth century, the practice of
bloodletting reached a high point with the theories of F.-J.-V. Broussais
(1772-1838) and others. After 1830, however, the practice gradually
declined until, by the end of the century, it had all but disappeared.
This decline occurred even though many medical theories were brought to
the defense of bleeding. A French medical observer commented in 1851 that
"l'histoire de la saignee consideree dans son ensemble, constituerait
presque a elle seule l'histoire de toutes les doctrines medicales" (the
history of bloodletting, considered in its totality, would constitute
almost by itself the history of all medical doctrines).[72] There was no
crisis of medical opinion, and no one event to account for this decline.
The French physician, Pierre Louis's statistical investigation (numerical
method) into the effect of bloodletting in the treatment of pneumonia has
often been cited as a cause for the downfall of venesection,[73] but the
results of Louis's research showed only that bloodletting was not as
useful as was previously thought. Louis's work, however, was typical of a
new and critical attitude in the nineteenth century towards all
traditional remedies. A number of investigators in France, Austria,
England, and America did clinical studies comparing the recovery rates of
those who were bled and those who were not.[74] Other physicians attempted
to measure, by new instruments and techniques, the physiological affects
of loss of blood. Once pathological anatomy had associated disease
entities with specific lesions, physicians sought to discover exactly how
remedies such as bloodletting would affect these lesions. In the case of
pneumonia, for example, those who defined the disease as "an exudation
into the vessels and tissues of the lungs" could not see how bloodletting
could remove the coagulation. John Hughes Bennett, an Edinburgh physician,
wrote in 1855: "It is doubtful whether a large bleeding from the arm can
operate upon the stagnant blood in the pulmonary capillaries--that it can
directly affect the coagulated exudation is impossible."[75] Bennett felt
that bloodletting merely reduced the strength of the patient and thus
impeded recovery.
Bloodletting was attacked not only by medical investigators, but much more
vehemently by members of such medical sects as the homeopaths and botanics
who sought to replace the harsh remedies of the regular physicians by
their own milder systems of therapeutics.[76]
As a result of all this criticism the indications for bleeding were
gradually narrowed, until at the present time bloodletting is used in only
a few very specific important instances.
In England and America, in the last quarter of the nineteenth century, a
last serious attempt was made to revive bloodletting before it died out
altogether. A number of Americans defended the limited use of bleeding,
especially in the form of venesection. The noted American physician, Henry
I. Bowditch, tried in 1872 to arouse support for venesection among his
Massachusetts Medical Society colleagues. He noted that venesection
declined more than any other medical opinion in the esteem of the
physician and the public during the previous half century. At the
beginning of his career, he had ignored the request of his patients who
wanted annual bloodlettings to "breathe a vein" to maintain good health.
He eventually found that to give up the practice entirely was as wrong as
to overdo it when severe symptoms of a violent, acute cardiac disease
presented themselves. Lung congestion and dropsy were other common
disorders that seemed to him to be relieved, at least temporarily, by
venesection.[77]
In 1875 the Englishman W. Mitchell Clarke, after reviewing the long
history of bloodletting and commenting on the abrupt cessation of the
practice in his own time, wrote:
Experience must, indeed, as Hippocrates says in his first aphorism,
be fallacious if we decide that a means of treatment, sanctioned by
the use of between two and three thousand years, and upheld by the
authority of the ablest men of past times, is finally and forever
given up. This seems to me to be the most interesting and important
question in connection with this subject. Is the relinquishment of
bleeding final? or shall we see by and by, or will our successors
see, a resumption of the practice? This, I take it, is a very
difficult question to answer; and he would be a very bold man who,
after looking carefully through the history of the past, would
venture to assert that bleeding will not be profitably employed any
more.[78]
An intern, Henri A. Lafleur of the newly founded Johns Hopkins Hospital,
reported on five patients on whom venesection was performed between 1889
and 1891. Lafleur defended his interest in the subject by calling
attention to other recent reports of successes with bleeding, such as that
of Dr. Pye-Smith of London. He concluded that at least temporary relief
from symptoms due to circulatory disorders, especially those involving the
pulmonary system, was achieved through venesection.
Pneumonia and pleurisy were the primary diseases for which venesection was
an approved remedy.[79] It had long been believed by bloodletters that
these complaints were especially amenable to an early and repeated
application of the lancet.[80] Austin Flint had explained in 1867 that
bloodletting "is perhaps more applicable to the treatment of inflammation
affecting the pulmonary organs than to the treatment of other inflammatory
affections, in consequence of the relations of the former [pulmonary
organs] to the circulation."[81] Thus, while bloodletting for other
diseases declined throughout the nineteenth century, it continued to be
advocated for treating apoplexy, pneumonia, and pulmonary edema.[82]
The merit of phlebotomy for those afflicted with congestive heart failure
was emphasized again in 1912 by H. A. Christian. This condition led to
engorgement of the lungs and liver and increased pressure in the venous
side of the circulation. Articles advocating bloodletting continued into
the 1920s and 1930s.[83]
Bloodletting is currently being tested as a treatment for those suffering
from angina or heart attacks. Blood is removed on a scheduled basis to
maintain the hematocrit (the percentage of red blood cells in the blood)
at a specified level. Keeping the hematocrit low has provided relief to
those being tested.[84] Other benefits of removing blood, including the
lowering of blood pressure, can be obtained by the use of antihypertensive
drugs. Thus the valid indications for bleeding are being supplanted by the
use of modern drugs that accomplish the same end.
By the twentieth century the lancet was replaced in some quarters by safer
devices for removing blood and injecting fluids into the bloodstream.
Heinrich Stern improved Strauss's special hyperdermic needle. In 1905
Stern designed a venepuncture or aspirating needle that was 7 cm long with
a silver cannula of 4 cm. Attached to the handle was a thumb-rest and a
tube for removing or adding fluids and a perforator within the cannula. He
recommended that the forearm be strapped above the elbow and that the
instrument be thrust into the most prominent vein. This streamlined vein
puncturing implement reduced the possibility of injecting air and bacteria
into the blood.[85] It was, and continues to be, used to withdraw blood
for study in the laboratory, to aid in diagnosis of disease, and to
collect blood for transfusing into those who need additional blood during
an operation or to replace blood lost in an accident or disease. The blood
is collected in a glass or plastic graduated container and stored under
refrigeration. The study of blood donors has, incidentally, given insights
into the physiology of bloodletting since the volume customarily removed
from a donor is about the same in volume as that taken by a bleeder (one
pint or 500 cc).[86]
The annual physical examination today includes taking a small amount of
blood from the finger or a vein in the elbow. This blood is then analyzed
for the presence of biochemical components of such diseases as diabetes,
anemia, arteriosclerosis, etc. A tiny sterile instrument called a blood
lancet may be used by the technician who draws the blood, who is still
called by the historical name, phlebotomist.