Since the dawn of civilization, we have been fascinated by the blood coursing through our veins. From ancient rituals of bloodletting to the precise techniques of modern healthcare, phlebotomy has been a practice humans have been using in medicine for a long time. Explore how civilizations have approached the extraction and understanding of blood, from the ancient use of lancets and cups to the advancements in techniques and equipment that define contemporary phlebotomy. This dive into history will not only show how our ancestors worked with the medical knowledge they had, but also will shed light on the innovative powers of the human mind.
Ancient Beginnings
Phlebotomy finds its roots in ancient civilizations where blood was believed to hold mystical and healing properties. For the ancient Greeks, Hippocrates theorized the humoral theory, which posited that the body’s health depended on the balance of four bodily fluids – blood, phlegm, yellow bile, and black bile. Being ill during this time meant that there was a disruption of equilibrium between these four humors. So, treatment meant draining one of those four in order to get back to balance. [1]
Additionally, the dominant medical voice of Rome around 2-300 AD, Galen of Pergamum shifted this idea that humoral imbalances come from specific organs, as well as in the body overall. Along with this, he proclaimed that blood was the most important humor. Coupled with him discovering that arteries carried blood rather than air, as was taught for over 400 years, bloodletting became bigger within medical care, as well as Galenic physiology, for the next 1400 years [2]. Galen advocated for leeching – the practice of using leeches to draw blood as a method for healing. This practice soon spread across Europe and Asia. [3].
Middle Ages to the Renaissance
The Middle Ages marked a transition in medical practices, where the boundaries between surgery, pharmacy, and healing arts were often blurred. During this era, the role of barber-surgeons emerged prominently, encompassing a range of duties from simple haircuts to surgical procedures and bloodletting. First recognized around 1000 A.D., barber-surgeons were the grooming and surgery experts during the middle ages. They first began in monasteries, where due to health and sanitary reasons, monks needed to keep a clean shaven head. Barber-surgeons were hired by monks, and even then taught the practice of blood-letting performed regularly by the monks, as barbers had a knack for handling sharp objects and tools [4]. As Jennie Cohen from History.com says, “the modern striped barber’s pole harkens back to the bloodstained towels that would hang outside the offices of these “barber-surgeons.”” And after Pope Alexander III prohibited clergymen from performing bloodletting in 1163, barber-surgeons took over the practice as a whole.
The most common method of bloodletting at this time was cutting into a vein, at the forearm or the neck, to drain the blood. Another method was cupping – where the barber-surgeon would scrap the skin and placing a cup over the skin. They would then apply heat or suction to create a vacuum so that the blood would be drawn out. Leeching was still common to use in these medical practices as well. [3].
18th and 19th Century
The 18th and 19th centuries witnessed significant advancements in phlebotomy techniques, blood transfusion, and the understanding of circulatory physiology, marking a pivotal period in the history of medicine. During the 18th century, phlebotomy tools underwent notable advancements. Lancets evolved to include spring-loaded mechanisms for quicker and more precise incisions. William Harvey, known for being the person to recognize blood circulation all over the human body, lauded bloodletting for being beneficial to remedying many diseases [3]. His theories laid the foundation for understanding the dynamics of blood flow and the role of the heart in circulation. This newfound knowledge influenced phlebotomy practices, emphasizing the importance of vein selection, and avoiding arteries during blood collection.
The late 18th and early 19th centuries witnessed the experimental use of blood transfusion as a medical intervention. Dr. James Blundell, a British obstetrician, conducted pioneering work in blood transfusion, particularly in cases of postpartum hemorrhage. His first was donating blood from a husband to his post-partum wife – ending in success. He performed 10 transfusions between 1825 – 1830, 5 of which were successful. He created several devices to perform these transfusions while publishing papers on the practice within that time. [5]
20th Century
The 20th century witnessed a revolution in phlebotomy practices, marked by technological innovations, standardization of procedures, and advancements in transfusion medicine. Bloodletting started becoming denounced as a viable practice of medicine as physicians began to recognize that losing large amounts of blood at a time hurt rather than helped patients. As explained by Brittanica, “the extraction of large volumes of blood… could lead to low blood pressure, difficulty breathing, loss of consciousness, and, in some cases, death. Bloodletting also carried a risk of infection from the implements used to create the incisions for bleeding.” This began to turn the tide of bloodletting turning into what we know now as modern phlebotomy.
Modern Phlebotomy
In the contemporary healthcare landscape, phlebotomy has evolved into a specialized discipline characterized by precision, safety protocols, and a patient-centered approach. Modern phlebotomy practices encompass a range of innovations and standards that ensure efficient blood collection, accurate testing, and optimal patient outcomes. And though it’s possible that the history of bloodletting has lead to a lot of fear and myths, modern phlebotomy continues to be a major push for diagnostic care. Click here to read more about modern phlebotomy and how it is not like many stereotypes.
Famous Cases of Bloodletting
With such a vast history of medical uses, bloodletting has plenty of famous names you will recognize that utilized such practices. Here are three major historical figures who were known to use the practice:
- George Washington: The famous first United States president utilized bloodletting after falling ill from a throat infection. However, it is also the reason why the inaugural leader died after nine pints of blood were drained from him. With our modern eyes, we can see now that losing that much blood was most likely the reason for his death as opposed to the throat infection he wanted to treat [6].
- King Charles II: After suffering a seizure, King Charles II lost a total of 24 ounces of blood from both an arm venipuncture and cupping [1]. He later died between this and a combination of other treatments his physicians tried to give him.
- Marie Antoinette: The infamous French queen had her blood released by her physician after she fainted during the birth of her first child. However, we know now that didn’t end her life, not until the guillotine over a decade later [7].
The journey through the history and evolution of phlebotomy unveils a narrative of constant innovation, precision, and patient-centered care that defines modern healthcare practices. From ancient rituals of bloodletting to the techniques of contemporary phlebotomy, the practice has gone from blood draining for equilibrium to precision drawing for diagnostic care. In essence, modern phlebotomy stands as a testament to human ingenuity, scientific progress, and compassionate healthcare delivery, embodying the timeless commitment to advancing medical science for the benefit of individuals and communities worldwide. To learn how you can join a career in phlebotomy, go to an.edu.
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Sources:
- Greenstone, G. (2010). A history of bloodletting. BC Medical Journal Premise, 52(1), 12-14. Retrieved from https://bcmj.org/premise/history-bloodletting.
- Nutton, V. (1998, July 20). Galen. Encyclopedia Britannica. Retrieved from https://www.britannica.com/biography/Galen (Last updated March 6, 2024).
- Raikar, S. P. (2023, September 29). Bloodletting. Encyclopedia Britannica. Retrieved from https://www.britannica.com/science/bloodletting (Last updated March 15, 2024)
- Hue, D. L. (2017, November 6). History of the Barber-Surgeon. Barbers Surgeons Guild Magazine. Retrieved from https://barbersurgeonsguild.com/magazine/history-barber-surgeon/.
- Association for the Advancement of Blood and Biotherapies (AABB). (n.d.). Highlights of transfusion medicine history. Highlights of Transfusion Medicine History. Retrieved from https://www.aabb.org/news-resources/resources/transfusion-medicine/highlights-of-transfusion-medicine-history.
- Phlebotomy Coach. (2015, September 9). History of phlebotomy. Phlebotomy Coach. Retrieved from https://phlebotomycoach.com/resources/history-of-phlebotomy.
- Cohen, J. (2012, May 30). A brief history of bloodletting. com. Retrieved from https://www.history.com/news/a-brief-history-of-bloodletting (Updated: March 28, 2023).
