MADNESS OF KING GEORGE III: Bloodletting and Blistering

Bloodletting and Blistering

18th century doctors could not give a scientific explanation for the numerous diseases that plagued the population. They had no concept of bacteria or for that matter germs. They had few remedies for most of these diseases. They had found that quinine was effective against malaria, but it was the exception rather the rule.

One of the more popular beliefs of the day was that blood was the carrier of the "poisons of disease". Hence blood letting released the bad blood and allowed the body to produce good blood and regenerate itself. We now know the fallacy of this thinking, but it is based on logic, and that is always difficult to overcome. The amount of blood removed was approximately one pint, however for more serious illness more was taken, as was the case in Washington's death, where a full quart was taken. It appears that they had no idea that blood made up only only seven percent of the body weight, but worse yet, it was thought that the removed blood would be replenished within a few hours, instead of the weeks it actually takes.

If the bloodletting didn't kill the sick, then the extensive use of laxatives and emetics did. It is generally believed that more patients succumbed to dehydration and weakening by these "cures", than the diseases themselves would have.

Another delightful "cure" was blistering. Colonial Doctors would raise blisters on the skin in the belief that the inflammatory process could drawn from the inside to the outside. This practice inflicted a great deal of unnecessary pain on patients. With all things considered, it is no wonder that few people lived to "old age". Washington's grandfather died when he was 37, his father at age 49. His mother at 82. George Washington apparently inherited his strong constitution and endurance from his maternal side.

Phlebotomy: The Ancient Art of Bloodletting
By Graham Ford

The practice of bloodletting seemed logical when the foundation of all medical treatment was based on the four body humors: blood, phlegm, yellow bile, and black bile. Health was thought to be restored by purging, starving, vomiting or bloodletting.

The art of bloodletting was flourishing well before Hippocrates in the fifth century B.C. By the middle ages, both surgeons and barbers were specializing in this bloody practice. Barbers advertised with a red (for blood) and white (for tourniquet) striped pole. The pole itself represented the stick squeezed by the patient to dilate the veins.

Bloodletting came to the U. S. on the Mayflower. The practice reached unbelievable heights in the 18th and early 19th centuries. The first U.S. president, George Washington, died from a throat infection in 1799 after being drained of nine pints of blood within 24 hours. The draining of 16-30 ounces (one to four pints) of blood was typical. Blood was often caught in a shallow bowl. When the patient became faint, the "treatment" was stopped. Bleeding was often encouraged over large areas of the body by multiple incisions. By the end of the 19th century (1875-1900), phlebotomy was declared quackery.

A variety of devices were used to draw blood:

• The lancet was first used before 5th Century B.C. The vein was manually perforated by the practitioner. Many shallow cuts were sometimes made.

Spring loaded lancet

• Spring loaded lancets came into use during the early 18th Century. The device was cocked and a "trigger" fired the spring-driven blade into the vein.
  
• The fleam was heavily used during the 18th and 19th centuries. Many varieties exist. Sometimes a wooden "fleam stick" was used to hit the back of the blade and drive it into the vein. (Ouch!) The fleam was often used by veterinarians.

Scarificator

• The scarificator, a series of twelve blades, was also in vogue during the 18th Century, This device was cocked and the trigger released spring-driven rotary blades which caused many shallow cuts. The scarificator seems more merciful than the other blood-letting instruments.

Blood was caught in shallow bowls. During the 17th to 19th centuries, blood was also captured in small flint glass cups. Heated air inside the cups created a vacuum causing blood to flow into the cup - a handy technique for drawing blood from a localized area. This practice was called cupping.

Flint cup

The data above is based on Antique Medical Instuments by C. Keith Wilbur, M.D. (1987). For more details, see Bloodletting Instruments by A. Davis and T. Appel (1983).