Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

We will employ the principles of evidence-based medicine to test alternative therapies, so it is crucial that we properly explain what it is and how it works. Rather than introducing it in a modern context, we will go back in time to see how it emerged and evolved, which will provide a deeper appreciation of its inherent strengths. In particular, we will look back at how this approach was used to test bloodletting, a bizarre and previously common treatment that involved cutting skin and severing blood vessels in order to cure every ailment.

The boom in bloodletting started in Ancient Greece, where it fitted in naturally with the widespread view that diseases were caused by an imbalance of four bodily fluids, otherwise known as the four humours: blood, yellow bile, black bile and phlegm. As well as affecting health, imbalances in these humours resulted in particular temperaments. Blood was associated with being optimistic, yellow bile with being irascible, black bile with being depressed and phlegm with being unemotional. We can still hear the echo of humourism in words such as sanguine, choleric, melancholic and phlegmatic.

Unaware of how blood circulates around the body, Greek physicians believed that it could become stagnant and thereby cause ill-health. Hence, they advocated the removal of this stagnant blood, prescribing specific procedures for different illnesses. For example, liver problems were treated by tapping a vein in the right hand, whereas ailments relating to the spleen required tapping a vein in the left hand.

The Greek medical tradition was held in such reverence that bloodletting grew to be a popular method for treating patients throughout Europe in the centuries that followed. Those who could afford it would often receive bloodletting from monks in the early Middle Ages, but then in 1163 Pope Alexander III banned them from practising this gory medical procedure. Thereafter it became common for barbers to take on the responsibility of being the local bleeder. They took their role very seriously, carefully refining their techniques and adopting new technologies. Alongside the simple blade, there was the phleam, a spring-loaded blade that cut to a particular depth. In later years this was followed by the scarificator, which consisted of a dozen or more spring-loaded blades that simultaneously lacerated the skin.

For those barbers who preferred a less technological and more natural approach, there was the option of using medicinal leeches. The business end of these bloodsucking parasitic worms has three separate jaws, each one of them carrying about 100 delicate teeth. They offered an ideal method for bloodletting from a patient’s gums, lips or nose. Moreover, the leech delivers an anaesthetic to reduce pain, an anticoagulant to prevent the blood from clotting, and a vasodilator to expand its victim’s blood vessels and increase flow. To enable major bloodsucking sessions, doctors would perform bdellatomy, which involved slicing into the leech so that blood entered its sucker end and then leaked out of the cut. This prevented the leech from becoming full and encouraged it to continue sucking.

It is often said that today’s red-and-white barbershop pole is emblematic of the barber’s earlier role as surgeon, but it is really associated with his position as bleeder. The red represents the blood, the white is the tourniquet, the ball at the end symbolizes the brass leech basin and the pole itself represents the stick that was squeezed by the patient to increase blood flow.

Meanwhile, bloodletting was also practised and studied by the most senior medical figures in Europe, such as Ambroise Paré, who was the official royal surgeon to four French kings during the sixteenth century. He wrote extensively on the subject, offering lots of useful hints and tips:

If the leeches be handled with the bare hand, they are angered, and become so stomachfull as that they will not bite; wherefore you shall hold them in a white and clean linen cloth, and apply them to the skin being first lightly scarified, or besmeared with the blood of some other creature, for thus they will take hold of the flesh, together with the skin more greedily and fully. To cause them to fall off, you shall put some powder of Aloes, salt or ashes upon their heads. If any desire to know how much blood they have drawn, let him sprinkle them with salt made into powder, as soon as they are come off, for thus they will vomit up what blood soever they have sucked.