Hull, England, UK
|Fig 1. Broussais & leeching. Credit: Encyclopædia Britannica.|
The practice of bloodletting began with the Egyptians and was succeeded by the Greeks, Romans (including Galen), and healers in India. In medieval times it spread throughout Europe. The “leech craze” was so popular in the nineteenth century that it has been estimated that five to six million leeches per year were used in Paris, and about 35 million in France. Its dubious rationale was that bloodletting helped to balance the traditional humors: blood, green bile, phlegm, and black bile.
One of its chief advocates was François-Joseph-Victor Broussais (1772-1838) (Fig 1), a French physician who used bloodletting, leeching, and fasting. He was a major influence in Parisian practice.1 The application of leeches was a “gentler” means of bloodletting than lancing a vein; along with scarification and cupping they were all standard treatments for pneumonia, plague, typhoid, typhus, dysentery, smallpox, epilepsy, gout, and other ailments.
The application of leeches (hirudines) was based on the European medicinal leech (Hirudo medicinalis). After attaching its head sucker to the skin, the leech uses its razor-sharp teeth to cut the skin. (Fig 2) Its saliva contains a local anesthetic, vasodilators, and the potent anticoagulant hirudin. A single leech ingests about 15 ml. of blood in half an hour. When engorged, the leech detaches itself and its wound continues to ooze for about ten hours, resulting in a blood loss of about 120 ml. The leech is then replaced.
Among its many supporters were John Hunter, Benjamin Rush, and surprisingly, William Osler, who wrote in The Principles and Practice of Medicine (1892):
During the first 5 decades of this century the profession bled too much, but during the last 5 decades we have certainly bled too little. Pneumonia is one of the dis- eases in which a timely bleed may save life.
In 1799, George Washington (1732–1799) developed a fever and throat infection. Under the care of his three physicians he had an estimated five to seven pints of blood removed in sixteen hours plus emetics and laxatives. He died the next night of what has been diagnosed retrospectively as epiglottitis.2 His treatment provoked fierce argument about bloodletting.
The procedures became controversial.3 In Edinburgh, William Alison (1790–1859) was a proponent while his colleague Hughes Bennett (1812–1875) derided bleeding, believing in the more modern treatments. In Paris too, Pierre Charles Alexandre Louis (1787–1872), another scientific physician observed that the procedure “was actually much less effective than has been commonly believed.”
|Fig 2. The Medicinal leech. Credit: Encyclopædia Britannica.|
Broussais (1772-1838) was born at St. Malo, son of a Breton physician to whom he was apprenticed before serving as a sergeant with the Republican Army. In 1792, he studied in the hospital of St. Malo and worked as a naval surgeon before moving to Paris in 1800, and graduated MD in 1803, having studied with Bichat, Corvisart, and Pinel. During three years campaigning with Napoleon’s forces he developed, without experimental evidence, his theory of disease.4 After the fall of Napoleon in 1814, he returned to Paris at the military hospital at Val-de-Grâce. In 1831 he became Professor of Pathology in Paris.
Influenced by M. Bichat’s theory of the physiological irritability of tissues and J. Brown’s theory of excitability, he opposed the idea of specificity in pathology. He thought that all disease resulted from inflammation and irritation of tissues. Broussais attributed many diseases, especially fevers, to irritation of the gastrointestinal tract that caused widespread inflammation. His treatment was therefore to control inflammation by giving relaxants, bloodletting, and leeches. His main works were Histoire des phlegmasies ou inflammations chroniques (1808), and Cours de pathologie et de thérapeutique générales. Later in life he lectured on phrenology.
When his treatment of victims of the 1832 Paris cholera epidemic ended disastrously, his techniques of bleeding fell into disfavor. Although leech farms also declined, leeching persisted until the beginning of the twentieth century. It is now seldom used except in attempts to restore blood flow to areas of damaged veins after reattaching severed body parts, such as fingers or after tissue grafts.
- Ackerknecht EH. Broussais or a forgotten medical revolution. Bulletin of the History of Medicine 1953;27(4): 320-343.
- Parapia LA. History of bloodletting by phlebotomy. Brit J Haemat 2008;143:490-495.
- Kerridge IH, Lowe M. Bloodletting: The story of a therapeutic technique. Med J Aust 1995;163:631-633.
- François Joseph Victor Broussais (1772-1838) System of Physiological Medicine. JAMA. 1969;209(10):1523.
JMS PEARCE, MD, FRCP, is emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England.