[rael-science] Bloodletting: Return of a radical remedy‏

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Source: http://www.newscientist.com/article/mg21628912.200-bloodletting-return-of-a-radical-remedy.html?full=true

Bloodletting: Return of a radical remedy

It was unsanitary and dangerous, but for centuries bloodletting was standard practice. Could it now be used to relieve some of the complications of obesity?
WHEN King Charles II suffered a sudden seizure on the morning of 2 February 1685, his personal physician had just the remedy. He quickly slashed open a vein in the king's left arm and filled a basin with the royal blood.

Over the next few days, the king was tortured by a swarm of physicians buzzing around his bedside. They gave enemas and urged him to drink various potions - including boiled spirits from a human skull. The monarch was bled a second time before he lapsed into a coma. He never awoke.

Even without his doctors' ministrations, the king may well have succumbed to whatever ailed him, yet his final days were certainly not made any easier by the relentless bloodletting and purging. By the time of Charles II's death, however, bloodletting was standard medical practice.

Bleeding would very rarely have been beneficial. In fact, it would usually have been unsanitary and dangerous - sometimes even deadly. But now it seems that, with certain caveats, drawing off blood could have some health-giving properties for a select group of people.

Bloodletting dates back to the Roman physician, Galen, who lived in the 2nd century AD. Galen taught that blood was the product of food. After reaching the stomach, food was liquefied and then sent to the liver, where it was turned into blood. Sometimes people produced an excess of blood, he believed, which was the cause of all manner of disorders, including fevers, headaches - even seizures. The only recourse was to rid the body of this superfluous fluid.

As vital as bloodletting was felt to be, many physicians believed the "cutter's art" was beneath their station. Instead, they referred those in need of bleeding to barber-surgeons, who carried out this duty in addition to a diverse range of other personal services.

The traditional striped barber's pole harks back to that era, when it served as an advertisement for their proficiency as bloodletters. The pole represents the rod that the patient gripped to make their veins bulge and the brass ball at the top symbolises the basin used to collect the blood. The red and white stripes represent the bloodied bandages. Once washed and hung to dry on the rod outside the shop, they would twist in the wind, forming the familiar spiral pattern adorning poles of today.

Most practitioners used a double-edged knife called a lancet, which later gave rise to the name of the famous medical journal. An array of different-sized lancets were available, to prevent cutting into a vein too deeply. The Greek physician Hippocrates cautioned bloodletters to be careful when choosing their lancet, "for there are certain parts of the body which have a swift current of blood which is not easy to stop".

People could be bled from various parts of the body. In the 16th century, the German surgeon Hans von Gersdorff identified 41 suitable points, including the forehead, neck, arm, wrist, thigh and even genitals. During this period, veins were seen as belonging to the heart, breast or head. The nature of the illness indicated where a person should be bled. To treat nosebleeds, for instance, Galen advised bleeding from behind the knee.

This kind of thinking fell out of favour after the English physician, William Harvey, described how blood circulated around the body in his groundbreaking publication, De Motu Cordis (On the Motion of the Heart), in 1628. As word spread, most practitioners began confining their attention to the median basilic vein on the inside of the upper arm.

Bloodletting reached its apogee in the 18th century. By then, people were not just bled when they were ill, it was also used for preventative purposes, typically in the spring, seen as a time of rebirth and rejuvenation.

While bloodletting seems barbaric to modern eyes, it was considered a standard part of medical treatment, demanded by many people when they felt ill. Take George Washington, who woke on the morning of 14 December 1799 complaining that he couldn't breathe. Fearing his doctor would not arrive in time, Washington asked for the overseer of his slaves to step in and bleed him.The cut was deep, and Washington lost nearly half a pint before the wound was closed. Eventually, the physicians arrived and proceeded to bleed Washington four more times in the next 8 hours.

By evening, America's first president was dead. One of his physicians, James Craik, later admitted that he thought the blood loss was partly responsible.

By the mid-19th century, bloodletting was falling out of favour as different medical techniques emerged, reflecting new understandings of disease and its causes. Yet it may be that this ancient practice would be beneficial for people with a particularly modern problem: obesity.

Many people who are overweight have a cluster of medical problems including high blood pressure, high cholesterol and poor control of blood sugar levels, which is a precursor to diabetes. Together these are known as "metabolic syndrome".

Meat lovers

While not one of the classic signs, another common symptom in metabolic syndrome is a high level of iron in the blood, which seems to be caused by a genetic predisposition combined with a diet high in red meat. While it is unclear how these factors interrelate, high iron seems to play a causal role in high blood pressure and poor blood sugar control. It has also been implicated in fatty liver disease, another condition in which an unhealthy diet plays a part.

When we give blood - typically up to 470 millilitres - it takes a few weeks for our blood iron levels to be restored. That raises the intriguing possibility that a key mediator of at least some of the harmful effects of obesity could be combatted by the simple act of regularly siphoning off some blood.

It almost sounds too good to be true, but earlier this year, a study suggested it could, in fact, be that easy (BMC Medicine, vol 10, p 54). The trial involved 64 obese people with metabolic syndrome. Half had 300 millilitres of blood withdrawn at the start of the trial and a further 250 to 500 taken a month later. Six weeks from the start, those who had undergone two bleedings had improved blood pressure, cholesterol and glucose levels.

It is only one trial, of course, and a small, short-term one at that - further work is needed to see if the effect is real. But the results chime with a couple of other small studies that show bloodletting benefits people with high blood pressure or diabetes. Given that rising rates of obesity and its knock-on effects are arguably the western world's biggest health problem, perhaps this line of investigation should be prioritised. "It would have a big impact on public health if this is borne out," says Andreas Michalsen, a physician at the Charité-University Medical Centre in Berlin, Germany, who led the recent trial.

In the meantime, anyone with high iron levels and metabolic syndrome or fatty liver disease who finds it hard to switch to a healthier diet might want to consider donating blood as often as it is safe to do so, suggests Michalsen. In the UK, men are allowed to donate once every three months and women once every four months.

A surge in the popularity of blood donation would have benefits for our blood banks, too. "Everyone's a winner," says Michalsen.

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"Ethics" is simply a last-gasp attempt by deist conservatives and
orthodox dogmatics to keep humanity in ignorance and obscurantism,
through the well tried fermentation of fear, the fear of science and
new technologies.
 
There is nothing glorious about what our ancestors call history, 
it is simply a succession of mistakes, intolerances and violations.
 
On the contrary, let us embrace Science and the new technologies
unfettered, for it is these which will liberate mankind from the
myth of god, and free us from our age old fears, from disease,
death and the sweat of labour.
 
Rael
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