On Bloodletting.

Selected writings of John King:

This is another of Dr. King's educational tracts, in which he attempts to teach the effects of blood-letting. Such papers were powerful assets in the hands of the reformers, whose opposition to the lancet was almost a matter of religious obligation. While not strictly in accord in all respects in points of pathology as understood to-day, it may yet be profitably read as furnishing valuable information upon the pernicious effects of the abstraction of large amounts of blood. Such arguments as offered herein did much to teach physicians the undesirability of certain old and established forms of routine treatment and to bring about the complete abolition of the practice of bleeding, thus fulfilling a part of the mission of the early Eclectics.—Ed. Gleaner.

ON BLOODLETTING.—Many individuals are in the habit of being bled once, or perhaps several times yearly, and some of them state that they have not experienced any bad effect from it; yet upon a close examination we find them subject to nervousness, dizziness of the head, debility, fainting, and often convulsions, with other strange and unpleasant sensations, for which they are unable to account, attributing them to any other cause than the loss of blood, which, in fact, they -consider a remedy for these symptoms. And it often happens that from the general debility caused by it the absorbents, exhalents, and the secreting and excreting organs perform their offices irregularly and unhealthily, producing diseases of solids, and dropsical affections, which more or less speedily determine the death of the individual. Some who read this article can, no doubt, bear testimony to the truth of the above statement. An idea has prevailed in community that bleeding removes only the bad blood, which absurdity is even encouraged by physicians themselves, but for what purpose, we are left to conjecture. It is, indeed, very true that a ligature being placed around a limb will obstruct and retard the circulation in its extremity, from which cause the blood takes up an increasing quantity of carbon of the animal substance, rendering it darker, thicker, and disposed to, coagulate or clot; but this certainly does not prove that the whole nervous system partakes of a similar character; it merely proves that an obstructed or deficient circulation causes an increase of carbon in the blood, from which may result many dangerous diseases.

It has likewise been remarked by some that in case we draw the healthy and unhealthy portions of the blood from a vein at the same time, (the new blood which is constantly forming being pure and healthy,) that by repeated bleedings we may gradually remove all impurity in the same manner as we might purify a cask of foul water, by drawing off the foul water and, at the same time, supplying its place with pure, thus slowly correcting its impurity. But the cases are not parallel, for it must be observed that bleeding produces debility, disposes to disease, and every subsequent depletion increases this disposition; and, even should we admit the newly formed blood to be pure, yet by its assimilation with the unhealthy it soon ceases to be such, and becomes gradually diseased with the rest; the old symptoms again present themselves, and another bleeding is considered necessary, thus surely increasing the disposition to disease.

Let it be remembered, however, that bleeding also injures the powers of digestion, in consequence of diminishing the quantity of oxygen necessary for the health of the animal, producing dyspepsia and impaired chyle, from which neither pure nor healthy blood can be formed.

The effect of the loss of blood upon the lungs is also very serious, it subtracts the nervous energy, as if the eighth pair of nerves were divided.

Professor Andral states "that in cases where bleeding has been employed the lungs present similar appearances to those of animals in whom the pneumogastric nerves had been divided, or of individuals who, died apoplectic." In addition to these evils resulting from bleeding alone, how much more serious do they become when the mineral poisons are administered in conjunction. By referring to the London Medical Gazette of April, 1829, we find that Drs. Brodie, Ward, and others agree that bleeding in cases of poisoning promotes the, absorption of the poison. And as the action of many of the mineral remedies upon the system is poisonous, if may be readily perceived how much more serious must be their effects when used in connection with bleeding.

It may be enquired, "Do you bleed in case of falls, severe bruises, pleurisy, or apoplexy?" We unhesitatingly answer—No.

Apoplexy is produced in consequence of the blood becoming thick and viscid; from its sluggish circulation in the venous system particularly, and also from a consequent determination of blood to the brain, * * * bleeding can not remove this viscidity, neither does it equalize the circulation, but always disposes to an aggravation of these symptoms, which, it must be borne in mind, generally result from a diseased condition of the liver, brain, or other organs.

Bleeding is not recommended by physicians in falls or blows until the natural reactive effort has taken place, which is the only effort that can restore the equilibrium of the circulation which has been deranged by the blow or fall-and the object of bleeding, then, is "to, moderate the violence of the reaction when it does come on, as, if unrestrained, it often endangers the structure of the organ affected by inducing in it inflammation." We will presently enquire how bleeding may prevent inflammation.

In pleurisy, which is an inflammation of the pleura, bleeding may produce relief, but it does not cure the disease,—it only relieves one of the accompanying symptoms, pain, but does not allay the inflammation, or rather the cause of it.

Suppose we admit the above indication for the lancet in falls or blows, and for the sake of illustration grant even further, that inflammation is the invariable result of every blow or fall, howsoever severe it may have been. What then? Can not this inflammation be reduced without taking blood? Does bleeding reduce the inflammation. in a healthy manner? On the contrary, does it not only reduce the quantity, (not the quality) of the blood in the system, affording a relief which is speedily followed by debility and increase of disease?

What is inflammation? Dr. Dunglison, who is excellent authority, informs us, "It is an irritation in a part of the body occasioned by some stimulus, owing to which the blood flows into the capillary vessels in greater abundance than natural, and those vessels become dilated; whence result pain, redness, heat, tension, swelling, etc."

Here then are three actions previous to inflammation, or rather three causes to produce inflammation. Firstly, a stimulus in some part of the body, which produces. Secondly, an irritation, from which is caused. Thirdly, a greater determination of blood to the part.

Now, does bleeding remove this stimulus? No, it only removes a portion of blood, and the blood certainly did not produce the stimulus. Does it prevent the irritation? No, it only prevents the patient from retaining his natural quantity of blood and thereby from recovering more rapidly. Does it lessen the determination of blood to the part? No, it only lessens the quantity of it in the system; and the patient in many instances lingers for days, and even weeks, when he might have been benefited in a few hours by a treatment more rational and more in accordance with the laws of the animal economy-namely, by properly and healthily equalizing the circulation of blood, without that lasting debility which is certain to follow its abstraction.

We are aware that by many physicians bleeding is considered a means of equalizing the circulation—of such we would enquire—how that portion of the blood which has been received into the basin equalizes its circulation throughout the system?

Let us endeavor to ascertain or investigate why and how bleeding injures. The material part of our system derives its maintenance from the food which we eat, and vitality is imparted to it from the atmosphere by which we are surrounded during the action of respiration.

It is universally admitted that the oxygen of the atmosphere contains that principle which bestows and sustains life, and that if we were deprived of it death would be the consequence.

Now let us examine this. The food which we eat undergoes the process of chylifaction, by which the chyle, a milk-like liquor, is separated from it, and from which fluid the: blood is formed. But the blood thus formed from the chyle is entirely destitute of vitality, is utterly incapable of renovating the system until it has been thrown into the lungs, where it undergoes a complete new change, life is imparted to it, and it can now renew the wasting energies of the constitution. That change through which it has just passed is the excretion or expulsion of the carbon, derived from the food and animal substance in the form of carbonic acid gas, and the absorption of the oxygen gas of the atmosphere.

It has been found that 100 parts, in weight, of atmospheric air contains 21 parts of oxygen, and 79 of azote; but that after the action of expiration, or its expulsion from the lungs, it has undergone a material physical and chemical change. In the place of 21 parts of oxygen we have but 18 or 19 parts, with the same quantity of azote as before its inhalation, and three to four parts of carbonic acid gas. Hence we observe that at every inspiration which we make the blood thrown into the lungs absorbs 3 to 4 parts of the oxygen, or life-giving principle of the atmosphere, while at the same time it parts with an equal quantity of its carbonic acid gas.

It is now that the blood is ready to fulfill its proper offices—it is distributed throughout the system by means of the arteries, parting with the principal portion of its oxygen as it flows along, and thus continually supplying all the various parts, of the body with vitality, at the same time freeing them of the carbon, azote, and hydrogen which they may contain, likewise depositing portions or globules of itself to supply the waste of the animal or material substance; it is then, by means of the veins, reconducted to the heart and lungs, again to receive the all-invigorating principle of life-, having its hydrogen excreted by the liver—its azote by the kidneys—and its carbon by the skin and lungs.

From these facts it may be readily understood how bleeding injures and debilitates. By the loss of blood the quantity which is thrown into the lungs becomes decreased, the necessary amount of oxygen is not received into the system, consequently vitality is diminished, and the whole frame becomes debilitated. The lungs not having the requisite quantity of blood passing into them lose their energy—those gases which are deleterious when retained in the system, as hydrogen, azote and carbonic acid, and which are continually accumulating in the system, thus producing both unhealthy blood and bile, are from diminished vital action not separated and excreted as rapidly, nor in that proportion which health requires; hence arise diseases variously characterized as palsy, epilepsy, tic doloureux, apoplexy, impotency, sterility, etc., confined principally to the nervous system, as the nerves, spinal marrow, and brain receive more of this recuperant power than any other organs of the human body.

And when in addition to this loss of blood we have it still further injured by the presence of poisonous minerals, acting as foreign and irritating substances, partially destroying that principle on which the absorption of the oxygen depends, we are not at all surprised at the serious results, nor at a loss to conceive how and why they originated.

It may be said in reply to the above that if the venous blood holds all these deleterious gases, instead of being injured by bleeding, we are on the contrary benefited by losing only a portion of the blood which is deleterious to life.

But it must be remembered that there are certain organs which remove these gases with which we have been wisely provided, namely, liver, lungs, kidneys, and skin,—but no lancet, which is unnatural, unwise, and dangerous. By bleeding we remove both the blood and gases together—by increasing the excretions we remove only the deleterious matter, and the blood remains ready for the absorption of the oxygen in the lungs. And if we must bleed to remove these noxious gases, then do it effectually, by removing all that venous blood which holds them.

Dr. Thacher, in his Practice, page 203, says: "We have no infallible index to direct us. It is impossible from the state of the circulation in fever to point to any certain criterion for the employment of the lancet; the state of the pulse is often ambiguous and deceptive. Circumstances require the nicest discrimination., as the result is often very different in cases seemingly analogous. A precipitate decision is fraught with danger, and a mistake may be certain death."

How presumptuous, then, must be that man who, at the risk of destroying his patient, takes from him not only ounces, but often pounds of blood, and that too without any kind of knowledge as to its future effects; for we are told by Dr. Mackintosh that "no physician, however wise and experienced, can tell what quantity of blood ought to be taken in any given case."—J. KING, M. D., Western Medical Reformer, 1846.

The Biographies of King, Howe, and Scudder, 1912, was written by Harvey Wickes Felter, M. D.