As a medical therapy, bleeding or blood-letting endured for approximately 2,500 years. It was only abandoned at the beginning of the 19th century. The roots of bleeding as a medical therapy can be found in the Aristotlean idea thatall matter is composed of four elements: air, fire, earth, and water. The ancient Greek physician Hippocrates adopted this idea to explain health and disease in humans. In the body, the four elements were represented by four humors: blood, phlegm, black bile, and yellow bile. When the humors were ideally balanced, a person enjoyed good health; if the humors were unbalanced, a person suffered an illness. Unbalanced humors were supposed to be caused by an over-accumulation of one of the four humors. Quite reasonably, physicians decided that to regain balance, and therefore health, it was necessary to rid the body of the excess humors. Galen (A.D. 130-200) endorsed Hippocrates's theories and medical treatment did not change too much in the following 1,800 years.

The identity of the excess humor was revealed by the symptoms of the ill person. Since blood was thought to be the major humor, nearly any disease could be interpreted as arising from its excess. Through the history, bleeding was used to treat conditions as diverse as inflammation, pain, epilepsy, insanity,pneumonia, syphilis, fractures, and, incredibly, hemorrhage. Bleeding was often used alongside other treatments intended to balance the humors. These other treatments included purging, which meant inducing vomiting or diarrhea, and sweating. Along with bleeding, these treatments made up what was known as heroic medicine. Bleeding was sometimes employed even in the absence of any disease under the assumption that it could maintain health.

Bleeding was done by physicians as well as barber-surgeons. There were several ways in which a patient could be bled. The most extreme method was venesection, in which a vein would be opened and a bowl used to catch the blood. In addition to the danger of losing too much blood, the patient also ran the riskof infection or scarring. Local blood-letting was less extreme and was donethrough cupping or scarification or with leeches. Cupping involved placing aheated glass cup on the skin and allowing it to cool. A partial vacuum wouldform and when the glass was pulled from the skin, the area would bleed. Scarification required making slight to moderately deep cuts into the skin, but not so deep that veins were opened. Leeches, which are blood-sucking parasites,were applied directly to the skin and were thought to be especially useful in treating children and for drawing blood in areas where cupping could not beused.

If they were lucky, patients would recover from their diseases in spite of heroic medicine. In many cases, it's likely that people died from blood loss asthere were no rules on how much blood should be removed to restore health. That amount was left to the physician's best judgment. The case of George Washington, first president of the United States, illustrates how that judgment might not lead to the best outcome for the patient. According to his physician's notes, Washington was afflicted with an inflammation of the upper windpipeon a Friday night. As it progressed, he developed a fever and difficulty breathing. Following medical standards of the time, he had someone come to bleedhim that night. Twelve to 14 ounces of blood were removed, but he did not improve. The next afternoon, he was bled "copiously" twice more. When that proved ineffective, another 32 ounces of blood were removed. In addition to bleeding, his physicians also tried purging. By Saturday night, he was dead.

Through medical history, bleeding had opponents. For example, Erisistratos (300-260 B.C.), an early Greek physician, argued that it was a dangerous practice. He pointed out that the patient could lose too much bloodor that the physician might accidentally cut into tendons, arteries, or nerves. However, the practice of bleeding a patient was not given up until the 19th century. Even as late as the 1850s, some physicians still argued passionately for its efficacy against disease. It wasn't until Louis Pasteur and RobertKoch proved that many diseases arose from infection with microorganisms thatbleeding was finally abandoned as a standard medical therapy. Today, bleeding (or therapeutic phlebotomy) is used to treat a very specific set of blood diseases in which certain blood factors are overproduced or produce incorrectly.

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