surgeon letting blood from woman's arm

Misquotes litter the internet, spreading like wildfire through faulty retellings via Twitter, Instagram, Facebook, and other social media channels. One of the most iconic of these sayings is reportedly a part of the Hippocratic Oath, "First, do no harm." But as the National Library of Medicine reports, the original Greek text doesn’t include this direct statement. Instead, think of it more like an overarching theme.

The intellectual wellspring from which the Hippocratic Oath sprang can be attributed to the Greek physician Hippocrates of Kos, per Live Science. He lived from 460 B.C. to 375 B.C. and gained acclaim as one of the first individuals to look at illness in a natural rather than supernatural way. Essentially, he argued that curing ailments required proper upkeep rather than devotion to the gods. He dedicated his life to creating the first intellectual school of medicine, earning a reputation as the "father of medicine." Hippocrates and his students produced 60 medical documents still preserved today and unified by the concept of a "healthy mind in a healthy body" (via the Journal of Medical Ethics and History of Medicine).

But one of Hippocrates’ most famous medical theories, the four humors, inadvertently led to incalculable harm for centuries, leaving a veritable blood bath in its wake. It involved the practice of bloodletting, considered an essential tool in reestablishing balance in the four humors through the removal of excess liquids. Keep reading as we explore the radical history of bloodletting and some of its most famous victims.

Bloodletting boasts a 3,000-year history

Egyptian ancient papyrus

According to the British Columbia Medical Journal, the ancient Egyptians first documented bloodletting (aka venesection) roughly three millennia ago. But they didn’t enjoy a monopoly on the practice for long. Soon, everyone from the Greeks and Romans to the Arabs and some Asian groups would let the blood spill in the name of healing. One of the world’s oldest and most universal medical practices, bloodletting enjoyed broad application, whether you suffered from a fever or a migraine, per History. (It also filled the gap for just about every condition in between.)

The practice continued throughout the Middle Ages and beyond, both culminating and falling into question in the Western world during the 19th century. That said, books such as Heinrich Stern’s "Theory and Practice of Bloodletting" still advocated for the practice into the early 20th century. Writing in 1915, he predicted a bright future for phlebotomy, arguing, "Whoever has devoted some attention to the periodical literature on bloodletting knows that in the last 10 years, the number of advocates of this remedial procedure has increased and that of its opponents decreased."

Fortunately, Stein remained (mostly) dead wrong when it came to this prediction. Yet, it demonstrates how recently bloodletting got lauded as a cure. To play devil’s advocate, the practice continues today for a narrowly circumscribed list of diseases. (We’ll explore this later.)

The paradigm of disease that made bloodletting legit

Fresco in crypt of the Cathedral

More than two millennia ago, Hippocrates first steered people away from supernatural explanations regarding natural ailments of the body (via the British Columbia Medical Journal). Instead of sending sick people off to make sacrifices to the gods, he counseled them to participate in holistic health management that involved eating better, regular exercise, and even art therapy, per the Journal of Medical Ethics and History of Medicine. Sound familiar? If so, that’s because Western medicine still takes significant cues from him.

Hippocrates represented a man ahead of this time, except when it came to the disease paradigm to which he subscribed. He perceived disease in terms of four basic elements: air, earth, water, and fire. Hippocrates and his students related these to four humors in human beings: phlegm, black bile, yellow bile, and blood. In other words, illness stemmed from too much of a good thing when it came to an imbalance of humors.

To right such a situation, physicians naturally advocated for the removal of the excess humor. Unfortunately, this removal required some really unpleasant treatment options: purging, catharsis, diuresis, and bloodletting, to name a few. But phlebotomy as the be-all, end-all of cures didn’t have a firm foundation until the first-century medical figure Galen of Pergamum (via Heinrich Stern’s "Theory and Practice of Bloodletting"). Concluding that blood marked the dominant culprit in 99 percent of diseases, you could say he put venesection on the map. Soon, everybody was doing it.

 Bloodletting from a German Medical Manuscript
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