In the shadow of India’s largest mosque, the gutters run red with blood.
It’s a bizarre scene, if you’ve never seen a modern-day bloodletting. First, men wrap patients’ arms and legs with straps as tourniquets, to control the blood flow. Then they use razor blades to make tiny pricks in the hands and feet, and blood trickles into a concrete trough stained red with the day’s work.
The bleeding people look pretty happy, though. After all, they’ve paid for the service. They come to be cured of everything from arthritis to cancer.
(Video: Meet the bloodletters of Delhi and their patients.)
But why? How has the bloodletting business, which many doctors today would rank along with reading bumps on the head as olde timey quackery, managed not to dry up?
The appeal seems to be in its simple logic.
Muhammad Gayas runs his bloodletting business in the garden of the Jama Masjid mosque in Old Delhi. He says pain and illness happen “when the blood goes bad,” which is pretty much the same basic premise that bloodletters have sold the public since Hippocrates advocated balancing the four humors—blood, black bile, yellow bile, and phlegm—more than 2,000 years ago.
Bloodletting has been practiced around the world even longer than that, tracing at least 3,000 years ago to the Egyptians. It remained an obsession among many Western doctors through the 19th century, and was still a recommended treatment for pneumonia in a 1942 medical textbook—lest you think it went out after the Middle Ages along with the laying on of leeches. (Oh, and leeches still get some play, too, mainly for drawing down pockets of blood after plastic surgery or vascular microsurgery.)
So Does Bloodletting Ever Work?
It may be helpful for people with a few particular blood abnormalities. Doctors still use bloodletting, for instance, in cases of polycythemia—an abnormally high red blood cell count—and in a hereditary disease called hemochromatosis, which leaves too much iron in the blood.
I also came across a preliminary study suggesting vascular benefits in some diabetics with high iron levels, but this is far from a general treatment for the disease. Another small study in BMC Medicine got a lot of press in 2012 for showing that 33 people who gave up to a pint of blood had improved cholesterol ratios and blood pressure six weeks later compared with people who didn’t give blood, which the doctors also attributed to a reduction of iron levels. (Note that the amount of blood removed in the study was fairly low—a pint is about as much as you’d give when donating blood, which for the record is a great thing for healthy people to do and is not the same thing as bloodletting.)
But the design of that study doesn’t rule out a placebo effect—which has certainly contributed to bloodletting’s popularity in the past. What’s more, other studies suggest that too little iron is bad for cardiovascular health, so again, the potential benefit of removing blood is unclear.
Meanwhile, depleting the body’s blood supply can be risky. Not only is there the risk of losing too much blood, causing a dangerous drop in blood pressure and even cardiac arrest, but people who are already sick take their chances with infection or anemia. Not to mention that in most cases, bloodletting doesn’t cure what ails you.
So no, we don’t need to revive the tradition of the neighborhood bloodletter. In a sense, though, their legacy is still around: Red-and-white barber poles represent blood, bandages, and the stick that patients would grip during barbers’ days as bloodletters.
How Bloodletting Bled Out
It took the great bloodletting wars of the 1800s to begin turning the tide against the practice. The prominent doctor Benjamin Rush (a signer of the Declaration of Independence) set off a fury when he began bleeding people dry during the 1793 yellow fever epidemic in Philadelphia. By all accounts, Rush was a bloodletting fanatic and in general a real piece of work: “unshakable in his convictions, as well as self-righteous, caustic, satirical, humorless, and polemical,” writes doctor Robert North in a biography.
Rush recommended that up to 80 percent of his patients’ blood be removed, and during the yellow fever outbreak, North recounts that “so much blood was spilled in the front yard that the site became malodorous and buzzed with flies.”
Bloodletting’s detractors grew in numbers after that, and eventually Pierre Louis, the founder of medical statistics, began convincing doctors to rely on statistical evidence over anecdotal “recoveries” of patients who had been bled. A particularly impressive analysis showed that bloodletting did not help pneumonia victims in Europe, and after bitter disputes among doctors in the 1850s, the practice began dying out.
In fact, one history of bloodletting refers to the stamping out of the practice—over the objections of the medical establishment, no less—as a triumph of reason and “one of the greatest stories of medical progress.”