|
|
|
|
|
|
To Bleed or not to Bleed?
|
|
By
Aisha
El-Awady |
27/07/2004 |
|
|
| Bloodletting
has been used as a therapeutic measure for more than 3000 years
|
The
practice of bloodletting, medically known as phlebotomy, has been used as a
therapeutic measure for more than 3000 years. This practice was also advised by
the Prophet Muhammad (peace be upon him) in more than one hadith, such as that
narrated by Ibn Abbas (may Allah be pleased with him) that the Prophet (peace
and blessings be upon him) said: “Healing is in three things: in the
incision of the cupper, in drinking honey, and in cauterizing with fire, but I
forbid my Ummah (nation) to use cauterization” (reported by Al-Bukhari).
Bloodletting
reached its peak in the early 19th century, but
with the advance in medical research and knowledge, the study of the physiology
of the human body and the understanding of the role of bacteria in infections,
the practice underwent a steady decline and acquired a bad reputation among
medical personnel.
The
History of Bloodletting
Up
until the mid 19th century, bloodletting in its different forms was believed to
have a therapeutic role against a wide range of diseases. Many methods were in
use and these methods, as well as the theories behind them, changed over time.
Bloodletting
instruments have been found that date as far back as the Stone Age. It is known
that many ancient civilizations used bloodletting as a form of therapy,
including the Ancient Egyptians, Aztecs, Babylonians, Greeks, Romans as well as
the Hindus.
Tools
used in this practice varied widely and included thorns, sharply pointed sticks,
bones, flint or shell, shark teeth, lancets and the dreadful scarifier, which
was an instrument that produced numerous incisions at the same time. In South
America and New Guinea, miniature bow and arrow devices have also been found.
Leeches
are thought to have been used for bloodletting since the second century BC.
During the 19th century, they were the mainstay of medical practice in European
countries. Their use was so extensive that in 1833 the number of leeches
imported by France alone was more than 42 million. They were superior to other
tools of bloodletting as they could remove blood painlessly and the amount of
blood removed could be more or less controlled. They were used to treat
headaches, to reduce inflammation, as well as to remove blood from hard to reach
areas such as hemorrhoids, the tonsils, and the cervix. The use of leeches
declined with the decline of the practice of bloodletting; however, in the past
30 years their application has returned once again to bio-medicine.
Theories
Behind the Practice
|
|
| Bloodletting
was needed to re-establish the proper balance of the four humors
|
The
theories behind the practice of bloodletting have changed over time as the
theories behind the causes of disease evolved. In primeval times, disease was
thought to be caused by evil spirits, demons and other supernatural causes.
Religious ceremonies were performed in which sorcerers or witch doctors would
use bloodletting as a means to flush out these evil spirits and force them to
leave the body.
The
first documentation of the practice of bloodletting was found in the Corpus
Hippocraticum. The concept of the four humors was developed by Hippocrates,
who believed that all diseases were caused by an imbalance of the four humors
namely blood, phlegm, yellow bile, and black bile. In order to restore health,
bloodletting was needed to re-establish the proper balance of the four humors.
During
the 14th and 15th centuries, astrology played a vital role in the medical
practice. Patients would be positioned on a phlebotomy table designed to show
the relation of each body part to the signs of the zodiac. Surgical procedures
and bloodletting were only performed when the planets were in a certain
position. Therefore, bloodletting would only be performed at certain times for
certain body parts.
The
Decline of the Practice
Research
performed in the 1830s by Pierre C. A. Louis on hundreds of patients in Paris
hospitals was the first sustained critique of the therapeutic value of
bloodletting. Between the mid and late 19th century, scientific advances and
laboratory studies led to the understanding of physiology and pathology at the
cellular and biochemical levels, the identification of the components and
functions of blood, as well as the physiology of the cardiovascular system and
knowledge regarding bacteria.
Furthermore,
the study of blood pressure and volume as well as the understanding of the
importance of blood in the delivery of oxygen to tissues made the custom of
intentional removal of large amounts of blood appear to be counterproductive to
healing. Such knowledge led to the steady decline of the practice. However,
bloodletting did not disappear completely and was still being used in the early
20th century for certain conditions such as cerebral hemorrhage, arterial
aneurysms, during high fevers in patients with acute renal insufficiency and
also to treat gas poisoning before and throughout World War I.
The
Return of Bloodletting into Modern Medicine
Although
bloodletting had begun to receive a bad reputation in the 19th century, the
practice did not disappear entirely from the medical practice. In the 1920s, it
was used as an emergency procedure for patients requiring a rapid reduction of
venous pressure to help relieve stress on the heart and lungs such as for relief
of congestion following acute heart failure. It was also - and is still - used
for patients suffering from polycythemia (American Society of Hematology), which
is a disease characterized by having an excess of red blood cells and of blood
volume. These individuals were found to benefit from routine bloodletting.
In
1950, it was also found to benefit those with hemochromatosis. Patients with
this disease suffer from the deposition of excessive iron in their various body
organs. Bloodletting allows the body to use the excess iron for the production
of new red blood cells instead of those lost in the procedure.
It
was recently discovered that bloodletting also helped patients with hepatitis C
to better respond to interferon since it reduces their serum iron content. Given
that the virus needs iron to replicate, high iron levels may therefore correlate
with high viral replication. Furthermore, most patients with hepatitis C have an
abundance of iron stored in their liver and it has been found that high levels
of hepatic iron may reduce patient response to interferon therapy
(U.S.
Pharmacist Continuing Education, May 2002).
Bloodletting
using leeches has also recently re-emerged on the medical scene after they were
found to have exceptional benefits to certain procedures following plastic and
reconstructive surgery (American Journal of Orthopedics).
In
the 1980s, leeches were rediscovered by plastic surgeons for their local
anticoagulant and bloodletting properties, which were found to be extremely
useful following certain procedures such as the re-implantation of fingers, skin
grafts and breast reconstructions. It was found that by placing the leech on the
region, the rapid blood sucking and anticoagulant properties of the leech could
relieve any congestion at the surgery site and allow the blood to flow more
efficiently (Microsurgeon.org).
Bloodletting
in Islam
|
|
| Cupping
is a popular form of phlebotomy in the Middle East
|
According
to Sheikh `Abdul-Majeed Subh, a prominent Azharite scholar, “Bloodletting or
cupping is a practice approved of by the Prophet (peace and blessings be upon
him) who used to pay an amount of money for this therapeutic measure”
(Islamonline.net).
However,
although bloodletting is recommended in Islam, it should be practiced in
accordance with the scientific data and knowledge currently available, and not
in the disorderly and unscientific manner in which it is being used in many
Islamic countries today by unprofessional individuals for everything from aches
and pains to weight loss. A proper understanding of the procedure and its
benefits is also required by those who perform the technique to avoid any side
effects.
It
should also be noted that despite the fact that certain medical procedures such
as bloodletting were previously considered to be outdated, by no means should
they be deemed obsolete nor should their possible re-emergence as respectable
therapeutic intervention be disregarded.
Sources:
-
U.S.
Pharmacist Continuing Education (May, 2002) - Update on Hepatitis C Virus -
Lesson
-
Lawrence,
Susan C. (1999): Two
Millennia of Bloodletting: Part II. Debating Therapeutic Value: Decline and
Survival in Modern Medicine.
-
Weinkove,
Robert (1998): The
fall and rise of the medicinal leech, Student BMJ August
-
Seigworth,
Gilbert R. (1980): Bloodletting
over the Centuries. New York State Journal of Medicine, 2022-2028.
-
Fatwa
bank (2004): Cupping
as a Therapeutic Measure (Islamonline.net)
-
Spivak,
Jerry L. (2002): Polycythemia
vera: myths, mechanisms, and management Vol. 100, No. 13, pp. 4272-4290.
American Society of Hematology
-
Daane
S, Zamora S, Rockwell WB. Clinical use of leeches in reconstructive surgery.
Am J Orthop. 1997 Aug; 26(8):528-32.
-
Hirudensis
Medicinalis-Medicinal Leeches. Microsurgeon.org.
*
Aisha El-Awady has a bachelor’s degree in medicine, a
master’s degree in parasitology and is currently working as lecturer of
Parasitology in Cairo University’s Faculty of Medicine. She may be
contacted at aawady@islam-online.net
|
|
|
|
|
|
