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What’s with the blood-letting?
By C. Allyn PiersonAnyone who reads pre-Victorian literature or watches period films has come across an episode in which a character is ill and they are bled by their doctor. Sense and Sensibility, Jane Austen’s first published book, now celebrating the two hundredth year of publication, is a classic example. When Marianne Dashwood becomes seriously ill after her disastrous relationship with Willoughby, her doctor bleeds her to try and reduce her fever and save her life. My friends, who know I have an interest in the history of medicine, often ask me, “What’s with the bleeding? Was this really a treatment, and what were they trying to accomplish?” Yes, indeed, bleeding was a major treatment for a number of disorders before the mid-1800s, when a massive wave of medical scientific discoveries completely changed the practice of medicine.
Medical science in England before the modern era was based on concepts first delineated by ancient Greek physicians, such as Hippocrates and Galen. These principles were distilled into the holistic medicine (treatment of the entire body or constitution) practiced in the Georgian and Regency Eras. Human health was a situation where the patient’s constitution was balanced between “weakness” and “plethora.” Plethora was diagnosed in conditions where the patient became more red and warm, and might include fevers, localized infections such as cellulitis (where affected areas of skin become red and swollen), inflammatory arthritis (such as gout), and pregnancy (where the skin is typically more pink and warm than usual because of the increased blood volume during pregnancy). Weakness, on the other hand, was any condition that would make the patient paler, thinner or weaker: blood loss, fainting, chills, or wasting diseases.
The treatment of plethora included changes in diet to avoid anything which was thought to be “heating”, and generally meant anything red, rich or fatty, or stimulating. Foods to be avoided included red meat, eggs, spices, and stimulants such as wine, coffee, and tea. “Cooling” foods were encouraged, such as fruits and vegetable, and simply prepared meats. In addition, physicians would take blood from patients to directly remove the “excess” blood that was engorging their patients and causing them to be red and hot. This treatment would be likely to help patients with gout, where there is an excess of uric acid in the blood caused by too much red meat and red wine and not enough of the enzyme which breaks it down. This results in red, hot joints, most commonly in the big toe and the knee.
Fever was a common medical problem because of the lack of antibiotics and vaccinations (except for smallpox vaccination, which was widespread by the Regency Era). With this theory of health and disease states, bleeding a patient who was hot and feverish to decrease the fever made perfect sense. We cringe at this because we know that removing blood also removes white blood cells which fight infections, and weakens a patient who is already struggling with infectious organisms.
Pregnant women were often given “reducing” diets, not to decrease weight, but to decrease their plethora, or excess blood and heat. These “reducing” or “lowering” diets would consist of foods which were simple and “cooling”. These would include plenty of fruits and vegetables and limited red meat and heavy sauces. The improvement of constipation, which is common in pregnancy, on this diet was taken as encouragement that the diet was working as it should. Fortunately for the patients and their babies, most women did not follow these diets as strictly as their physicians would have liked. Women who had a history of miscarriage or infertility would be more likely to rigorously follow the suggestions of their physician, and to change physicians if their condition did not improve.
Patients who were pale and weak, such those who were having chills in the early stages of a cold were encouraged to have a “heating” diet and could eat as much red meat and drink as much wine, especially red wine, as they wished to warm an overly cool and weakened constitution. They would also be treated with heating treatments, such as mustard foot baths or mustard plasters to the chest. In this case, of course, blood-letting was not used.
An interesting historical side note to this treatment was the condition of the Prince Regent and his father, King George III. The king is well known for the periods of insanity from which he suffered, which eventually became permanent and required that the Prince of Wales become Regent. A number of medical historians believe the King George III suffered from a form of porphyria, an inherited disease in which the patient lacks one of the enzymes required to break down hemoglobin into smaller molecules which can then be excreted by the kidneys. The major symptoms of hereditary porphyrias are abdominal pain and psychiatric symptoms. The treatment of porphyria, still used today, is to remove blood from patients until they are slightly anemic and thereby decrease the number of porphyrins in their blood. The Prince Regent had a long history of various types of illness, including abdominal pain, and he was a great believer in blood-letting, having it done whenever he felt unwell. His symptoms might have been from his unrestrained eating and drinking, but if they were an indication of porphyria, his enthusiasm for having his blood let might have prevented him from developing the severe mental symptoms from which his father suffered.
C. Allyn Pierson is the pen name of physician and novelist Carey A. Bligard. She is interested in the works of Jane Austen and in the history of medicine, particularly that of the Regency Era. She lives in Iowa with her husband and two dogs.
*** GIVEAWAY ***
Mr Darcy's Little Sister
Darcy and Elizabeth have found their happily ever after - now it's Georgiana Darcy's turn! Joining her brother and his new bride, Elizabeth in London is a dream come true for the shy, sweet Georgiana Darcy. Eager to learn to negotiate polite society from her graceful and composed new sister-in-law, Georgiana is ready to make her entrance into the matchmaking and intrigue filled ballrooms of London. Making her way through the sea of rogues and fortune hunters, Georgiana will make the transition from being simply Mr. Darcy's little sister to a confident young woman with her own engaging story to tell.
C. Allyn Pierson has graciously offered up a copy of her novel, Mr Darcy's Little Sister for a giveaway!
THIS GIVEAWAY IS NOW CLOSED
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