Blood-letting

For gases and vapors, the amount absorbed is highly dependent on the partial pressure of the gas and the solubility of the gas in blood. Let s take the simple case of a gas that is not metabolized and is excreted by exhalation (e.g., an anesthetic gas or a Halon-type fire-extinguishing agent). At any given concentration (or partial pressure) in the atmosphere, the concentration in the blood will reach a steady state in the blood. Accordingly, prolonged exposure does not lead to continual buildup. 

A bite from any such parasite is characterized by prolonged host bleeding. This property led to the documented use of leeches as an aid to blood-letting as far back as several hundred years BC. The method was particularly fashionable in Europe at the beginning of the ninteenth century. Many doctors at that time still believed that most illnesses were related in some way to blood composition and blood letting was a common, if uneffective, therapy. The Napoleonic Army surgeons, for example, used leeches to withdraw blood from soldiers suffering from conditions as diverse as infections and mental disease. 

To understand this apparent nonsense, let us look at an analogy. Instead of drugs and blood let us substitute water and ants eggs. 

Because mental illnesses are due to an imbalance between the body fluids, treatment must seek to restore the balance. Methods directed to the body were recommended, such as diet, bathing and showering, blood-letting and laxatives (hellebore). 

The major authority for medicine in the Middle Ages was Galen of Pergamon, who worked in Rome in the second century AD. Galen adopted the humoral theory of Hippocrates, including the classification of mental illnesses, and his therapeutic recommendations were also based on the tradition of the Hippocratic school diet, vomiting, blood-letting and the administration of soporifics. 

Between the Middle Ages and modern times stand physicians such as Paracelsus (1491 1541), Johann Wever (1515 1588) and Felix Plater (1536 1614), who turned more or less clearly against the concepts of witches and spirits that prevailed at that time, and restored natural causes to the centre-stage of mental illnesses. They had no new treatments to offer and, true to the Galenic tradition, prescribed blood-letting and purging to clean the body... 

The term diuretics comes from the Greek diuresis, meaning to urinate. In medieval medicine, diuretics were used to restore the body s humors (blood, bile, and phlegm) to balance, along with other therapeutic methods such as blood-letting and induced vomiting. 

The word arthritis simply means inflammation of the joints and the disease has been recognised as an affliction of the human condition since early times. The Hindus of India wrote about it as long ago as 1000 BC, and Hippocrates in ancient Greece believed it to be a symptom of poisoning which could be relieved by blood letting. A hundred years ago doctors thought it was caused by an infection and one way to treat it was to remove sources of infection from the body, such as teeth, tonsils, and appendix. Today we regard arthritis as an autoimmune disease in which the body s defence mechanism has turned upon itself. 

Occasional historical references to what we now call menopause and therapy for the condition can be found, such as the reference to hot flashes and other menopausal symptoms in the 1628 book. The Anatomy of Melancholy by Robert Burton. A 1675 account described a cooling diet for menopause. In 1701, physician Thomas Sydenham described the tendency of women ages 45-50 to develop hysterick fits, and suggested blood letting as therapy. 

Venesection treatment (W.D. Davis et at., 1950) is the method of choice it is the most effective therapy. Bloodletting of about 500 ml blood frees the body of some 250 mg iron. With an average accumulation of >25 g iron, weekly venesection should be considered over a period of at least 2 years. In patients with haemochromatosis (without simultaneous anaemia), blood-letting of 500 ml is carried out once a week until the serum ferritin value has normalized. Experience shows that the de-ironing of the body using this technique takes about... 

Deferoxamine can also be used as an adjuvant agent in the initial treatment phase to reinforce venesection therapy. This is administered as an i.m. injection of 500 mg/week, usually by the family doctor, about 2-3 days before blood-letting is carried out. 

Fig. 6.20 Aztec ritual blood-letting with sting-ray spines and burning copal in front of deities as shown in an illustration from the Tudela Codex...

Milky blood was observed frequently by physicians of the last century when blood letting was liberally employed. The fact that this turbid to creamy appearance of the blood serum was usually attributable to a high fat content had been clearly demonstrated by Hewson in 1774. However, numerous reports of serum turbi ty prior to 1850 probably included conditions other than hyperlipemia (leukemias, etc.). 

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