The History of Bloodletting by Mark Twain

Mark Twain’s 1890 essay A Majestic Literary Fossil is a rebuke of the theories esteemed intellects in the field of medicine have had over the years. Modern readers might consider Twain’s rebuke of his yesteryear ironic, considering all of the advancements in medicine made since, but those readers should consider that Twain’s era saw an advancement from the common practice of Phlebotomy (bloodletting) in medicine to the “more advanced” methods of curing ailments. Mark  Twain described the advancement.

“The change from reptile to bird was not as tremendous, it just took longer.”

Twain’s essay A Majestic Literary Fossil describes the portion of his life he spent suffering under the common medical practice of bloodletting, and the 2,000 years of medical science produced by the most brilliant minds of their era that led to it.

Most modern readers would read such a thing and laugh with the knowledge that those in Twain’s day might have known more than blood letters, but that they didn’t know a fourth of what we know today. The question that these laughers should ask themselves is how many of those reading what we know to be true today are going to be laughing just as hard at us based upon what they know 123 years from our present. Will they be laughing at us for our prolific use of antibiotics to cure so much of what ails us? Will they be looking back on our use of chemotherapy as an archaic treatment of cancer? Are these the best of times in medical technology, or will future readers consider our advancements as laughable as we do those that occurred in Twain’s time?

Twain’s essay focuses most of its scorn on the bloodletting theories of the prominent physician, surgeon, and philosopher Galen of Pergamon from Rome (circa 129-216 A.D.). Historians considered Galen the father of Humorism, or bloodletting, and he based his theories on dissections of monkeys. Twain writes that Galen would’ve been welcomed into his father’s home, but that Galen might have been left waiting, because Twain’s family doctor “didn’t allow blood to accumulate in his system.” [Author’s Note: Writings from the day detail that optimum use of bloodletting’s preventative measures require that a doctor bleed a patient at least once a month.]

The commentary provided in this essay focuses on what they knew in their modern age (circa 1890), versus all they thought they knew yesterday. It focuses some scorn, some objective looks, and some hilarity on the prevailing wisdom of the previous eras. In their “modern era” of medicine, they saw how ridiculous collective wisdom could be, when viewed in the reflective “glare of the open day”. The essay details, without actually stating it, how much deference we offer doctors, their theories, and authority figures in general. The essay also focuses on how scientific theory can appear groundbreaking and miraculous in one era, until the “knowledge of the moderns” reveals the serious flaws of the previous era.   

Headache: “One could die of a headache in the age of bloodletting,” Twain writes. “For bloodletting was listed as the proper cure of a headache back then. One such victim “seized with a violent pain in the head” required bloodletting in the arms, the application of leeches to the nostrils, the forehead, the temples, and behind the ears.

“Alas,” observed the doctor, named Bonetus, who was focused on this particular patient, “These procedures were not successful, and the patient dy’d (sic). Had the patient not dy’d, and a surgeon skilled in Arteriotomy been present, that procedure would’ve been called upon.” [Author’s note: Arteriotomy, as defined by Twain, “Is the opening of an artery with a view of taking away more blood” when the opening of the veins proved insufficient to cure what ailed the patient.]

Twain comments: “Here was a person being bled from the arms, forehead, nostrils, back, temples, and behind the ears, and when none of this worked the celebrated Bonetus was not satisfied, and he wanted to open an artery for a view of the cure. Now that we know what this celebrated Bonetus did to relive a headache, it is no trouble to infer that if he had a patient that suffered a stomachache, he would disembowel him. Bonetus labels his writings as “observations”. They sound more like to confessions to me.”

Frostbite: Twain cites several remedies listed in the 1745 Dictionary of Medicine by Dr. James of London and Samuel Johnson. According to this book, “One can cure frostbite by mixing the ashes of an ass’s hoof with a woman’s milk” and “Milk is bad for the teeth, for it causes them to rot, and loosens the gums.”

Dentures: “They did apparently have false teeth in those days,” Twain writes, “But they were lashed to neighboring teeth with wires or silk threads. Wearers of these teeth were encouraged not to eat with them, or laugh with them, as they usually fell out when not at rest. You could smile with them, but you should not do so without practicing first, or you may run the risk of overdoing it. These false teeth were not for business, just decoration.”

Malaria: The cure for malaria, according to a man named Paracelsus, is a spider, a spider’s web, or water distilled through a spider’s web. As evidence of their homeopathic properties, Paracelsus, notes that when he gave a spider to a monkey for consumption, “That monkey is usually free of the disorders from which they normally suffer.” Paracelsus then backs this up with the case of a dying woman who was bled dozens of times a day without response. When these constant bleedings failed to yield satisfactory results, the desperate doctors forced this woman to swallow several wads of spider web, and the results were immediate. “She straight-way mended,” Paracelsus wrote.

“So,” writes Twain, “The sage (Paracelsus) is full of enthusiasm over the miracle cure that the spider web presented while mentioning, in only the most casual way, the discontinuance of the dozens of daily bleedings she had to endure. Paracelsus never suspected that this had anything to do with the cure.”

The theory behind bloodletting can be condensed in one succinct sentence: A body’s “humors” (fluids) have to be in proper balance to sustain health. All of the other theories listed below either contribute to, or support, that theory. Although Galen of Pergamon made some important discoveries regarding blood, he also contributed to this theory with the belief that blood “was created and eventually used up.” He did not believe that blood circulated in the manner we do today, and as a result, he believed that some blood could stagnate in the extremities and cause ill health. Thus, he believed that the vagaries inherent in humoral balance were the basis for health and illness. He believed that blood was the dominant humor and the one in most need of control. In order to perpetuate this balance of the humors, a physician would have to either remove excess, or stagnant, blood from the patient, or give them an emetic to induce vomiting, or a diuretic to induce urination. {1}

Humors of the body were broken down to four basic components by Galen: blood, phlegm, yellow bile, and black bile. “The theory of the four humors arose out of a Hellenic philosophy that attempted to relate all things to universal laws.” {2} Another component of the theory was that bloodletting could produce beneficial and countering effects on the body that was subjected to deleterious effects incurred as a result of the effects changing seasons could have on humors, how a person’s dietary habits could affect these fluids, the zodiac, a person’s age, and even the compass directions’ effects. The theory held that any, and all, of these exterior forces could shake up a body’s humors and cause a body to produce more of one humor (fluid) than was necessary in that body. By releasing the blood from the body, the body could then re-regulate the humors better in regeneration.

Twain takes some other cracks at the “home remedy” market of his day. He cites “Alexander’s Golden Antidote” that contains over one hundred ingredients, some of them common, others too complicated to mention, or attain over the counter. Twain concludes the lengthy description of this antidote, “Serve with a shovel,” but, he corrects, “We are only to take an amount that is the quantity of a hazelnut” according to the instruction on the listing.

He then mocks the “Aqua Limacum” antidote that lists the “homeopathic” qualities of the garden snail when properly prepared by washing in beer, baking in fires contained in a cleaned chimney until “they make a noise”. “And with a knife and a coarse cloth to wipe away any green froth that develops; then combining those snails with a quart of saline scoured earthworms; which should then be laid on a bed of herbs and combined with two handfuls of goose dung, and two handfuls of sheep dung, then put in three gallons of strong ale, and fixed on the head and refrigeratory until distilled according to art.” “The book does not say whether this is to be taken in one dose,” Twain writes, “or if you should split it and take a second shot at it … in case you live through the first one.

“The book does not specify what ailment this concoction is good for,” Twain continues, “But I have found that it is a formidable nostrum for raising good flatulencies from the stomach. It appears as though the advocates of this antidote sought to empty a sewer down the throats of those with malady so as to expel it. It is equivalent to dislodging larva from cheese with artillery fire.”

Most readers of this essay, yours truly included, would infer that Twain stood tall against homeopathy as a cure for anything, but he credits homeopathy for advancing modern medicine beyond bloodletting and other archaic forms of medicine. He states, “When you reflect upon the fact that your father had to take such medicines as those listed above, and that you would be taking them today yourself but for the introduction of homeopathy, which forced the old-school doctor to stir around and learn something of a rational nature about his business, you may honestly feel grateful that homeopathy survived the attempts of the mainstream medical proponents to destroy it, even though you may never employ any homeopath but a mainstream medical proponent in your life.”

The takeaway from this essay, as I see it, harkens back to the Dickens’ quote: “It was the best of times. It was the worst of times…” Are we living in the best of times in the arena of medical technology and advancement, or have we “advanced” to the worst of times where we run the risks of foregoing the natural, homeopathic, and organic cures of our forebears? Twain writes that the collective brains of modern medicine may still be bleeding us if it hadn’t been for homeopaths injecting some sense into the conversation, but such a statement leads us to a confusing fork in the road that asks whether we should continue to follow homeopathy or the advancements in modern medicine, or as Twain seems to suggest a healthy combination of the two?

In our more modern era, there is a move towards advancements in modern medicine that is just as strong, in some quarters, as the movement against it. There is a common sentiment, among those against, that states that proponents of modern medicine are relatively neglectful of the consequences of modernity. An old biology teacher of mine captured this when he said, “Any time you put a foreign substance into your body; there will be other ramifications.” When a patient puts something foreign in their body, this theory states, something else might fall out as a result. When the patient repeatedly takes a foreign, synthetic substance to solve an ailment of the left eye, it might deplete the stomach of bile, or they might not be able to hear out of their right ear in a year. We’ve all read the research, heard the disclaimers, and experienced horror stories, but which side of medical knowledge do we trust more?

Did the relative scarcity of medicinal techniques force our forebears to brilliantly, if simplistically, derive more natural –and in some opinions more effective– methods of survival in their age? Does our suspicion of advancement and technology cause us to reference old world, home remedies, and those remedies used by Native Americans, the Ancients, or any of those generations that preceded us, because they were forced to be more attuned to natural, more organic, and thus healthier cures?

Most of us are not students in the field of medicine, and we don’t understand how some guy in a lab can synthetically create some substance that makes our body work better, and what we don’t understand, we don’t trust. We’d much rather put our trust in the time-honored tradition of homeopathic remedies. Or, as my Biology teacher alluded, we’d much rather not introduce foreign, synthetic substances to our biology if we can avoid it, for fear of something else falling out.

How many of us have watched those commercials promising cures that are so laced with disclaimers that the disclaimers take up the majority of the commercial. It’s almost laughable. It’s enough for us to put out a call on the Federal Drug Administration (FDA) to up the average twelve to twenty-four years of testing on medicinal drugs before they hit our shelves. “I don’t trust them,” we say when a Big Pharmaceutical company puts another drug on the market, and we resort to the antidote that calls for snails, worms, goose dung, and lamb dung for a cure. “I just prefer the natural cures that we’re learning so much about nowadays,” we say to sound more intelligent than those that seek modern, Western advancements in medical technology. “They’re only in it for profit.” Fair enough, but if one of those Big Pharmaceutical puts a drug on the market that leads to nationwide headlines, the affect on their profit margin is such that they want to do everything in their power to prevent it. They may not care about their customers in the purest sense of the word, but they don’t want negative headlines to affect their bottom line, and the results are often the same.  

Bottom line for those who look back to a more natural, less synthetic era for their cures may want to consider the science that informed bloodletting and other cures and preventative measures that they considered sound science. Much of the science that informed those more traditional cures led to a 42.5 life expectancy, whereas modern science and medicine have our current life expectancy at 78.7. For every Eastern, homeopathic remedy that worked in Twain’s era, and could work now, there are also about one hundred, bloodletting type cures listed in the 1745 Dictionary of Medicine by Dr. James of London and Samuel Johnson that did not. Or, as the old saying goes, be careful what you ask for, because you just might get it. 




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