The History of Bloodletting by Mark Twain


It may strike modern readers of Mark Twain’s 1890 essay A Majestic Literary Fossil as a little ironic that Twain focuses such scorn on the theories of his yesteryear in the field of medicine. His age, after all, knew nothing of the world’s first synthetic drug aspirin, the medical uses of the X-ray, EKGs, antibiotics, penicillin, dialysis machines, advancements in vaccines and vitamin knowledge, MRIs, and of course the knowledge we’ve gained in our studies of the human genome. Those that disregard everything Twain calls “modern technology”, based on his age, should note that Twain saw the advancement from the common practice of Phlebotomy (bloodletting) in medicine to the “more advanced” methods of curing ailments in his lifetime. An advancement Twain describes thusly:

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

Mark_Twain_life_1900sIt should also be noted that bloodletting was the most common medical practice performed by the most brilliant minds of medicine in the 2,000 years that preceded Mark Twain. Twain knows this of course, and it forms the basis of the essay A Majestic Literary Fossil.

Most modern readers would read such a thing and laugh with the knowledge that those in Twain’s day may have known more than bloodletters, 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 now? 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 they later be perceived as the worst on a relative basis?

Twain focuses most of the scorn issued of his essay on those Bloodletting theories of the prominent physician, surgeon, and philosopher Galen of Pergamon from Rome (circa 129-216 A.D.). Galen was known as the father of Humorism, or bloodletting, and his theories were based on dissections of monkeys. Twain writes that Galen would’ve, unfortunately, been welcomed into his father’s home, but that Galen may 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 for bloodletting to be used as a proper, preventative measure, a citizen should be bled at least once a month.]

The commentary provided in this essay focuses on what they knew in their modern age (in the year 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 it is discovered to be seriously flawed by the “knowledge of the moderns” of another.

“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” was subjected to 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, that 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 blood.” It was the next step of the procedure to be used 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.”

Twain goes on to cite 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.”

“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.”

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 a spider is given to a monkey, “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 that 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 was that a body’s “humors” (fluids) had to be in proper balance to sustain health. Although Galen of Pergamon made some important discoveries regarding blood, he also believed 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 a humoral balance was the basis for illness or health. 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 either have to 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, and that 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 with: “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 actually credits homeopathy for advancing modern medicine beyond bloodletting and other archaic forms of medicine when 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 basically 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. This concern was perfectly captured by an old Biology teacher of mine that said: “Any time you put a foreign substance into your body; there will be other ramifications.” When you put something foreign in, this theory states, something else will fall out as a result. When you take a foreign, synthetic substance that fixes your eye, this concern states, how possible is it that you won’t be able to hear the next day? 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 seen 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 out 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 you’re looking to those homeopathic, Eastern cures that were prominent in Twain’s day, you must also account for the fact that 42.5 was their life expectancy, and it is 78.7 now. And for every Eastern, homeopathic remedy that worked in Twain’s era, and could work now, there are about one hundred, bloodletting type cures that are listed in the 1745 Dictionary of Medicine by Dr. James of London and Samuel Johnson that did not.

{1}http://en.wikipedia.org/wiki/Bloodletting

{2}http://www.maggietron.com/med/humors.php

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