A Century of Service - Eoin O'Brien

The Voluntary Hospital Movement and the Dublin School
The oldest of these techniques was blood-letting, which has been practised in one
form or another by almost all cultures and societies. 34 One method employed was
phlebotomy or venesection whereby a vein was opened with a lancet or fleam, the
blood then being collected in a bowl; alternative techniques were the local removal
of blood by means of scarification, cupping, or the use of leeches. Large quantities of
blood can be removed from a vein and the practice was often carried to extremes
causing the death of the patient. This was hardly surprising if the advice to “bleed to
syncope” was taken literally, or if credence was placed in the dictate: “as long as bloodletting
is required, it can be born; and as long as it can be born, it is required.” 35 The
rationale of the technique was based on the fallacious belief that by turning the
circulation of the blood from the centre of the body to the surface, the patient’s-illness
would be dissipated. 36 The physician’s reputation depended not only on his dexterity
and grace in employing the lancet, but also on his judgement in determining the
amount of blood to remove. Quite apart from the dangers to the patient, Robert
Graves was aware of the damage injudicious bleeding might do a doctor’s reputation.
In his Lectures he recounts his treatment of a patient with a stroke: “the face was
flushed, his temporal arteries were dilated and pulsated violently, and his pulse was
hard, while the heart pulsated with great strength. This attack came on during our
visit, and I ordered a vein to be opened immediately. The blood flowed freely. When
about fourteen ounces were taken the pulse flagged and grew extremely weak, and
never again rose. He died in about two hours, and an ignorant person would have
ascribed his death to the bleeding.” 37 Leeches were used as an alternative to
phlebotomy for blood-letting. The species used for bleeding was Hirundo medicinalis,
found in the streams and swamps of Central and Northern Europe. The leech was
usually between two to thirty centimetres long with a dull olive-green back and four
yellow longitudinal lines. 38 A large sucker at one end of its worm-like body was used
for anchorage and at the other end a smaller sucker with a mouth was used to
puncture the skin. Leeches were gathered in the spring months with a net, or leech
fishers themselves waded into the water allowing the leeches to fasten onto their legs.
Alternately cattle and horses were used as bait for the leeches. Leeches could be applied
to almost any area of the body, including the eyes, the mouth, nose, ear, vagina and
even the rectum. In preparation for the procedure the leech was dried with a piece of
linen, and the skin was washed and shaved. 39 The leech was often confined to the area
for bleeding by an inverted small wine glass. Sometimes the leech had to be enticed
to feed with a little milk or blood. Leeches generally fed until satisfied for an hour or
so when they would drop off; sometimes the tail was cut off so that it would continue
to suck. A good leech could be expected to remove about an ounce of blood. Once
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