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Practitioner’s Corner (continued)
as the father of medical statistics, who gathered historical data on 77 pneumonia patients who had been treated with bleeding. He compared the proportion of patients who benefited from blood- letting with those who did not and concluded that bloodletting was not an effective treatment. He made no claim that it was harmful.
The most powerful strikes against the status quo were most likely the work of such giants as Louis Pasteur (1822-1895) and Robert Koch (1843-1910) who firmly established the germ the- ory of disease by means of laboratory experimentation and mi- croscopic study of tissues. These techniques demonstrated the existence of infectious agents and constituted the basis for a new paradigm of disease to replace that of bodily humors. The new paradigm of medical science resulted in the elevation of con- trolled experimentation and evidence-based observation as the foundation of medical science. Rather than speculation about the balance of humors, today’s physician uses a systems-based ap- proach to diagnosis (hence the “review of systems” in the medical chart).
The therapeutic use of bloodletting continues only for rare conditions that make sense in our present paradigm – in heredi- tary hemochromatosis and porphyria cutanea tarda to relieve ex- cess iron loads and in polycythemia vera to prevent blood clots and hyperviscosity syndrome.
One instance of the triumph of scientific medicine over ancient practice, ironically, is the reverse of bloodletting – blood transfu- sion, a practice that became viable in the early twentieth century following the identification of blood groups by the Austrian Karl Landsteiner (1868-1943). Blood transfusion has proven to be lifesaving when used judiciously.
What lesson can the twenty-first century mind learn from the history of bloodletting? Learning is expensive in terms of the four elements of human existence – in lives, in pain, in time, and in treasure. But keep on learning. It’s worth the price.
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HCMA BULLETIN, Vol 68, No. 1 – Summer 2022