Phlebotomy

The origin of phlebotomy is unknown, but it was mentioned in the veterinary papyrus of Kahun about 2 , 0 0 0 ~ ~ ~ . Not only was it used extensively by the physicians for several thousand years, but it was also used by the surgeons to prevent and treat inflammation, to prevent arterial hsemorrhage, and to produce sedation, muscular relaxation, and ansesthesia. The neurosurgical indications for phlebotomy were described by Hippocrates, who recommended it for those cases of head injury in which pain and inflammatory fever had supervened2. These indications still held good in the nineteenth century, but they had now been extended to include the warding off of pains and inflammatory fevers that had not supervened, and many cases were described in the medical journals of the time3 4 5 6 7 8. Blood-letting had the additional advantage of weakening the violent neurosurgical patient, although a stout Welshman, Davis, was still almost uncontrollable after having been bled one hundred and twenty-four ounces in twenty-four hours3. Less fortunate was the man with a not very serious head injury whose dresser, an enthusiastic phlebotomist, prescribed venesection TDS. After ten days of this treatment, the patient died and the only cause of death revealed by the post-mortem examination was excessive loss of bloodg. The prevention and treatment of post-operative inflammation were common indications for phlebotomylo, and both Hey and Wardrop believed that the greater the operative blood loss, the smoother the convalescence11 12. Wardrop had noticed that soldiers who had suffered severe hcemorrhage and had been left for dead on the battlefield recovered with unusual rapidity from their wounds. He attributed this to the complete check on inflammation and said, ‘surely a fellow-creature should not be allowed to perish for the want of the loss of a quantity of blood’. Certainly Colonel Ponsonby at-