Bloodletting In Medicine: Was it an ancient cure or a deadly practice?
Picture this: you walk into a physician’s clinic, feverish and gasping for breath, only to watch the doctor open up a steel blade, tie a tourniquet round your arm, and drain a pint of your blood into a bowl while assuring you it is the only way to better health. For more than 2,000 years, this scene was not an anomaly, but the everyday medical care in ancient Egypt, a medical intervention that endured centuries, empires, and scientific revolutions despite its mortality rate and bodily harm. It was called bloodletting.
How Bloodletting Began
The earliest written record of bloodletting is found in the Ebers Papyrus, an ancient Egyptian medical text dating to around 1550 BCE, approximately 3,575 years ago. Long before classical philosophers and scientists formalized medical theory, the early Egyptian healers made incisions with lancets, sharp flints, and reeds to release what was termed “stagnant” body fluid, which in many cases was blood. While there is folklore that claims that the Egyptians first learned this technique from observing hippopotamuses scratch themselves to soothe illness, the more accurate rationale was proposed by ancient Greek physician, Hippocrates (460-370 BCE), the namesake for medicine’s “Hippocratic Oath”.
Hippocrates transformed bloodletting from a practice based on folk remedy to a comprehensive medical technique based on the theory that human health depended on maintaining a delicate balance between four primary body fluids, the four humors: blood, phlegm, yellow bile, and black bile. Disease was viewed as internal fluid disharmony, and sometimes, an over-fullness of fluid, termed plethora.
Years later during the Roman empire, the influential Greek physician Galen (129-c. 216 CE) began the era of physician-led bloodletting. He proposed that blood was the most dominant of all the humors but had the misconception that blood did not circulate in a loop and excess blood could become stagnant and rot in the body, leading to sickness. To balance the humors and restore health, the physician was to remove the excess blood or whichever fluid was in excess at the time.
Galen mapped out precise anatomical points of the body for bloodletting. The type of blood let (arterial or venous) was determined by the nature of the sickness and the body part it affected. The amount of blood let was also determined by the former while the method of bloodletting was dependent on whether the therapeutic goal was systemic or localized.
Methods of Bloodletting
With over 2,000 years of continuous practice, healers and physicians developed bloodletting techniques that were broadly categorized into “Generalized Bloodletting” and “Localized Bloodletting.”
Generalized Bloodletting was aimed at reducing the overall systemic blood volume and was done through venesection. Venesection involved the opening of a major vein such as the median cubital vein at the elbow or the jugular vein, using sharp instruments such as thumb lancets. Thumb lancets were small, double-edged instruments often encased in ivory or tortoise-shell.
The physician would place the sharp edge on the vein and make an incision, then drain the desired amount of blood into a bowl. Once done, they would place a pin through the edges of the incision and use some thread over the pin to keep the incision closed.
Localized Bloodletting on the other hand aimed to relieve localized pain or draw bad blood directly away from a diseased organ. It was typically carried out through scarification and leeches. Scarification involved the use of scarificators, cube-shaped brass boxes containing multiple spring-loaded blades to scrape the skin to create quick, parallel incisions and draw blood. This was then followed by cupping; placing dome-shaped vacuum glass over the skin, and extracting the blood by suction.
A thumb lancet with tortoise-shell covers. National Museum of American History. 
An English scarificator with six lancets. Wikicommons. 
Medicinal leech (Hirudo medicinalis). Wkikicommons. 
The Pewter bleeding bowl used to collect blood during bloodletting. Wikicommons.
From top right clockwise: 1. A thumb lancet with tortoise-shell covers. National Museum of American History. 2. An English scarificator with six lancets. Wikicommons. 3. Medicinal leech (Hirudo medicinalis). Wikicommons. 4. A Pewter bleeding bowl used to collect blood during bloodletting. Wikicommons.
The leeches used for bloodletting were usually the medicinal leeches (HIrudo medicinalis). A single leech could ingest 5-10ml of blood, up to ten times its body weight in blood. The therapeutic use of medicinal leeches became immensely popular in Europe in the early 19th century. France reportedly imported over 35 million leeches every year to supply hospital wards.
No matter the method of bloodletting used, the procedure always ended with the physicians carefully collecting the blood into graduated bowls referred to as bleeding bowls, to analyze it to determine patient health.
Cultures Where It has Been Practiced
Since its inception, the practice of letting blood to cure disease has risen through civilization to take on many forms and purposes. It began in Ancient Egypt in 1550 BCE, where healers used copper lancets and reeds to release “stagnant blood”. From Egypt, the practice spread to Greece where Hippocrates backed bloodletting with the principle of the four humors. By the 1st century AD, it had become standard therapy in the Roman empire, backed by the texts of the Greco-Roman physician, Galen.
By the Middle Ages, bloodletting had spread across Europe as a universal remedy for virtually every illness. The procedure was eventually turned over to the 12th century European barber-surgeons who combined grooming services with tasks like bloodletting and minor surgeries such as tooth extractions and amputations.
The practice was not only for everyday people. When King Charles II (1630–1685) of England suffered a sudden seizure on February 2, 1685, hIs royal physicians immediately initiated an aggressive treatment regimen that entailed bleeding 16 ounces of blood from his left arm, followed immediately by another 8 ounces extracted via cupping. Over the next four days, he endured further bleeding alongside other treatments before dying.
Brought across the Atlantic by European settlers, bloodletting became a cornerstone of colonial American medicine. The most famous recipient of this approach was former U.S. President George Washington (1732–1799). After riding across his Mount Vernon estate in bad, snowy weather, Washington developed a severe fever, sore throat, and acute respiratory distress on December 13, 1799.
Under the care of his three physicians, Washington was subjected to an intense protocol that included gargles, blisterings, emetics, laxatives, and massive bloodletting. Over a 12-hour period, his doctors drew large amounts of blood across four separate sessions; totaling approximately 80 to 82 ounces before his death that night.
Did Bloodletting Actually Work?
The procedures and historical tragedies detailed so far clearly demonstrate how dangerous bloodletting was. Naturally, it makes one wonder: did it ever work to cure disease, and what made physicians persist with such a lethal intervention for thousands of years?
Scientifically, bloodletting was hardly ever proven to cure infections or illnesses, at least not in the way the healers then thought it did. However, the practice survived because it created an illusion of recovery. When physicians drained large amounts of blood, the patient's blood pressure crashed, triggering fainting and lethargy. To ancient healers, an agitated patient who suddenly became still appeared to be "calmed" of their feverish energy from illness, and this signaled recovery to them.
In reality, the stillness was often due to low blood volume-induced shock, not a lowered pulse from recovery. The illusion was further reinforced by confirmation bias, from cases when the patients survived illnesses after bloodletting. It made it possible for the physician to credit the procedure for saving their lives and argue that patients who died after should have just been bled sooner.
There were some exceptions though, where bloodletting did offer scientifically-backed relief. In hypertension and pulmonary edema, letting blood lowered blood pressure and eased buildup in the lungs. In bone marrow disorders such as apparent polycythemia, draining blood and the excess red blood cells in them improved patient health.
Beyond those rare cases, bloodletting remained a practice rooted in misplaced assumptions, until the late 1830s when French physician Pierre Louis presented statistical data that finally proved that patients treated with bloodletting died at higher rates than those who were not.
What Remains of The Practice Today
Bloodletting is no longer considered a universal cure, but it survives in modern medicine as the evidence-based practice of therapeutic phlebotomy used to manage specific conditions including hemochromatosis (high iron levels in the blood), polycythemia vera (overproduction of red blood cells), and sickle cell disease.
Sterile medicinal leeches remain FDA-approved bloodletting tools used in reconstructive surgery to drain congested blood in reattached fingers and skin grafts until the tissue can handle circulation on its own.
What began as a dangerous attempt to balance bodily fluids has now evolved into a life-saving medical procedure backed by an understanding of why and where it actually works.
Sophie Adekola is a writer from Nigeria with a passion for topics in beauty and health. She is interested in the intersection of modern culture and the historical application of beauty techniques.
Additional Reading
Deep Cut: The Story of Spring Lancets and Medical Change. (2026). [online] Illinois.edu. [Accessed 1 Aug. 2026].
Aird, W. (2025). Letting Blood: The Rise, Reign, and Fall of Medicine’s Oldest Therapy • The Blood Project. In The Blood Project.
Assi, T. B., & Baz, E. (2014). Current Applications of Therapeutic Phlebotomy. Blood Transfusion = Trasfusione Del Sangue, 12 Suppl 1(Suppl 1), s75-83.
Bloodletting and Leeches, Not So Ancient. (2021). In Www.bl.uk.
“Galen on Bloodletting.” Google Books, 2026,
George Washington’s Mount Vernon. (2024). In George Washington’s Mount Vernon. Mount Vernon.
Greenstone, G. (2010). The History of Bloodletting. In British Columbia Medical Journal.
Hackenberger, P. N., & Janis, J. E. (2019). A comprehensive review of medicinal leeches in plastic and reconstructive surgery. Plastic and Reconstructive Surgery - Global Open, 7(12), e2555.
Oh, K. Y., & Kim, K. (2016). Clinical Applications of Therapeutic Phlebotomy. Journal of Blood Medicine, 7, 139–144.
The Death of King Charles II — Centre for Evidence-Based Medicine (CEBM), University of Oxford. (n.d.). In www.cebm.ox.ac.uk. Retrieved August 1, 2026, from
“THE ENGLISH BLOODLETTING REVOLUTION, or MODERN MEDICINE before 1850 on JSTOR.” Jstor.org, 2025, ALT Link. Accessed 2 Mar. 2025.
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