Dark Banquet: Blood and the Curious Lives of Blood-Feeding Creatures

by Bill Schutt

  “Don’t be afraid,” Washington told the overseer, who suddenly appeared reluctant about slicing into his master’s arm. Soon after, the incision was made, and according to Tobias Lear, “The blood ran pretty freely.”

  A pint of blood was removed.

  In Colonial America (as well as throughout Europe), a bladed instrument called a lancet was commonly used during bloodletting. Lancets were produced in huge numbers and often stored in ornate cases. Their importance can be demonstrated by the fact that England’s premier medical journal took its name from the instrument. After tying off the arm at the elbow, the lancet was applied lengthwise to the now bulging vein, which prevented the vessel from being severed in two. A number of spring-loaded mechanical devices (called scarificators) were also concocted to facilitate the drawing of blood, which was often collected in specially designed bleeding bowls. Some of these were quite beautiful, and they were often marked with inner concentric rings arranged in one-ounce increments.

  When Washington’s wife, Martha, came upon the gory scene she begged that the procedure be stopped, but her husband insisted that the bleeding continue.

  “More, more,” he said, hoarsely, after complaining that the cut Rawlins had made wasn’t large enough.

  After the bleeding, Washington’s neck was wrapped in flannel soaked in hartshorn ammonia*43 and his feet were bathed in warm water.

  Dr. James Craik had been treating George Washington for over thirty years, and when he arrived, at around 9 a.m., he knew immediately that he was dealing with a potentially fatal illness. He applied a blister of cantharides to Washington’s throat,*44 then instructed his famous patient to gargle with yet another mixture—vinegar and sage tea this time. The results must have been terrifying to those standing by. The former president, who was already struggling to breathe, nearly suffocated on the concoction. Alarmed that Washington could not swallow and was having great difficulty breathing, Dr. Craik sent messengers calling for two additional physicians, Dr. Elisha Dick and Dr. Gustavus Brown. Following this, Craik bled the former president and repeated the procedure at eleven o’clock.

  By the time the two additional doctors arrived later that afternoon, Washington had been bled a total of three times. Although Washington’s skin was blue when they arrived, to the physicians of his time this would have indicated an improvement in their patient’s condition (except for the fact that the man was unable to speak, swallow, or breathe without great effort). Medical men of the day often sought to reduce fever or a high pulse rate by decreasing the volume of body fluids. It appears that as far as a patient’s condition was concerned, cool, calm, and cyanotic was preferable to feverish, frenetic, and flushed. Inflammation and fever were not yet recognized as the body’s attempt to combat infection, and so patients were typically bled to alleviate the heat, redness, and pain that were thought to result from “abnormal vascular congestion.”

  According to George Washington Custis (Martha’s grandson from her first marriage), the three physicians held a brief consultation: “The medical gentlemen spared not their skill, and all the resources of their art were exhausted.”

  What course of treatment had the three doctors agreed upon? Additional bloodletting, and their patient (who had no medical training) agreed with them.

  Another full quart of blood was removed, so that by early evening George Washington had been drained of eighty ounces within a thirteen-hour period. Much to the dismay of everyone present, Washington’s blood flow was so weak (and his blood so “thick”) that physicians were unable to induce him to faint, the long-sought end point for most bloodletting treatments.

  Deeply distressed at his rapidly deteriorating condition (he was reportedly in great pain and having tremendous difficulty breathing), the doctors administered calomel, a strong laxative and emetic tartar.*45 These purges were as commonly administered as bloodletting in the eighteenth century, but in this instance, although they had their expected results—“a copious discharge from the bowels”—there was no improvement in the patient’s condition.

  Alarmed but undaunted, the three physicians kept trying. In an attempt to draw the poisonous humors away from Washington’s throat, blisters were raised on his extremities. Additionally, a poultice of wheat bran was applied to his feet and legs, and he was asked to inhale a solution of ammonia and water. Still, the former president’s condition continued to worsen. Unbeknownst to his doctors, not only had Washington lost a dangerous amount of blood but the “medications” they prescribed to purge him had, in all likelihood, left their patient severely dehydrated as well.

  In desperation, Dr. Dick suggested a tracheotomy (or bronchotomy, as it was then referred to). This was a relatively new procedure that was sometimes employed to treat injuries in which the larynx (voice box) had been crushed.*46

  Unfortunately, no one will ever know if this procedure could have saved George Washington’s life. Apparently, the two elder attending physicians overruled Dr. Dick.

  Back at Washington’s bedside, it soon became apparent to all (including the great man himself) that the end was near. According to Tobias Lear, by this point, his master “spoke but seldom, and with great difficulty; and at so low & broken a voice as at times hardly to be understood.” Washington asked his wife to fetch two wills from his desk, then instructed her to burn one of them (since it had been superseded by the other). He called upon Lear and struggled to make certain that his letters and papers were in order and that his accounts would be settled upon his death.

  At around 10 p.m., Lear bent in close as George Washington struggled to voice his final words. “I am going,” he said. “Have me decently buried; and do not let my body be put into the Vault in less than three days after I am dead.” This seemingly odd statement can perhaps be explained by a widespread fear of premature burial that existed at the time.

  After Lear confirmed that he’d understood what Washington had said, the first president of the United States uttered his last words, “Tis well.”

  Shortly after that, the most famous man on the planet expired, “without a struggle or a sigh.”

  George Washington was sixty-seven years old.

  Over two hundred years later there is still debate over the specific illness that had stricken the Founding Father. While some have suggested laryngeal diphtheria or a peritonsillar abscess, most experts now believe that Washington suffered from an acute case of bacterial epiglottitis (an inflammation of the leaf-shaped flap that covers the entrance to the trachea during swallowing). Although rare in these days of antibiotics, this malady is potentially fatal since it causes the epiglottis to swell, blocking the airway and rendering the sufferer (as in Washington’s case) unable to breathe.

  There is no debate that the loss of approximately 40 percent of Washington’s blood volume within a thirteen-hour period hastened the great man’s demise. For comparative purposes, the American Red Cross generally requires an eight-week period between blood donations of one-tenth the volume drained from the former president on what was to be his last day alive.

  Eighty ounces.

  “What the hell were those guys thinking?” I asked myself, initially.

  But as easy as it is to scoff at Washington’s physicians and their chosen course of treatment, I know now that I was dead wrong in doing so. These men were, after all, simply trying to save their patient’s life, and bloodletting had been the accepted treatment not only for sore throats but also for scores of other maladies since the time of the Mesopotamians, Egyptians, and ancient Greeks (as well as the Mayans and Aztecs).

  There was, in fact, a storm of criticism following Washington’s death and those comments are quite revealing. One physician claimed that Washington’s tonsils should have been scarified, while another suggested that the former president’s doctors should have bled him from under the tongue, since that location was anatomically closer to the problem. Other suggestions included rubbing Washington’s throat with “warm laudanum” (a mixture of alcohol and opium) and, fol
lowing this, the application of a bag of warm salt to his neck. Instead of calomel, some insisted that he should have been urged to drink small portions of hot whey, laudanum, or spiritus volatilis aromaticus, a mixture of ammonia, carbonate of potash, cinnamon, cloves, and lemon peel.

  Rather than condemning Washington’s attending physicians, these nineteenth-century armchair quarterbacks have actually exonerated them, for it is unlikely that anyone could have saved him using the medical practices of the day. What might be even more difficult to accept is that even if George Washington had lived a century later—in all likelihood his treatment and its outcome (in the absence of antibiotics) would have been exactly the same (the only difference being that his physicians probably would have used leeches to draw off his blood).

  But why was this so? With tremendous advances in nearly every field of science, why were renowned physicians still bleeding their patients, often to fatal excess, right into the twentieth century? How did this practice of bloodletting come about? Does it ever work and if not, then why are thousands of leeches being used by physicians today around the world?

  To answer these questions, we’ll need to take a slight detour from blood-feeding creatures to examine our knowledge (or until recently, our lack of knowledge) concerning blood and the circulatory system.

  As opposed to our longstanding misconceptions about bats, bad information on blood and the circulatory system didn’t start with the Europeans—although they were responsible for carrying this miserable banner for well over a thousand years.

  The ancient Egyptians certainly had some vague ideas about the function of the circulatory system (as revealed in the Smith and Ebers papyri, dated to the seventeenth and sixteenth centuries BCE, respectively). They knew, for example, that there was a relationship between the heart and a person’s pulse. Their knowledge was somewhat limited, however, by an inability to differentiate among blood vessels, nerves, tendons, and ureters (the tubes which carry urine from the kidneys to the urinary bladder). This led to confusion about substances like sperm, urine, tears, and blood, although the latter was put to some use. For example, some ancient Egyptians took the blood of a black calf or a black ox, mixed it with oil, then slathered it on top of their heads. Why? To combat graying hair, of course—a sort of Grecian Formula 44 before there were actual Greeks. Maybe that sounds ridiculous today, but the implication is that there was something in the blood itself that would restore blackness to the hair.

  The word blood shows up in the Bible over four hundred times with the earliest mention coming in the Old Testament (Genesis 4:10), right after Cain has murdered his brother, Abel: “And the Lord said, ‘What have you done? The voice of your brother’s blood is crying to me from the ground.’” Later, an even more significant passage concerning blood occurs in Genesis 9:6: “Whoever sheds the blood of man, by man shall his blood be shed.”

  Since the ancient Hebrews believed that the spirit resided in the blood, killing someone was more often referred to as spilling or shedding their blood. It was and is, arguably, the most serious thing we can do to another human. So serious, it seems, that it calls for the spilling of more blood from those deemed responsible.

  Blood pops up (oozes up?) again in the Old Testament, in Genesis 9:3–4, as God is chatting with Noah: “Every moving thing that lives shall be food for you; and as I give you the green plants, I give you everything. Only you shall not eat flesh with its life, that is, its blood.” (Note: This passage follows right after God’s more popular command that Noah and his sons “be fruitful and multiply.” )

  This notion, that life itself resided in the blood, appears to have led to the requirement that animals slaughtered for food be drained of blood before being eaten.*47 Apparently, exsanguination spares people from eating the spirit of the animal—which presumably escapes the red puddle sometime before the clotting process is completed. Did I mention that this procedure also comes in handy if you’re looking for a way to feed your vampire bat colony?

  The Hebrews certainly weren’t alone in their belief that blood was a special juice, nor were they the only ones who spent considerable time and effort spilling it for those beliefs. So important was this fluid that the offering up of blood was thought by many cultures to be the ultimate way to atone for one’s sins, to pay homage to one’s god or gods or to cure one’s self of various ills. (Countess Báthory serves as a rather extreme example of the latter.) Generally, animals were sacrificed. Calves were popular, possibly because they were easy to lead around and their blood could cover a lot of altar surface, but in far too many cases to fathom human blood was considered to be the ultimate sacrifice—whether it was shed for atonement, revenge, the gods, or a cure.

  Scientific knowledge of blood and the circulatory system was, to put it mildly, rather slow to come about. To put it less mildly, most of the early information was dead wrong, yet somehow it lingered in the field of medicine for over two thousand years. Here’s how it happened.

  Around 400 BCE, Hippocrates proposed (among many other things) that the human body contained four substances called humors: black bile, yellow bile (or choler), phlegm, and blood. When the four humors were balanced, the person remained healthy, but any humoral imbalance led to sickness, misery, and despair. Accordingly, to the ancient Greeks, it was the volume of blood that dictated the health of an individual.*48 It should come as no surprise, then, that starvation, vomiting, and bleeding were used to treat perceived excesses in humors, while other patients were instructed to gorge themselves when their humoral levels needed boosting.

  As adopted by Claudius Galenus (better known in English as Galen) nearly six hundred years after Hippocrates, humoral imbalances were not only used to explain how people got sick but how they got their personalities. Too much phlegm, for example, led to a lack of emotion in the individual—a phlegmatic personality. On the other hand, too much blood led to a “sanguine” or carefree temperament. In this case, nosebleeds, hemorrhoids, and menstruation were looked upon as the body’s way of restoring normal blood levels.

  Earlier, while working as a physician at a gladiator school in the Turkish city of Pergamon, Galen, the son of a wealthy architect, had glimpses of internal human anatomy, referring to wounds as “windows into the body.” The thirty-two-year-old Galen moved to Rome in 160 CE, but the Roman ban on human dissection meant that he would never get to explore what was on the other side of that window. Galen was reduced to making inferences about the human condition by examining animals like macaques (a type of Old World monkey), pigs, and goats. These animals were often dissected alive and in public, and Galen’s “hands-on-guts” public demonstrations made him incredibly popular. Unfortunately, although Galen’s dissections set him apart from more traditional physicians (who employed a distinctly less hands-on approach), his reliance on inference, conjecture, and his own imagination often led to conclusions about the human body that were dead wrong.

  Galen eventually became the personal physician of Emperor Marcus Aurelius and later his son Commodus.*49 Although Galen was much more interested in the central nervous system than he was in the circulatory system, he did prove, among other things, that blood, not pneuma (an airlike spiritual essence dreamed up by the ancient Greeks), traveled through arteries.

  On the other hand, Galen had no real concept of blood circulation. He believed that blood ebbed and flowed like the tides, with venous blood originating from and returning to the liver.†50 Unwilling to abandon the concept of pneuma, Galen proclaimed that blood within the heart passed through invisible pores in the wall separating the heart’s chamberlike ventricles. After mixing with the pneuma, the blood was then distributed to the body.

  Granted, as far as circulatory system basics go, figuring out that blood and not air was carried in arteries was significant, but Galen’s deeply flawed concepts of human anatomy and physiology would have a serious and long-lasting effect on the field of medicine—especially with regard to the circulatory system. As previously mentioned, Galen’s over
arching ideas on the human body were generally extensions of those proposed by the ancient Greeks, and these mistake-laden views came to completely dominate the field of medicine. Not only did Galen’s take on medicine and anatomy remain pervasive for fifteen hundred years, it remained unchallenged. According to Bill Hayes, the author of Five Quarts—A Personal and Natural History of Blood, “In the early Middle Ages, church leaders declared his work to have been divinely inspired and thus infallible.” Rather than experimenting or dissecting specimens (and thereby bringing down upon themselves the serious and often deadly wrath of the church), the disciples of “Galen the Devine” simply deferred to their long-deceased master and his stance on any given medical topic. Anything else would have been blasphemous.

  How did bleeding become such a popular therapeutic tool? What was it that compelled the most learned physicians of their day to drain their patients until they were cold, blue, and unconscious?

  During ancient times, bleeding was generally thought to rid the body of evil spirits. Later, once the concept of balancing humors became accepted, regularly scheduled bouts of bloodletting were prescribed in much the same way that a balanced diet and exercise are extolled today. For example, fever and headache were thought to be symptoms of excess amounts of blood (“plethoras”) and called for immediate drainage. Galen considered blood to be the most important of the four humors. (Is anyone shocked that it edged out both shades of bile and survived a late run by the cigarette smoker’s favorite—phlegm?) He used his knowledge and expertise to write a series of books that soundly trounced his critics—especially those who denounced his bloodletting techniques.