The Early Use of Blood for Medicine
The Beginnings of Intravenous Medication by Horace Manchester Brown M.D., F.A.C.S. 1918
"Pliny describes the drinking of the flowing blood of gladiators in the arena "as if out of living cups," for epilepsy."
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ARISTOTLE (B.C. 384-322) saw the blood of a fish flow from its heart into its gills. ("De Part. Animalium," III.) Undoubtedly many men who have had the taste and disposition for wandering in the sinuous paths of medical investigation, or who have found joy in philosophizing with the ancients, have dreamed dreams of speculation as to what might have been the position of the theory and art of medicine and our civilization and religious thought, had Aristotle but had sufficient imagination to have gone a step farther and have thought of the possibility of the way of the return of the blood to the heart.
There is no limit to the horizon toward which such dreams might lead; and to speculate upon the possibilities of such a conception is almost to wander away among the djinn of an Arabian tale, or to intoxicate oneself with musings among the Sepiroth of the Kabbalah.
Whatsoever might have been the result that must of necessity have been the outcome of such a discovery at a period almost 2000 years before the time of Harvey, it is not beyond the realm of reason to believe that the world would have been spared the degradation of the ignorance of the Dark Ages, and the erroneous philosophy of St. Thomas Aquinas, founded upon the physiology of Aristotle, the controversies of the scholastic and dogmatic theologians, the proposition of "two kinds of truth: the Philosophical, founded upon proof, and the Theological, founded upon faith" (See Matthieu Paris. "Hist. Maj.," p. 541, and Mosheim. "Eccl. Hist.," Part II, Cap. 3.), the futile discussions as to the nature of and location of the soul, the problems of generation, metabolism and nutrition: the nature and functions of the liver, spleen, lungs, and heart, and a thousand other things which are but common-places today, but which were insurmountable obstructions to true knowledge up to the middle of the seventeenth century, would never have been considered, or would many centuries ago have been cleared away.
The reader may well ask, What has all this to do with the subject upon which this paper is supposed to treat? The answer is not difficult.
Nothing that can result from philosophizing is ever of any value, until, like the result of any other form of mental activity, it finds its application ad hominem. The study of the history of medicine is, in the most intense degree, the study of the development of civilization, not only as applied to community life but as well when applied to the development of the individual. It is a study of the great struggle of mankind as led by its teachers, against the destructive forces of nature, and in so far as the teachers have failed in their grasp of the meaning of things and phenomena about them, in so much has man failed in the speed of his journey toward better health, better mentality, better living and better appreciation of the things of life.
Throughout the world, up to the time of William Harvey, mankind was struggling blindly in a fog of theory, superstition and fear, toward the light, the first glimmerings of which came with the coming of the great anatomist Vesalius, the controversialist Servetus, the keen observer Fabricius; a glimmering which was to burst into a full effulgence which should illumine the path that science might tread, when Harvey by his discovery of the circulation of the blood, illumined the leaders of the world of philosophy and science, and through them gave to the human race those facts which have made all exact medical knowledge possible since his time.
It has seemed to me in view of the great interest that the medical profession has taken in the matter of intravenous medication since the introduction of salvarsan, that a short account of the early history of that method of treatment may not be without interest, and therefore I have to offer a somewhat incomplete review of the records relating to infusion of medicaments and transfusion of blood, during the period between 1490 and 1680.
It will be necessary to glance first at the conditions of knowledge in our profession in relation to the physiology of the blood and its movement during the centuries previous to the discovery of the circulation by Harvey in the year 1613, and his announcement of his discovery by the publication of his book in Frankfort in 1628.
In the year 201 A.D., there died a man in Rome, a physician, who had had seven emperors as his patients and who left behind in his writings, an accumulation of the knowledge of his predecessors, and a system of medicine, which was perfect in its kind, logical in its reasonings, complete and well proportioned in its form and which ruled the medical world for 1400 years; influencing not only the writers on medicine as no other man had influenced them, not only as to the physical welfare of the entire world, but also furnishing the Christian world with a basis for a complete system of theology, although but little of it was founded upon anything more than speculation, while those parts of it which seem to be demonstrations of facts were but falsehoods and erroneous conclusions due to error in observation. This man was Galen.
If we but stop to consider our own surroundings and relations to our own patients, we are brought to realize that his influence extends even to ourselves, and that on every hand and every day the medical profession here, now, is forced to contend with the erroneous conceptions that were handed down through the years from Galen, and which still hold not only in the minds of the laity, but also in the acts and thoughts of many men within the profession of medicine itself.
Erasistratos, of the School of Alexandria, had established the belief in the minds of medical men and philosophers that the arteries contained only air. Galen by his famous experiment with the hollow reed or a bronze tube (Liber, "An Sanguis in Arteriis Contineatur," Cap. 8) had proved the folly of this belief.
For Galen, the liver was the source of the blood and the natural spirit, and the heart was the seat of the essential heat and of the vital spirit, while the blood mixed with air in the left ventricle of the heart and passing to the brain through the carotid arteries became perfected in the lateral ventricles, so as to produce the animal spirit, which was the food of the soul.
The soul was looked upon as a sort of a triad. The concupiscent soul, the epithumos, resided in the liver. This was the passive or feminine element, the desiring or acquiring element in the triad. In the heart resided the acting soul, the thumos, the active, masculine element of the triad which produced the vital heat and sent it throughout the body, and which when refined became part of the governing soul, the begemonos, which was the controlling element of the triad. The natural spirit was in the liver and veins, the vital spirit was in the heart and arteries, the animal spirit was in the brain and nerves.
A certain movement of the blood was recognized, and had been since the time of Hippocrates; but this movement was in nowise recognized as a circulation but rather as a perioidos haematos, a tide-like movement which was compared to the tides of Eripos, in the strait of that name in Greece. The blood was produced from the chyle in the liver and then moved back and forth in the veins-until it was consumed, a new supply always being produced by the liver.
Some of the blood oozed through certain foveae, or supposed porosities in the intraventricular septum of the heart, from the right to the left ventricle there to form the vitalized blood, which, mixed with air, was sent out through the arteries up to their finer filaments which were supposed to be nervous in character. Some of this vitalized blood went to the brain for further perfection, but none returned, in a circulating sense, to the heart. That blood that went to the lungs was sent to them to nourish them, or to be cooled by them.
It is necessary that we should recall these things in order to understand that which occurred after the discovery of the circulation of the blood.
Wm. Harvey of Folkstone and London, England, lectured to the students upon his discovery of the circulation at St. Bartholomew's Hospital, in the year 1613; this date should be kept in mind. In the year 1628 his book "De Motu Cordis" was published in Frankfort. His discovery was quickly accepted in England, Holland and in Germany; but such was the temper of the time, the respect paid to and the fascination of the opinions of the ancients, that almost an hundred years elapsed before it was admitted in Italy, the southern part of France or by the acknowledged master-teachers in medicine of the University of Paris; for we find a certain Vigerius, professor of medicine at Montpelier, still teaching the Galenic ideas as late as 1694., while his colleague of the same faculty, Dionis, was demonstrating its truth at the Royal Garden in Paris, by command of Louis XIV and at the same time it was being denied in the same city, under the lingering influence of Riolan, by the Faculty of Medicine of that center of learning.
In view of the absence of any speedy means of communication between nations at the time when this discovery was published, it is with astonishment that we observe how quickly information in regard to it was transmitted throughout Europe.
Hope was high in every breast that through this knowledge disease and its cure might be approached with confident tread. Alas! these hopes were to be dashed to the ground because of too sanguine anticipations, the result of the lack of other facts that were to be learned only through experience, or by the gradual evolution of instruments of precision, used as aids to the acquirement of collateral and related knowledge.
No discovery or discoverer is great enough to be beyond the range of shafts of doubt or envy, and it was so in the case of Harvey. Hardly had his discovery been noised abroad, before there arose a number of detractors whose purpose it was to prove by what seemed to them sufficient evidence that the knowledge of the circulation was as old as civilization.
An attempt was made to show by the testimony of a workflby Pére Halde, put into Latin by Michael Boym and published by Andreas Cleyer of Cassel, and Batavia in Java, that the circulation was "understood by the Chinese at a time 4000 years before the Christian era, and later Cleyer wrote a book ("Specimen Medicae Sinicae," Frankfort, 1682) in one chapter of which, "Tractatus de Pulsibus," this claim is maintained. It will not be without interest for anyone desiring to go further into this matter, that the article on Chinese medicine by Neuburger, vol. 1, and Renouard
("Hist. de la Medicine," Tome I., fol. 46 et seq.) should be investigated.
Again: Conrad Victor Schneider ("Diss. de Catarrhis," 1664, Cap. 2) and Johannes Schmidius endeavored to show that King Solomon, among the other evidences of his great wisdom, was acquainted with the mystery of the circular movement of the blood, taking as proof of that proposition the meaning of the text as it appears in the Douay version of the Vulgate, "Before the silver cord be broken, and the golden fillet shrink back, and the pitcher be crushed at the fountain, and the wheel be broken upon the cistern." (Eccl 12:6)
To the writer it would seem that these men must have been possessed with the most marvelous capacity for engendering conceptions based upon unwarranted imaginings.
In investigating this matter it seemed so far beyond possibility that such deductions should be drawn from this text, that, fearing that a misprint may have led me astray, I took pains to discover what might have been written in the book of Ecclesiasticus, of Jesus Son of Sirach, which appears in tghe Vulgate, but not in the St. [King?] James Version. The citation as given in the
English reads: "Do good to the humble, and give not to the ungodly: hold back thy bread, and give it not to him, lest thereby he over-master thee." Which seems to be very good practical advice, but hardly applicable to the problem of the knowledge of the circulation.
It would take too much time for the reader to enter upon the various claims for the discovery, on behalf of Cesalpinus and Sarpi, nor is such a digression desirable in this article, but it may not be without interest at this point to note some of the ideas entertained among the ancients as to the use of blood as a remedy, or as to the effects of the abuse of the blood, as in certain cases of perversion.
I quote from Petro de Abano ("De Venenis," circa 1250-1316, Editio Jacobus Thanner, Liptzen, 1498, Cap. 74, "De Sanguine Menstruo aut Leprosi.")
"He who drinks of menstrual blood or of that of a leper, will be seen to be distracted and lunatic, evil minded and forgetful, and his cure is to drink of daisies, powdered and mixed with water of honey, and to bathe in tepid water, and to copulate with girls according to the law natural, and to play with pretty girls and young boys: and the antidote (bezoar) is to eat serpents whose heads and tails have been cut off with the edge of a palm frond."
Pliny ("Natural History," fol. 498, v. 9) describes the drinking of the flowing blood of gladiators in the arena "as if out of living cups," for epilepsy.
Again Pliny states that "a man's own blood rubbed upon himself will relieve him of pain." (Fol. 501, v. 2.)
Again Pliny, as does Diodorus Siculus, describes the employment of baths of human blood by the Egyptian kings as a cure for elephantiasis. (Fol. 469, v. 49.)
The use of blood as a remedy is mentioned in many other places in Lib. XXII.
In Thomas Bartholin's famous book, "De Sanguine Vetito" (Frankfort, I673), we shall find numberless instances of the use of blood as a remedy, many of the stories being not without humor as, for instance, in that portion in which he treats of the use of the blood of cats, doves, turtles and other animals in the treatment of epilepsy, he tells of a certain girl, an epileptic, at Breslau, who, after taking cats' blood, was quickly endowed with the characteristics of a cat. She climbed upon the roofs of the houses, imitating the manners of cats in voice, jumping, scratching, yowling, and even sitting for hours gazing into a hole in the floor.
Ettmuller gravely informs us, upon the authority of Hildesheim ("Spicilegium," VII, p. 609) that if a black cat's tail be cut off at the distal third, and the first three drops of blood that exude be given to an epileptic, it will prove a powerful means for cure, but he considers the blood from a wild cat to be more potent. However, blood from the ear of a black cat is most valuable in the treatment of erysipelas.
The ancient pagans advocated the use of the blood not only of brutes, but also of human beings in the treatment of epilepsy.
Scribonius Largus (Comp. XVI) says: "A simple woman, one of the common people, sold as a valuable remedy and a secret one, the mixed blood of a turtle and a pigeon--as much as would flow out -- as a certain cure for this disease (epilepsy), which seems to have been as mysterious a malady then as it is to-day."
Paulus AEgineta ("De Re Medica," Lib. VII, Cap. 3) advises the use of the mixed blood of many animals for this disease and Galen and Dioscorides also, the drinking of the blood of a weasel, or the blood of a dog for the cure of the bite of one that was rabid.
Caelius Aurelianus (Lib. I, Chronic., Cap. 4, Editio Amsterdam, 1722, fol. 314) ridicules the use of the mixed blood of men, seals and turtles for the cure of epilepsy, and says, "from this remedy none reaches a cure." Among the Norwegians from time immemorial the blood of seals and whales has been used as a remedy for fits and scurvy, and the blood of the reindeer is used in Lapland for the same purpose.
Artaeus (Lib. I, "De Cur. Diut. Morb.," Cap. 4) describes the manner of filling a vial with the blood flowing from the wounds of the soldiers, that it might be drunk as a remedy, and says: "Oh what a mighty necessity, that any one should be forced thus to cure one evil by the use of a greater."
Nicolaus Marepsus (Sect. I, "De Antidotis," c. 439) advised the use of the mixed blood of kids, geese, and male and female ducks for a number of diseases affecting the "spirits." Celsus (Lib. III, Cap. 23) deplores the custom of the people who rushed into the arena at the time of the gladiatorial games to drink the blood fresh-flowing from the jugular veins of the dying victims, and Tertullian ("Apolog.", IX) asks, "Where are those who at the shows in the Arena, where men are slaughtered, drank the flowing blood (but not that from the throat) with eager thirst, that they might be cured of epilepsy?" Here we have a reference to the danger of taking in any portion of the "spirit" of the bleeding man in the froth of his blood. There can be but little doubt of the use of distillates from the blood, for we shall find in the "De Distillatione" of Hieronymus Rubaeus (1585) a full description of its use on pages 123-127 et seq., and the distillate of blood was often employed combined with the waters and oils extracted by distillation from human and other feces for many diseases.
One might well quote from Dioscorides, Galen, Alexander of Trales, Benedictus Victorius, Mizaldus, Levinius Lemnius, Avicenna and a long list of others, but what has gone before is quite enough to prove a multitudinous use of blood as a remedy.
About the use of blood hung always the idea that it was the container of the various spirits, and that therefore it might be, if rightly chosen or confected, of use as a restorative in cases of maladjustment of those mythical factors when they were disarranged. Indeed we may well imagine that in its use, as well as in the employment of the crushed testicles of goats, asses, rabbits and cocks, there was some sort of foreshadowing of the organotherapy of to-day. What could be more convincing (if precedent were a proof) of the value of goats' lymph in the treatment of diminished virility, than the grave and serious statements of the ancients as to these things of applied medicine being arcana or specifics.
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