Read Five Quarts: A Personal and Natural History of Blood for Free Online

wasn’t unheard of. Leeches were handy for hard-to-reach spots, such as up the anus, down the throat, or inside the vagina. Tiny thread leashes kept the leeches from getting lost. The leech of choice was the European
Hirudo medicinalis,
exported worldwide from Sweden and Germany. In 1833 alone France imported 41.5 million of the suckers. A standard part of medical practice, leeches were kept close by in water-filled clay or glass jars.

    A woman self-medicating with leeches, as depicted in a seventeenth-century woodcut
    One would think that the huge gains made in understanding human biology from the Renaissance forward would’ve curtailed the popularity of bloodletting. But no. In fact, the practice reached its height in the eighteenth and nineteenth centuries. The Western world’s most powerful people, receiving what was considered the very best of care, were needlessly bled, cupped, and leeched. Retired president George Washington’s death in December 1799 was hastened by excessive bloodletting, for example, historians conclude. The president, sixty-seven and suffering from a severe throat inflammation, was tended by three top physicians who could have saved their patient’s life had they had access to two things not yet invented: antibiotics and steroids. Instead, they bled Washington four times within a twelve-hour period, a total of 2.5 quarts. He died that day. It sounds like manslaughter to me, but the doctors’ actions were considered both medically appropriate for the time and even heroic. Under less grave circumstances, the rule of thumb for a single letting session was to keep the vein open until the patient passed out. “Bleeding to syncope,” this was called. In a statement of near Galenic aplomb, the English physician Marshall Hall wrote in 1830: “As long as bloodletting is required, it can be borne; and as long as it can be borne, it is required.” Dr. Hall and his fellow physicians were, of course, a few facts shy of our modern understanding. A healthy person can, in fact, replace a lost pint of blood in about an hour, but it takes weeks for the oxygen-carrying red blood cells to return to normal levels. Thus, frequent and copious lettings served only to create in patients an endless cycle of chronic anemia. These days the amount of blood a phlebotomist withdraws for testing is minor, about half an ounce per vial. And rarely more than seven vials are collected. If a patient does faint, more than likely it’s from a touch of hemophobia, fear of the sight of blood and/or needles.
    Rosemary became a licensed phlebotomist in 1965 and thinks of herself as an old-timer in the field. “I started in a little mom-and-pop lab across the hall,” she recalls, gesturing the direction with a tilt of her head. “In those days I’d both take blood and perform basic tests. Everything was done manually—cholesterol levels, blood sugar, enzymes, pregnancy tests.” Wistfulness is just a flash in her eyes. Of course, she explains, the whole field changed virtually overnight with AIDS. Safety procedures tightened. New tests were introduced, others replaced, most now performed with computers at a facility across the Bay. The patients changed, too. For the past fifteen years the majority of Rosemary’s clients have been gay men, like Steve.
    “You must have lost a lot of patients,” I say quietly.
    Without glancing up from her work, Rosemary considers this. “Oh, gee,” she begins, then changes course. “I’ve gotten to
know
a lot of patients,” she replies with a smile to Steve.
    “Okay, you’re about done for today,” she adds, watching the last vial fill.
    Rosemary withdraws the needle while pressing down with a wad of cotton so large it looks like a chunk of pillow. “Hold that, will you?” she tells him. She deposits the butterfly and tubing into a Sharps container, a receptacle for used needles, and then affixes the clump of cotton to the site with half a foot of tape. And that’s that. The whole