Bloodletting was a common medical procedure of antiquity that involved draining sometimes large quantities of blood from ill patients. It was believed to be helpful for a plethora of diseases, including everyday ailments like fever and headaches. There were detailed medical protocols for how much blood to take, how often, and from which anatomical locations. In infants,  the entry-point of choice for bloodletting was from the anterior fontenelle, or the “soft spot” on the top of the baby’s still-forming skull.

Modern medicine has demonstrated that bloodletting has little therapeutic benefit for most of the diseases that it was standardly used for. Additionally, bloodletting introduced all sorts of horrific complications like infections, hypovolemic shock, and even brain damage when the needle went too far into the infant’s head.

That being said, I was surprised to discover that there is at least one disease for which bloodletting is effective, and still used today! The disease has to do with iron in the blood. Most people think about blood-iron in the context of iron-deficient anaemia, or not having enough iron to make adequate red blood cells. But, it is also possible to have too much iron in the blood.

Iron overloading in North America is most often due to a genetic disease called hereditary hemachromatosis. It involves a mutation for a protein that normally regulates iron absorption in the gut. As a consequence, the gut absorbs too much iron and the blood becomes “overloaded”. Iron overload can have serious consequences causing damage to the liver, pancreas, pituitary gland, and skin.

Since the body has limited capacity for excreting iron, the best treatment for hereditary hemachromatosis is regular bloodletting to remove the excess iron. Of course, nowadays we use the fancy term “plebotomy”, but the principle is still the same! Neat, eh?

And now, for an intriguing (but horrible) story:

Mary Mallon was an Irish cook who moved to New York City in the year 1900. Only 31-years-old at the time, Mary took up employment in a wealthy man’s home preparing meals for the family.  Sadly however, within a couple of weeks the entire family became very ill. Concerned, Mary soon found another family to work for. It wasn’t long after though that Mary’s new family started falling sick as well. Some became severely affected, and the laundress of the household was overcome and passed away. So Mary moved again, this time to the home of a lawyer. Sure enough a few weeks later, the lawyer and most his family were sick in bed. Mary did her best to care for them, but finally she moved to yet another household.

George Soper, a typhoid researcher, eventually caught up with Mary and heard about her succession of failed employments. George had a theory that he put forward to Mary; he suggested that she might be the very first reported case of a typhoid carrier – that is, someone who can spread the disease without personally suffering from it. Mary was adament that she wasn’t carrying typhoid, and proceeded to infect three more households. In fairness, the Irish were never treated very well in New York City, and Mary may have had good reason to be suspicious of George’s accusations.

Mary was eventually apprehended and taken into custody by the city’s public health department. She was held in quarantine for some time before the city released her on the condition that she change her occupation from cooking to something less conducive for spreading infection! Mary agreed, but later changed her name to Mary Brown so that she could resume her work as a cook. She infected two more households! Eventually Mary was apprehended again and, sadly, held in quarantine for the rest of her life.

Typhoid fever is a disease that results from the bacteria Salmonella enterica typhi. It causes severe, inflammatory gastroenteritis resulting in bloody diarrhea and rapid fluid loss. Before widespread use of antibiotics, it was a fatal disease. Many of Mary’s victims died. Salmonella enterica typhi are spread by fecal-oral transmission. Likely in Mary’s case, bacteria in her fecal matter contaminated her hands, and then as a result of poor hand hygiene were transferred to her clients via the food that she prepared.