TME 74: Blood Letting: From Barber Shops to Modern Hospitals
- Dr. ARUN V J
- Sep 30
- 3 min read
When you hear the word blood letting, you probably imagine something from the Middle Ages — leeches, dark rooms, and desperate cures. Strangely enough, this old practice still has a place in today’s hospitals, but in a safer, scientific way. Doctors now call it therapeutic phlebotomy.
A Quick Walk Through History of Blood Letting
Blood letting is one of the oldest medical practices known to humankind. Ancient Egyptians, Greeks, and Romans all used it. For thousands of years, people believed that most diseases were caused by “bad blood” or an imbalance of the body’s four humors (blood, phlegm, black bile, and yellow bile).
In the Middle Ages, barber-surgeons — yes, the same barbers who cut hair — were often the ones to perform blood letting. Their shops even had the famous red-and-white striped poles we still see today. The red stood for blood, the white for bandages. A barber’s chair could easily become a place for both a haircut and a medical “treatment.”
But here’s the problem: people were drained without proper science, sometimes losing huge amounts of blood. Many became weaker, and some even died. A tragic example is U.S. President George Washington, who died in 1799 after doctors removed nearly 40% of his blood while trying to cure a throat infection.
The Modern Version: Therapeutic Phlebotomy
Today, blood letting looks nothing like the past. It’s a medical procedure done under the guidance of a doctor, with lab tests, sterile needles, and strict safety rules.
How It’s Done
You sit or lie comfortably, much like during a blood donation.
A nurse or doctor inserts a needle into a vein in your arm.
Blood flows into a sterile collection bag or container.
Usually, about one unit (around 450–500 ml) of blood is removed.
The whole process takes 15–30 minutes. Afterwards, you’re advised to rest, drink fluids, and avoid heavy activity for a day.
It feels almost the same as donating blood — except this time, it’s not for another patient, it’s for your own health.
Who Needs It?
Doctors use therapeutic phlebotomy for certain conditions where the body makes or stores too much:
Polycythemia Vera (PV): A condition where the body makes too many red blood cells, making blood thick and increasing the risk of clots, strokes, or heart attacks.
Hereditary Hemochromatosis: A genetic disorder where the body absorbs too much iron from food. The excess iron builds up in the liver, heart, pancreas, and other organs, causing long-term damage.
Porphyria Cutanea Tarda: A rare condition where iron overload contributes to painful skin blisters and liver problems.
Secondary Erythrocytosis: When blood becomes too thick due to chronic lung disease, smoking, high altitude living, or other medical issues.
When Should It Be Done?
This is not something to try at home. Doctors recommend therapeutic phlebotomy only when blood tests and symptoms show that it’s needed.
For example:
In polycythemia vera, phlebotomy is often started as soon as the hematocrit (the thickness of blood) goes above safe levels.
In hemochromatosis, it’s started when iron levels (ferritin, transferrin saturation) are dangerously high, even before organ damage occurs.
In porphyria, it’s used when skin lesions appear or iron levels are rising.
How Many Times Does a Person Need It?
It depends on the disease and the patient’s body:
Some people may need weekly sessions for several months until their blood or iron levels drop to normal.
After that, they move into maintenance mode, which may be once every few months or just a few times a year.
Each session removes about 200–250 mg of iron. So, if someone has built up many grams of excess iron, they may need dozens of sessions in the first year.
Your doctor monitors your hemoglobin, hematocrit, and iron levels regularly, adjusting the schedule so it’s safe and effective.
Is It Safe?
Most people handle it very well. Side effects are usually mild — dizziness, tiredness, or bruising at the needle site. These fade quickly with rest and hydration.
The biggest difference from old-style blood letting is this: today it is precise, monitored, and backed by science. No barber chairs. No guesswork. Just a straightforward procedure that can prevent strokes, protect your liver, and even add years to your life.
The Takeaway
Blood letting is no longer a dangerous superstition. In its modern form, therapeutic phlebotomy is one of the simplest and most effective medical treatments for certain serious conditions.
It’s a reminder that sometimes, old ideas aren’t thrown away — they’re transformed, sharpened, and made safer by science.
So, the next time you see a barber’s red-and-white pole, remember: once it meant more than a haircut. And today, in the hands of doctors, that ancient practice is still saving lives.
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