The Evolution of Phlebotomy

Modern phlebotomy is defined by the dictionary as, “The act or practice of opening a vein for letting or drawing blood as a therapeutic or diagnostic measure; venesection; specimen collection.”

Phlebotomy’s history actually began as “bloodletting,” which was first practiced by the ancient Egyptians around 1000 BC. Because early Egyptian medicine combined observation and experimentation with magic and religion, it was believed that literally letting blood out of the body would cure diseases like acne or the plague, as removing the blood was considered to be a way to cast out evil spirits and reduce ‘plethora’, an apparent excess of blood that they believed caused inflammation and fever.

Bloodletting spread to the Greeks and the Romans and because of their belief in “humorism”—the idea that the body has four humors (blood, phlegm, black bile, and yellow bile). They believed that imbalances in these humors were the primary cause of all illness.

Recovered Greek and Roman medical texts led to the use of bleeding as a medical treatment in Europe in the Medieval era. The thought surrounding the practice was that blood was stagnant in the extremities, not flowing through the body as we know it does today, and thus would cause disease. Releasing the stagnant blood would, therefore, cure the patient by forcing the blood to move.

The Middle Ages

In the middle ages, bloodletting was not performed by physicians, but by “barber-surgeon”. These barber-surgeons also performed amputations and pulled teeth, which is why the red stripe on a barber pole is symbolic of the bloodletting portion of their profession while the white stripe represented sterile bandages.

Towards the end of the 16th century, surgery became more sophisticated as a number of fields of medicine began to advance and the job of bloodletting went back to trained physicians.

Bloodletting

By the 1800’s the popularity of bloodletting was high. For the procedure, the physician would make an incision in veins or arteries. They also used ‘cupping’, a method of blistering the skin so blood could be released from the blisters.

Leeches were also used to suck up blood, as they can suck up ten times their body weight in blood. Bloodletting at the time was thought to cure conditions such as acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy and many more.

There is very little evidence that historical bloodletting was an effective treatment, outside of very specific medical conditions we recognize today. This includes Hereditary Hemochromatosis (where the body has too much iron) or Polycythemia Vera (where the body produces too many red blood cells). In these modern ‘therapeutic phlebotomy’ cases, removing blood is still a vital, life-saving treatment.

It is far more likely that bloodletting had a placebo effect, with those receiving the treatment simply believing it was making them feel better.

The Death of George Washington

Of course, releasing too much blood from a body will do irreparable harm. An excellent example of a failed blood-letting is the death of George Washington.

In the days before his death, Washington had been complaining of a sore throat. When he woke one night and had difficulty breathing, several doctors were called, but before the doctor could arrive, Washington ordered estate overseer George Rawlins to remove nearly a pint of his blood.

When the doctors arrived, they continued the bloodletting (approximately five pints), but it was futile, and his condition deteriorated. Modern scientists have speculated that Washington likely suffered from acute epiglottitis (a severe swelling of the windpipe), but having been bled several times weakened him and caused a massive loss of blood volume, making it impossible for his body to fight the infection.

Modern Phlebotomy

The true turning point for the profession occurred in 1947 with the invention of the evacuated tube system, or the Vacutainer. This moved phlebotomy from ‘open’ systems using syringes and glass jars to the ‘closed’ vacuum systems used today, drastically improving safety for both the patient and the technician.

Phlebotomy, as we know it today, has a different use. It is not used to simply release blood from the body, but to acquire a sample of blood from a patient for diagnostic tests under a physician’s orders. Moreover, taking a blood sample is a quick, safe, and virtually painless procedure, performed by a certified phlebotomist, in a healthcare environment, using sterile tools.

Today’s phlebotomists are also tech-savvy professionals. Beyond the draw, they are responsible for Point of Care Testing (POCT) and ensuring data integrity within Electronic Health Records (EHR), making them a critical link in the modern diagnostic chain.

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