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

this way, we evacuate the actual inflammatory materials themselves. And nothing else.” It’s a remedy that was “esteemed by the ancients.” By contrast, the main Erasistratean solution, starvation, “apart from the long time it requires, evacuates the whole system indiscriminately.” Even now, I can almost hear Galen’s
tsk-tsk,
as well as the grumbling of the Erasistrateans gathering at the back of the crowd.
    In addition, starvation, Galen warns, is accompanied by a host of evils: severe fatigue, nausea, heartburn, constipation, and perhaps the most serious side effect, turning the other humors “bilious and painful,” thereby exacerbating rather than alleviating the imbalance. Pausing, I imagine, to let the crowd absorb these grim facts and to allow the stenographers to catch up, Galen then adds, “Yet Erasistratus sees none of these.” He and his adherents are “like blind men, who although a smooth, broad, and direct road is near, often take a narrow, rough, and long one, and go by a circuitous route.”
    A surgeon by training and temperament, Galen next attacks their use of powerful laxatives and purgatives as a foolhardy reliance on fate. “The flow to the stomach cannot be stopped in the way you can immediately put an end to the bleeding by putting your finger to the divided vein.” He then brings this argument home: A “grave disturbance of the entire body [may occur] as a result of being evacuated either insufficiently or to excess,” whether it be loss of consciousness or “pulselessness.” Indeed—pause for dramatic effect—“the ultimate misfortune often ensues in this state.”
    What’s fascinating is that Galen’s own last remarks could equally have been used to denounce his beloved bloodletting. Erasistratus held that it was impossible to determine precisely how much excess blood a patient had and therefore how much should be let. Further, he had seen the handiwork of incompetents who’d slashed through tendons, nerves, and arteries in their hunt for a vein, leaving behind lifelong damage if not death. The practice was so fraught with risk that Erasistratus viewed bloodletting as tantamount to committing murder. But Galen felt himself beyond reproach. He well understood that a patient could die quickly if an artery were severed, which was the primary reason he rarely attempted opening these thicker vessels with their greater blood volume. (They were also harder to access, anatomically speaking.) As for patient safety, Galen again placed himself above Erasistratus, who “paid little attention to examining patients, but stayed at home and wrote down mere opinions.” Adamant that only an experienced physician should perform phlebotomy—he, of course, being best suited—Galen advised cutting parallel to a vein, never across it, and keeping puncture holes small. Bloodletting sounds ghastly, but, in fact, the amount Galen drained at one sitting was modest—about a pint at most, no more than you’d give today at a blood bank. However, the doctor often chose to repeat the procedure day after day after day.
    Galen saw no stronger argument for venesection than in the seemingly spontaneous bleedings orchestrated by “Nature.” He cites nosebleeds and menstruation as ways the body restores its humoral balance: “Does [nature] not evacuate all women every month by pouring forth the superfluity of the blood?” As a matter of fact, modern medical historians speculate that menstrual bleeding probably not only provided the initial inspiration for drawing blood but also helped reinforce its supposed benefits. After all, as my five sisters and numerous female friends attest, they feel great after their period is over.
    “But enough of women,” Galen says dismissively to the crowd. To further his argument, he calls on a most unlikely ally: the hemorrhoid. “Come now to consider the men, and learn how those who eliminate the excess through a hemorrhoid all pass through their lives unaffected