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Medicine during the Golden Age of Piracy
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Salty Dog
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PostPosted: Thu Jul 12, 2018 11:33 pm    Post subject: Reply with quote

Disorders of the Skin

Disorders of the skin involve disease of the skin, fingernails, hair, etc.; disorders that present themselves most visibly on the surface of the body. The ailment is not necessarily a skin disease but its signs appear on the skin. Any many cases disorders of the skin are actually a dietary problem. Even during the 18th century many of these ailments were believed to be caused by something internal.

The Itch

Scabies more commonly called "the Itch" is a general term for skin-diseases characterized by scabby or scaly eruption. Most often it is a contagious skin-disease, due to a parasite, Sarcoptes scabiei. The disease could have been easily avoided by regular bathing and wearing clean clothes. But what self respecting 18th century pirate is going to take a bath and wear clean clothes?

Cosimo Bonomo had discovered that the Itch was caused by parasitic louse in the late 1600s. He started a treatment using a salve containing sulfur which proved quite successful. Despite his correct diagnosis and effective treatment, most medical professionals continued to consider the disease caused but imbalance of the humors and continued to treat it by either sweating a patient or by bleeding a patient. Quacks on the other hand followed Bonomo's effective treatments and used various salves of either mercury or sulfur to treat the Itch. It would take several years for the medical profession to admit their wrong headedness in the treatment of scabies.

An interesting tidbit to the treatment of scabies and quite possibly one reason why physicians started treating it correctly involves none-other than Benjamin Franklin. the widow Sarah Read, Franklin's mother in law, ran advertisements in the Philadelphia Gazette promoting her ointment which was supposedly had no foul odor and was guaranteed to cure the Itch. It is safe to assume that Franklin, having an open and inquisitive mind, supported this quackery by his mother in law allowing such ads to run in his paper. While supporting the quackery of hi smother in law, Franklin debunked other forms of quackery such as the use of magnets to remove harmful electric currents from the body.
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PostPosted: Thu Jul 12, 2018 11:34 pm    Post subject: Reply with quote

Gout

In the 18th century, Gout was viewed as a disease of decadence caused by over indulgence especially of rich foods and alcoholic spirits and laziness. Most pirates, missed out on gout simply because they died young and couldn't afford the rich foods often attributed to it. However, diets high in sea food and organ meat could also lead to gout. Diets high in salt are also a problem. Port wine also was a major culprit. In the 18th century it was common to sweeten wines with sugar of lead. Sugar of lead was made from that "insipid Metal and sour salt of Vinager, has in it a sweetnesse surpassing that of common Sugar*". Basically vinegar was boiled down in a lead pot and what was left was sweet tasting syrup. The syrup caused chronic lead poisoning and this in turn brought on gout, a sign of lead poisoning.

The disease often led to severe joint pain and inflamed skin As it progressed, kidney stones could form leading to even more misery.
In sever cases, the skin would actually begin to shed form the excessive swelling. Outer joints such as toes or fingers might become so swollen that they would mortify and need to be amputated.

Today we know that gout is a form of arthritis brought on by monosodium urate crystals are deposited on the cartilage of joints. It can be controlled by diet but diet and laziness do not actually cause the disease and becoming more active will not prevent attacks of the gout.

It was most often treated through bleeding and sweating. The drug of choice was colchicine poisonous alkaloid, made from the autumn crocus or meadow saffron. Patients were also advised to stop drinking and eating sweets.

*Robert Boyle, The Sceptical Chymist 1661.
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PostPosted: Thu Jul 12, 2018 11:35 pm    Post subject: Reply with quote

Boils

A boil is a deep abscess in the skin. This section looks at carbuncles, a type of boil caused by staph (bacteria) infections. Boils have been a common complaint throughout history and many methods of treating them have existed.

Boils can form when a small cut or insect bite gets infected. If splinters or other foreign objects get lodged under the skin, they can also cause boils. A person with a weakened immune system due to illness, poor diet, or poor hygiene is more likely to get boils.

Typically, a boil begins as a tender spot on the skin that appears red in color. Over time the tender area becomes firm, hard and painful. In the final stages, the boil fills with pus (white blood cells) and forms a head. Because the boil is a staph infection it is sometimes associated with chills and fevers.
Once the boil comes to a head it is possible to drain it. Draing the boil is a very painful procedure that usually involves squeezing the boil to force out all the pus and fluids inside. Often it may involve lancing or probing the boil with a sharp instrument to dig out dead tissue and the head of the boil. As you can imagine the procedure is very painful. If the boil is not completely drained it will most likely recur. Once the boil is completely drained, the patient usually feels instant relief.

In order to prevent the boil from coming back, 18th century physicians probably used the most common antiseptic of the time, turpentine. Turpentine would burn like crazy when applied to the boil. Afterwards, the boil would be covered with a bandage. Turpentine would probably be a re-applied for a few days or unless the patient refused to return. Mercury might also be applied but that would have been for more stubborn boils. The use of Domba oil, another natural curative would have come into use around the late 1700s, well after the peak of the Golden Age of piracy.
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PostPosted: Thu Jul 12, 2018 11:37 pm    Post subject: Reply with quote

Fevers

Typhoid

Typhoid or typhoid fever is illness resembling or characteristic of typhus; applied to a class of febrile diseases exhibiting symptoms similar to those of typhus, or to such symptoms themselves, esp. to a state of delirious stupor occurring in certain fevers


Typhus: The fever

Typhus is an acute infectious fever, characterized by great prostration and a petechial eruption; chiefly occurring in crowded tenements.
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PostPosted: Thu Jul 12, 2018 11:38 pm    Post subject: Reply with quote

The Foul Disease

The Foul disease was also called the French Disease by the British and the Italian Disease by the French. Today the one disease is known to be two separate disease caused by the same type of behavior. The Foul Disease is actually gonorrhea and or syphilis. In the 18th Century it was believed that two diseases were one in the same with gonorrhea being an early stage of syphilis . There is no doubt that the foul disease was a very real threat to pirate crews.

It is believed that Black Beard kidnapped and held for ransom member of Charleston's most important families for medicines presumably to treat the foul disease. If this is the case, the medicines of the day would have mercury salves, ointments, and tincture of mercury which would have been taken internally.

The mercury ointments were applied liberally to the skin of the inflicted person and then the person would be wrapped in heavy blankets, forcing them to sweat out the disease. The salves would often blister the skin. The treatment would often go on for days or even weeks. Occasionally, a person would also take the mercury by mouth so as to purge the fouled disease from the person's inside. Among the various side effects from the mercury ointments was excessive salivation. causing the person to drool constantly. This was seen as a sign that the treatment was working. Other side effects were tremors, loss of balance, constant headaches, and bad stomach cramps. Again this was seen as the foul disease being forced from the body. Constant sweating, bleeding gums, and joint pain were also quite common. All of the symptoms were actually signs of mercury poisoning.

Despite the incorrect diagnosis, mercury compounds were supposedly somewhat effective in treating foul disease when caught in its early stages. It begins with a high fever followed by general aches and pains. Sometimes the patient is also vomiting. After a few days a rash begins, usually along the hairline. The rash quickly spreads, and forms little bumps which then blister and break. Those who survive the disease are scarred fro life.
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Pirate
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PostPosted: Fri Jul 13, 2018 12:32 am    Post subject: Reply with quote

I think hes calling me a stinky good for nothing flea invested toothless pirate. Smile
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Mr. Blue
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PostPosted: Fri Jul 13, 2018 12:43 am    Post subject: Reply with quote

Pirate wrote:
I think hes calling me a stinky good for nothing flea invested toothless pirate. Smile


Aye, but the last word of it all, pirate, turns it into a compliment.
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Pirate
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PostPosted: Fri Jul 13, 2018 1:35 am    Post subject: Reply with quote

Mr. Blue wrote:
Pirate wrote:
I think hes calling me a stinky good for nothing flea invested toothless pirate. Smile


Aye, but the last word of it all, pirate, turns it into a compliment.


Yeah it's a honor to be a pirate. In fact I stink so bad I put the first hole in the ozone layer long before the coal fired power plants came around. Smile
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PostPosted: Sat Jul 14, 2018 5:50 am    Post subject: Smallpox Reply with quote

Small-pox, pox, pocks

The pox or pustules on the skin which form the most characteristic feature of the acute contagious disease. It was known simply the pox until the Foul Disease entered Europe. Once venereal disease arrived they became known as "the Great Pox" and the pox became "Small-Pox"

Small pox was almost always fatal and contagious. After an incubation period of 10-14 days the disease comes on suddenly, is quite painful and would kill the patient within three weeks. After incubating, the patient usually gets a high fever, followed by general body aches and pains, and vomiting. After a few more days, a rash forms, usually starting along the hairline but spreading all about the face, and extremities. The rash them forms into blisters which burst and from scabs. The patient is in constant pain and itches all over from the scabs. Once the bumps begin to form pustules (sacks of puss) one of two things will happen. If the pustules remain separated, they will burst and the patient has a decent chance of surviving. This is called ordinary smallpox. In the case of confluent ordinary smallpox, the pustules merge together and instead of bursting push the skin away from the body, usually causing death. If the patient can survive the confluent small pox, the pustules will begin to deflate and after about 28 days the will dry up.

The worst type of small pox was the black pox which did not cause pustules to form but instead led to internal bleeding. The skin remained smooth and black spots formed under the skin from bursting blood vessels. The blood vessels in the eye would also burst causing the whites of the eye to turn red and eventually black. Eventually the internal organs would start bleeding and in almost all case the victim would die.

Sometimes the person is contagious as soon as the fever arrives but most often they becomes contagious once the rash appears. Once the scabs fall off the person is no longer contagious. For the most part direct contact with the patient or body fluids is need for the disease to spread but sometimes when smallpox infects the lungs, the disease is transmitted by breathing the same air. If the person lives through the disease, they are left scarred for life from the scabs.

Middle Eastern nations had learned to inoculate against the small pox long before the 18th Century. They did this by exposing people to the actual small pox virus through needle pricks. This caused a mild case of the disease which was survivable about 99 times out of 100. They probable learned this procedure from Far Eastern counties. The method was brought to the Europe by Lady Mary Wortley Montagu around 1716-1718 and possibly others. The procedure was always considered dangerous but when the fear of certain death swept through populations people would take the risk. Their is no cure for small pox once it is contracted and until 1799 a safe inoculation for the disease smallpox rested in the realm of quacks and old wives' tales. One such old wives' tale was a Scottish one that claimed that milk maids did not get smallpox if they had ever contracted cowpox. That story proved true and led to Jennings eventual vaccination against the disease which would eventually eradicate smallpox from the face of the Earth.
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PostPosted: Sat Jul 14, 2018 5:52 am    Post subject: Reply with quote

Tropical Fevers

The two principal fevers that caused the most damage were Yellow Fever and Malaria. Both are mosquito born diseases and both are common in the area that was once the Spanish Main, the stomping grounds of Caribbean pirates. Both Malaria and Yellow Fever present similar symptoms on their onset. These symptoms include: high fever, chills, headache, muscle aches, vomiting, and backache. It wasn't until around 1881 that a Cuban studying Yellow Fever began to speculate that diseases were being transmitted to human through mosquito bites, The doctor was Carlos Findlay. His suspicions would be proven over the next few decades.

A vaccine for Yellow Fever was not developed until the early 20th century. Europeans learned of a treatment for Malaria around 1640 when Jesuits observed Peruvian Indians using the bark of the cinchona tree to treat people infected with malaria. Today we know that it was the quinine, which occurs naturally in the cinchona bark, that was found helpful in the treatment of malaria. Neither disease can be cured once contracted. They can only be treated. Because Yellow Fever is caused by several similar viruses, a person can catch it more than once if not vaccinated.
After the initial stages of infection, the disease behave differently. Both will be treated separately below.

Malaria:


The earliest records of malaria infection date to 2700 B.C. The disease was also called marsh fever and has always been associated with swamp lands and tropical forests. It was initially believed that the disease was spread by the bad air of the swamp. The name "Malaria" is actually a contraction of the two Latin words -- mala = bad and aria = air. It would be a while before people realized mosquitoes were the principal cause of the disease. In 1880 a French doctor, Charles Louis Alphonse Laveran, discovered that parasites caused the disease. It wasn't until 1898 that a British doctor, Sir Ronald Ross, linked the disease to mosquitoes.

Once a person has malaria he will have it for life. There is no cure. Besides the initial symptoms listed above, malaria also causes anemia, which would lead to fatigue. After the initial onset, depending on what type of parasite is causing the outbreak, the patient will start showing the classical symptoms which is a cyclical occurrence of sudden coldness followed by the body becoming stiff and then fever and sweating lasting four to six hours. These bouts will happen every two or three days until death or the person receives treatment. In the most severe case of malaria a person will slip into a coma after 14-16 days of infection. In the 18th century this would spell certain disaster.

Yellow Fever:


Yellow fever as it was called by the British was known as vomito negro by the Spaniards. We know from written accounts by Alexander Exquemelin and Lionel Wafer, that buccaneers invading the Isthmus of Panama were plagued by Yellow Fever. Yellow fever was not always deadly and in fact many people caught mild infections and recovered without treatment. However, just about anyone who went into fever infested areas was likely to catch it. This meant that one person may get a mild case while the person next to him could get a sever case leading to death.

The patient first has flu like symptoms as described above and then seems to recovers. Shortly after this recovery , the infection may lead to shock, bleeding, and kidney and liver failure. Liver failure causes jaundice (yellowing of the skin and the whites of the eyes), which gives the disease its name. The name vomito negro (Black Vomit) is associated with the vomiting that occurs in this later stage as the patient continues to vomit bile.

The disease does not always remain isolated in the tropics. Outbreaks of the disease also decimated cities such as Havana in ---- and Philadelphia in in 1793. Outbreaks in urban areas tend to be more life threatening than in the rural areas. The reason the urban yellow fever is more dangerous than jungle yellow fever is because of the way the disease spreads. Jungle yellow is usually transmitted between monkey and mosquitoes. When humans enter this natural cycle they get the disease from mosquitoes infected by the monkeys. Urban yellow fever is caused when mosquitoes pick up the disease from humans and then pass it on to another human.

There is no cure for yellow fever. Once contracted it must run its course. The usual treatment is to drink plenty of fluids and rest. bleeding a patient with yellow fever would probably hasten death or at least prolong the illness.
Dr. Benjamin Rush, the only doctor to sign the United States Declaration of Independence, actually recommended bleeding and purging as the best way to treat Yellow Fever. Despite many nay-sayers, the advice of Dr. Rush, a respected physician was practiced by many throughout the colonies. His treatment involved a mixture of calomel and jalap*. Despite many critics, the so called cure was pushed on many hapless patient, adding excess misery to an already horrible disease.

*Jalap is a purging drug. It is a climbing, evergreen vine, that reaches about twelve feet in length , with heart-shaped leaves and trumpet-like purple flowers. It is native to Mexico. Today it is grown in Central America, parts of Peru, the West Indies, and Southeast Asia. The purgative properties of Jalap has been known for centuries. Natives of Mexico introduced it to the Spaniards who then passed it on to the rest of Europe. By 1565 it was being used by most European nations as well as their colonial counterparts for all types of illnesses. It fell out of favor in the 19th century. Calomel is mercurous chloride. In the 18th century, mercury compounds such as calomel were used to treat everything from syphilis to fevers.
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PostPosted: Sat Jul 14, 2018 6:25 am    Post subject: Reply with quote

Scurvy

Scurvy is a disease characterized by general debility of the body, extreme tenderness of the gums, foul breath, subcutaneous eruptions and pains in the limbs, induced by exposure and by a too liberal diet of salted foods

Pain

Have you ever stuck your self with a needle or stepped on a fishing hook? Have you ever cut yourself so badly that it required stitches? Imagine having someone sewing up that cut with needle and thread but not using pain killer, not even aspirin or Tylenol. Have you ever had to dig a splinter out of your finger. Imagine having to dig a bullet or a 6 inch piece of wood out your side, again without any pain killers. Imagine is you can, the pain of having a leg or arm cut off without pain killers. Fortunately with today's healthcare, few people today have had limbs removed without the benefit of anesthetics or analgesics. Unfortunately many soldiers and some civilians are the targets of Improvised Explosive Devices and mines which are often designed to blow off arms so too many people know the pain of traumatic amputation. But imagine being told you will die if your leg is not cut off and you know that there is nothing that will kill the pain of the operation or recovery; that was the state of surgery in the Golden Age of Piracy.
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PostPosted: Sat Jul 14, 2018 6:27 am    Post subject: Reply with quote

Amputation

Amputations in the 18th Century were a risky business at best even when done by the most skillful surgeons. Until 1718, a leg amputation above the knee almost always ended in the the patient bleeding to death. In 1718, a French surgeon, Jean Louis Petit, invented the screw tourniquet this dramatically reduced deaths from bleeding to death and made it possible to successfully amputate a leg above the knee (thigh amputations).

Unfortunately screw tourniquets did not stop the pain of the operation and if applied incorrectly caused mortification of the wound. The use of the screw tourniquet caught on relatively quickly among the learned surgeons but those in the outlying colonies or not schooled in a Surgeons College were less likely to know about the tourniquet or had the proper training to apply it correctly. By the time of the French and Indian War (1754) the use of the screw tourniquet was common practice among surgeons.

Blood loss was usually not the main cause of death from amputation, shock from the pain was most likely the leading cause of death from the actual amputation. Once again there was a disconnect between some common knowledge of the time and the conventional practice of the surgeon in the 18th century. Opium, a narcotic that lessens pain was well known in the 18th Century. Cocaine, another pain reducing drug was also known in the Caribbean However neither drug was seen as medicinally useful for another 100 years. The drug most commonly used to lessen pain was Strong spirits such as rum or whiskey. It was not effective for several reasons for more on pain killers see Analgesics and Anesthetics.

If the patient survived the injury that led to the need to remove a limb, survived the blood loss from the surgery and did not die from the intense pain of the operation, then he still needed to survive the almost certain infection that would follow the operation. Infection was not only common among amputees it was accepted as part of the healing process by many in the medical professionals of the time. The opinions on this progression of healing would slowly change so that by the 1770s only a very poorly taught surgeon would think infection was a necessary part of healing.

If an infection were to form, the laudable puss would show a few days after the operation. With the puss came high fevers and/or chills. After a few days of the laudable puss, fevers, and chills, if the patient responded well, the injury would start to heal and the patient would get well. If on the other hand, the patient did not start getting well, then further operations would follow or the patient would die. For more information on laudable puss see the entry on infection and mortification.
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PostPosted: Sat Jul 14, 2018 6:27 am    Post subject: Reply with quote

The actual procedure of amputating a limb was straight forward. Because of the lack of anesthetics speed was of the utmost importance. A good surgeon was able to remove an arm or leg in under ten minutes. In fact, even with the screw tourniquet it was necessary to remove the limb in less than 10 minutes to prevent the patient from dying from either shock or blood loss.

Up until the end of the 17th century most amputations were done with a straight cut through flesh and bone. By the end of the century and throughout the 18th century a two conical cut were made around the bone using a sharp surgeon's knife. this left the bone recessed inside the cone of flesh. In the case of remove a leg there were three major arteries that would be located and sutured closed. Afterwards a saw was employed to cut through the bone. Awash of water would follow the completion of the amputation in order to remove any bone fragments left on the exposed muscle and flesh. Once the leg or arm was removed, the cone was pushed together and sewn up to create a fleshy stub around the cut bone. Following the procedure bandages would be wrapped around the freshly amputated limb.

The major post operative problem with the surgery is sanitation was unknown and was not considered necessary. The bandage was not changed, the surgical knives and saws were not routinely cleaned, and it was not considered important to clean the wound area before or after the operation. In instances where a doctor may need to perform more than one surgery back to back, the blood of the first patient would quite often still be on the instruments when the doctor reached the second patient. The concept of spreading infection through bacteria or viruses did not exist because they had not been discovered yet. For more information on post operative infection see the entry on infection and mortification.
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PostPosted: Sat Jul 14, 2018 6:29 am    Post subject: Reply with quote

Analgesics & Anesthesia (pain killers)


The most common anesthetics used to date are derived from opium, cocaine, or for lesser pains forms of non-steroidal anti-inflammatory drugs-NSAIDs (aspirin, acetaminophen, ibuprofen). During the Golden Age, opium and cocaine existed but were not used medicinally. NSAID's were not even invented and only a few herbalists were aware of salicylic acid, a by-product of willow tree bark , a main ingredient in aspirin. In 1899 Bayer released his famous aspirin. Aspirin was actually invented by Wilhelm Siebel and Felix Hoffmann. They made acetylsalicylic acid which combines vinegar with salicylic acid to form a more useful product.

During the 18th century there was no aspirin but we do know that the medicinal usefulness of willow tree bark was known and had been known since ancient times. It was known by the ancient Greeks and remained common knowledge throughout Europe. It is also believed that the Native Americans knew of the its usefulness even before the arrival of the first Europeans. So while the professional doctors failed to recognize its usefulness to any great extent for some time to come, Quacks were most likely already selling patented creams that could cure acne, heal small abrasions, ease the pain of bruises and if taken by mouth calm a headaches. They would have made the cream from the bark of willow trees mixed with any kind of liquid that could soften the bark and allow it to be pulverized into a paste. The drug would have been somewhat effective yet just as quickly dismissed by the professional medical community.

Opium was a major trade product of the British East India Company beginning in 1757. The Company used opium as a cash crop trading it in China for tea. Eventually this led to the Opium wars in China. We have accounts of liquid laudanum (opium) being used to settle a person's nerves but was not considered useful for surgery. It wasn't until the 1800s, long after the Golden Age that opiates were used extensively for the suppression of pain.

Cocaine was used as a local anesthetic by the ancient Incans of Peru but its usefulness as a local anesthetic was not realized by Europeans until Carl Koller used it while performing eye surgery in 1884. It was used recreationally for much of the 19th century but was not well known during the Golden Age.
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PostPosted: Sat Jul 14, 2018 6:30 am    Post subject: Reply with quote

Bleeding

Bleeding was a common method for the treatment of several ailments, including infections from gun shot wounds, fevers, colds, gout, etc. Bleeding was only one of the more bizarre treatment methods. Other related treatments were purging, and cupping.

Bleeding was done in a number of way. One method was to apply leaches to the patient and let the leeches suck blood for a desired length of time. Another method involved the use of a lancet. The lancet was a spring loaded blade that would cut deep into a leg of forearm and open up a vein. The usual method was to apply a tourniquet around the leg or arm and then using the lancet, make an incision. Then the tourniquet would be loosened, the proper amount of blood would be allowed to flow into a measuring cup and then the bleeding would be stopped. as you can imagine, the lancet was not cleaned for antiseptic reasons but simply to keep it sharp and free from rust.

Purging is what it sounds like. A person would be fed something that would make him vomit or be given an enema to clean out his bowels.
Cupping involved placing a glass cup over a wound and then pressing down forcing the puss and blood to gush out of the wound. It would be similar to popping a black head except on a larger scale.

In some instances purging and cupping may have had some beneficial effects, however bleeding was rarely useful and this is why so much attention is paid on this harmful medical practice. As explained in the background section, bleeding was done in order to maintain a balance between the humors in body.

What is normally ignored when discussing bleeding during the 18th century is that there were physicians and surgeons who were questioning the logic of the procedure. Two such Doctors were Thomas Moffet and Cosimo Bonomo. By 1687 both men had determined that bleeding was useless when treating diseases or injuries. While main stream medicine disputed their findings, the men did have followers.
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