Medical Notes: `A bleeding in spring is physik for a King'

READ MOST medical histories and you read that the practice of bleeding patients, a mainstay of traditional medicine for centuries, was one of the most barbaric treatments ever conceived.

Whether the doctor pierced a vein, cut the skin or applied a blood-sucking leech, his behaviour was patently absurd. So, too, was the patient's ingestion of urine, usually dismissed by historians as a form of Drekapotheke - the misguided, wrongful use of disgusting substances as medicines. In both cases, however, this conventional history has it wrong. Far from irrational, these treatments met real medical needs in the past - and still do so in many advanced clinics today.

Phlebotomy was once so common that medical practitioners were known as "leeches" and the lancet became synonymous with the profession. Unfortunately, physicians in the past overused their tools, sometimes causing death by repetitive or massive bleedings and employing the remedy indiscriminately for any and all ailments. It is difficult for us to see any real benefits to the practice when such abuses are so glaringly obvious. Yet benefits there were, most notably the lowering of fever.

The Canadian physiologist Norman Kasting has shown that removing a pint of blood releases hormones that normalise body temperature. Significant bleeding also activates the immune system and depletes the body of iron, required by many bacteria for optimal growth. Since fever reduction was one of the most common of historical uses for bleeding, it is quite likely that many people actually did benefit from the procedure.

Many certainly do today. Regular phlebotomy is the preferred medical treatment for inherited and acquired blood diseases such as haemochromotosis, polycythema vera and porphyria cutanea tarda in which there is overproduction of red blood cells or a pathological retention of iron. Surprisingly, health benefits from bleeding may accrue to blood donors, too. Medieval Britons had a saying, "A bleeding in the spring is physik for a King." Regular blood donors do, indeed, have a longer life expectancy than the general population. Don't discount leeches, either. Microsurgeons use them to suck blood when all else fails to restore circulation to reattached digits, limbs, scalps, or transplants. Leech saliva is the original source for hirudin, a widely used "blood thinner" for heart attack and stroke patients, and more leech-derived drugs are in the works.

Like bleeding, the ingestion of human and animal urines was once a common medical remedy used to treat everything from menstrual irregularities and menopause symptoms to giddiness and sleeplessness - by the looks of it, another useless panacea. Yet, once again, the ancient uses have been validated by modern research and practice. Urine can contain high levels of hormones such as melatonin, used currently to facilitate relaxation and sleep, and oestrogen, the primary component of menopausal drugs like Premarinf, whose name is a contraction of the "pregnant mare's urine" from which it is distilled.

Urine contains other medicinal substances as well. People from time immemorial have washed wounds and burns in fresh urine. As long as the urine came from a healthy individual it was sterile and contained besides large amounts of urea, an antiseptic we still use in wound preparations today. Urine also dissolved scabs, an age-old observation that recently led scientists to discover the enzyme urokinase, now a clot-busting drug for heart attack and stroke patients. Even the folk tradition of rubbing urine on the body to improve the complexion or relieve chapped skin has its counterpart in modern practice. Urea is a common ingredient of skin moisturisers and lotions.

Such histories have their moral. Even the most absurd or disturbing of past medical practices may harbour a grain of medical wisdom. Understanding the practices of the past is the key to creating the treatments of the future.

Robert and Michele Root-Bernstein are the authors of `Honey, Mud, Maggots and Other Medical Marvels', (Macmillan, pounds 12.99)