演讲题目：Why doctors used to bleed their patients?

演讲简介：

放血疗法是一种广泛存在的医疗手段，其历史可追溯至古希腊时期，并一直延续至 19 世纪。像希波克拉底这样的医生认为，不良健康状况可能是由于体液失衡所致，并建议通过放血来帮助恢复身体的平衡。那么，为什么这种疗法能持续存在这么久呢？斯蒂芬妮·洪切尔·史密斯深入探讨了其流行的原因以及存在的缺陷。



中英文字幕

On December 14th, 1799, former US President George Washington woke struggling for breath, his throat searing with pain.

1799年12月14日，美国前总统乔治·华盛顿醒来呼吸困难，喉咙疼痛难忍。

He died later that day, from what's suspected to have been a badly infected epiglottis,

当天晚些时候，他去世了，疑似会厌严重感染，

but not before he was prescribed an enema, steam therapy, and rigorous bloodletting.

但在此之前，他被开了肠，使用了蒸汽疗法和严格的放血治疗方法。

During four bleeding sessions, Washington lost approximately two liters (roughly 40%) of his body's blood supply.

在四次出血过程中，华盛顿失去了大约两升（约40%）的血液供应。

And yet this wasn't totally out of the ordinary for the time.

然而，这在当时非常普遍。

Bloodletting was a pervasive medical practice that dated at least as far back as ancient Greece.

放血是一种普遍的医疗实践，至少可以追溯到古希腊。

Physicians like Hippocrates believed good health came from balance among what they called the body's four humors: yellow bile, black bile, phlegm, and blood.

希波克拉底等医生认为，良好的健康来自于他们所谓的身体四种体液之间的平衡：黄胆汁、黑胆汁、痰和血液。

They attributed bad health to humoral imbalance, so treatments included purging, peeing, enemas, and bloodletting.

他们将健康状况不佳归因于体液失衡，因此治疗方法包括净化、小便、肠和放血。

How people were bled varied with time, place, and practitioner.

人们的放血方式因时间、地点和从业者而异。

Sometimes it was with sharp tools like quills, animal teeth, and metal blades; others, using leeches; or through wet cupping,

有时是用鱼叉、动物牙齿和金属刀片等尖锐工具;其他人则使用韭葱;或者通过湿拔火罐，

which involved scraping the skin and drawing blood out with heated glass containers.

其中包括用加热的玻璃容器刮擦皮肤并吸出血液。

In the 2nd century,

在二世纪，

the prolific Greco-Roman physician Galen declared blood the most dominant humor and recommended bloodletting for just about every ailment imaginable.

多产的希腊罗马医生盖伦宣称血液是最主要的幽默，并建议对几乎所有可以想象到的疾病进行放血治疗。

The practice flowed into the medieval Islamic and European world, with physicians discussing its do's and don'ts extensively.

这种做法流入了中世纪的伊斯兰和欧洲世界，医生们广泛讨论了它的做和不做。

It was to be avoided during cold weather, and certain body parts were to be used or bypassed

在寒冷的天气中应避免这种情况，

based on the lunar cycle, zodiac calendar, and location of the ailment.

并且要根据月亮周期、黄道历、以及疾病的位置。

While on Crusade in the late 12th century,

12世纪末十字军东征时，

King Richard the Lionheart of England postponed negotiations with Sultan Saladin's envoy

英格兰国王狮心王理查德推迟了与苏丹萨拉丁特使的谈判，

to recover from one of his regular, preventative bloodletting sessions.

就是为了从他定期进行的预防性放血治疗中恢复过来。

In 1685, after King Charles II of England began convulsing, he was bled from multiple veins, barraged by enemas, emetics, and purgatives,

1685年，英国国王查理二世开始抽搐后，多条静脉流血，并被泻药、催吐药和泻药猛烈攻击，

and fed an elixir containing powdered human skulls.

并喂食含有人类头骨粉末的灵丹妙药。

Despite bloodletting's ubiquity, not everyone was enthusiastic.

尽管放血无处不在，但并非每个人都对此热衷。

In the feverish days preceding the poet Lord Byron's death in 1824, he called his physicians a "set of butchers,"

在1824年诗人拜伦勋爵去世前的狂热日子里，他称他的医生是“一群屠夫”，

as they went about draining some 2.5 liters of his blood.

当时他们正在抽取他大约2.5升的血液。

So, why did bloodletting stick around so long?

那么，为什么放血会持续这么久呢？

Well, simply receiving care might have led to perceived benefits by way of the placebo effect.

好吧，简单地接受护理可能会通过安慰剂效应带来明显的好处。

And although some bloodletters were dangerously overzealous, modest bloodletting may not have been all bad.

尽管一些放血的宣传者过于热情，但适度放血可能并不全是坏事。

Blood donors today give about half a liter of blood at a time, and some studies suggest that regular donors do see long-term cardiovascular benefits.

如今，献血者一次献血约半升，一些研究表明，定期献血者确实看到了长期的心血管益处。

It's also theoretically possible that, when done sparingly and early on, bloodletting could help fight some infections by reducing levels of iron,

理论上也有可能，如果在早期少量放血，放血可以通过减少铁的含量来帮助对抗一些感染，

which infecting microbes use for energy.

感染微生物的能量。

But back then, no one even knew that pathogenic microbes existed yet, and bloodletting also caused infections.

但在当时，甚至没有人知道致病微生物的存在，放血也会引起感染。

This problem became especially pronounced in the 1700s, when the spring lancet was invented, with its tough-to-clean retractable blade.

这个问题在1700年代变得尤为明显，当时弹簧柳叶刀被发明，其具有难以清洁的可伸缩刀片。

Bloodletting gained popularity throughout the 1700s.

放血在18世纪广受欢迎。

To supply the booming industry, leech catchers waded through boglands, using themselves as well as animal meat and organs as bait.

为了满足这一蓬勃发展的产业需求，采集水蛭的人员纷纷跋涉至沼泽地之中，用自己以及动物肉和器官作为诱饵。

But bloodletting's shortcomings began to show.

但放血的缺点后来开始显现。

Philadelphia physician and Declaration of Independence signatory Benjamin Rush was one of bloodletting's biggest backers.

费城医生、《独立宣言》签署人本杰明·拉什是放血运动的最大支持者之一。

He advocated for taking 80% of a patient's blood.

他主张抽取患者80%的血液。

Rush also tended to over 100 patients daily, and his front yard became fetid and fly-infested from all the tossed-out blood.

拉什每天还要照顾100多名病人，他的前院因被扔出的血液而变得恶臭，苍蝇出没。

In the 1790s, English journalist William Cobbett accused Rush of dramatically increasing Philadelphia's daily mortality rates,

1790年代，英国记者威廉·科贝特指责拉什大幅增加了费城的日死亡率，

but Rush successfully sued Cobbett for libel.

但拉什成功起诉了科贝特的诽谤。

Still, as late as 1836, the largest London leech suppliers were importing around 600,000 leeches for bloodletting every month.

然而，直到 1836 年，伦敦最大的水蛭供应商每月仍需进口约 60 万条水蛭用于放血手术。

But as Cobbett and others dug into the data, bloodletting's supposed benefits became all the more dubious.

但随着科贝特和其他人深入研究这些数据，放血所谓的好处变得更加可疑。

And by the 20th century, its use slowed to a trickle, when humoral theory was finally replaced by germ theory,

到了20世纪，它的使用逐渐减少，体液理论最终被细菌理论取代，

which demonstrated that many illnesses were actually caused by microorganisms.

这表明许多疾病实际上是由微生物引起的。

Today, bloodletting is used to treat certain blood disorders like hemochromatosis,

如今，放血被用于治疗某些血液疾病，例如血色病，

which causes dangerous levels of iron to build up in the bloodstream.

这会导致血液中铁含量达到危险水平。

But generally, bloodletting has been relegated to the ranks of outdated, misguided medical treatments, bled dry by progress.

但总体而言，放血疗法已被归入那些过时且错误的医疗手段之列，因时代的进步而逐渐被淘汰。