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2013년 11월 29일 금요일

About 'phlebotomy equipment'|Fixing bad blood tests







About 'phlebotomy equipment'|Fixing bad blood tests








Vocabulary               Antiphlogistic-               Pertaining               to               counteracting               inflammation
               Apoplexy-               Condition               resulting               from               a               crippling               or               serious               injury
               Plethoric-               Red,               red-faced
               Pleurisy-               Inflammation               of               the               pleura               of               the               lungs,               with               or               without               exudate
               Quincy-               Unknown
               Scarifier-               Brass               box               or               cylinder               that               contained               many               small               knives               (1-20)               averaging               12               blades               that               were               activated               by               a               spring               mechanism.
               Spirit               heater-               Torch               soaked               in               spirits               of               wine               and               lighted               with               a               candle
               Spitting               blood-               Tuberculosis
               Suppuration-               Producing               and               exuding               pus
               The               Evolution               of               Phlebotomy               Technique               and               Equipment
               The               practice               of               bloodletting               is               one               of               the               oldest               therapeutic               treatments               known.

Medical               lore,               bloodletting,               magic               and               religious               ceremonies               have               been               tightly               intertwined               throughout               human               history.

The               practice               of               medicine               first               began               during               the               late               Stone               Age,               known               as               the               Neolithic               age.

The               people               of               the               time               had               a               view               of               medicine               and               magic               as               different               parts               of               the               same               practice,               deeming               disease               to               be               a               curse               cast               upon               the               sick,               injured,               and               unlucky.

Disease               was               attributed               to               one               cause               with               variable               symptoms.

It               was               believed               that               the               skull               contained               the               evil               spirit               or               demon               that               caused               disease,               and               which               could               be               drawn               out.

To               this               end               priests,               witch               doctors,               or               sorcerers               used               flint               tools               in               trepanning               the               skull               in               an               effort               to               release               the               demon.

Given               the               beliefs               of               the               time               the               logic               was               sound,               but               it               was               based               on               an               erroneous               theory,               and               so               history               goes               on.
               Bloodletting               originated               in               a               similar               manner,               with               the               objective               of               cleansing               the               body               of               bad               blood               and               releasing,               or               driving               out,               the               evil               spirit.

It               has               been               theorized               that               the               practice               was               developed               through               observation               of               the               menstrual               cycle               and               its'               apparent               restorative               properties.

Also,               it               was               believed               that               the               process               of               bloodletting               would               rid               the               body               of               poorly               defined               impurities               and               an               overabundance               of               fluid.
               Dating               from               1400               B.C.,               several               Egyptian               wall               paintings               exhibit               the               use               of               leeches               in               drawing               blood.

Tools               implemented               in               the               early               history               of               blood               letting               included               thorns,               sharp               pieces               of               flint               or               shell,               pointed               bones               or               sticks,               and               sharks               teeth.

Archeology               digs               in               both               South               America               and               New               Guinea               yielded               miniature               bow               and               arrow               devices,               while               tiny               crossbows               were               found               in               Greece               and               Malta.
               Blood               letting               first               became               a               wide               spread               practice               in               Egypt               1000               B.C.

The               practice               spread               around               the               Mediterranean               and               became               widely               accepted               throughout               western               civilization.

Hippocrates               (460-377               B.C.),               a               Greek,               observed               the               ill               and               recognized               that               specific               disease               states               had               corresponding               symptoms.

He,               with               Galen,               developed               the               concept               of               balance               between               the               four               body               humors,               consisting               of               blood,               phlegm,               and               black               or               yellow               biles.

The               theory               became               the               foundation               of               many               extreme               therapies               including               bleeding,               purging,               sweating,               vomiting,               and               blistering.
               Blood               was               thought               to               be               the               seat               of               the               soul,               carrying               the               vital               force               of               the               body.

It               was               also               the               easiest               to               manipulate               and               provided               the               practitioner               with               the               reassurance               of               an               immediate               effect.

The               blood               from               fallen               gladiators               was               sought               after               in               the               hope               of               consuming               the               warriors'               strength.

There               exists               a               later               story               of               an               epileptic               girl               that               drank               the               blood               of               a               cat.

She               then,               reportedly,               took               on               the               characteristics               of               a               cat               climbing               roofs,               jumping,               scratching,               howling,               and               gazing               into               a               hole               in               the               floor               for               hours               at               a               time.

All               insanity               and               body               weakness               was               thought               to               be               due               to               some               defect               of               the               blood.
               General               bloodletting               consisted               of               venisection               and               arteriotomy,               the               intent               being               to               take               a               large               volume               of               blood               from               a               vein               or               artery               so               that               the               vascular               system               became               noticeably               diminished.

The               average               blood               loss               in               general               bloodletting               was               16-30               oz.

creating               decreased               tension               on               the               walls               of               the               blood               vessels               and               the               heart.

Bloodletting               was               also               indicated               in               patients               subject               to               phlebitis,               obesity,               spitting               blood,               quinsy,               pleurisy,               falling               sickness,               apoplexy,               madness,               gout,               and               the               wounded               in               an               attempt               to,               "prevent               the               inflammation,               which               is               to               be               feared."
               Venisection               was               the               most               common               method               of               bloodletting.

The               median               basilic               vein               was               the               most               frequently               utilized.

Venisection               was               most               often               employed               in               febrile               patients               with               a               full               pulse,               red               skin,               and               agitated               state.

The               doctor               could               render               the               patient               pale,               cool,               and               calm               which               was               considered               an               improvement.

However,               this               treatment               often               resulted               in               cardiovascular               collapse,               shock,               and               death.
               Various               tools               were               used               throughout               the               history               of               phlebotomy.

Among               them               were               the               thumb               lancet,               spring               lancet,               scarifier,               fleam,               blood               stick,               and               the               artificial               leech.

The               thumb               lancet               was               small               with               a               sharp               double-edged               point.

It               was               the               principle               instrument               for               humans               as               the               doctors'               preference.
               The               instructions               for               use               of               a               thumb               lancet               were               to               apply               a               broad               tape               tourniquet               above               the               elbow,               compressing               the               vein               without               diminishing               the               arterial               pulse.

The               blade               was               grasped               between               the               thumb               and               forefinger,               using               the               remaining               three               fingers               to               steady               the               hand.

Next,               the               vein               was               anchored               with               the               left               thumb               below               the               draw               site.

The               lancet               was               then               introduced               at               an               oblique               direction               (vague               description)               until               blood               rose               up               the               point.

The               front               edge               of               the               lancet               was               pulled               up               in               as               straight               a               line               as               possible               to               increase               the               size               of               the               skin               wound               to               the               size               of               the               wound               in               the               vein.

The               anchoring               thumb               was               then               removed,               allowing               room               for               the               blood               to               flow               into               the               bowl               for               measurement.
               The               spring               lancet               was               used               by               laymen.

Some               referred               to               it               as               a               fleam.

The               device               had               a               single               blade               scarificator.

The               lancet               case               resembled               a               pocket               lighter               in               appearance.

The               case               was               made               of               silver               or               tortoise               shell               and               it               had               folding               guards               of               tortoise               shell,               ivory,               or               pearl.

The               handle               was               made               of               brass               or               white               metal               with               a               release               lever.

It               was               spring               loaded               and               difficult               to               control.

Major               concerns               with               use               of               a               spring               lancet               included               transfixation               of               a               vein,               artery,               tendon,               or               nerves               as               the               depth               of               cut               could               vary               from               5-8               cm.
               "Fleam"               was               a               name               applied               to               several               bloodletting               tools.

The               name               principally               indicated               a               bloodletting               instrument               with               several               shafts               that               fold               into               a               case,               similar               to               a               folding               pocket               knife.

Blade               sizes               were               variable,               but               all               were               oriented               at               a               90˚               angle               to               the               shaft.

The               blades               were               brass               and               some               handles               were               constructed               of               animal               horn.

There               were               small               blades               for               humans               and               large               ones               for               domestic               stock.

The               fleam               was               primarily               a               farrier's               tool,               as               they               not               only               cared               for               the               horses'               feet,               but               also               acted               as               veterinarian.

The               fleam               was               preferred               over               the               lancet               for               horses               because               it               gave               a               larger               wound               more               easily,               preventing               escape               of               the               animal               due               to               pain               response,               or               insufficient               blood               flow               from               a               shallow               cut.
               The               fleam               gave               a               predictable               depth               of               cut.

The               blade               was               held               firmly               against               the               long               axis               of               the               vein               where               the               handle               was               struck               with               the               bottom               of               the               fist               to               drive               the               blade               through               skin               and               vein.

A               blood               stick               could               be               used               to               replace               the               fist               in               striking               the               fleam.

The               blood               stick               was               a               small               hardwood               club               with               a               lead               weight               at               one               end.

The               force               of               the               fist               or               blood               stick               determined               the               depth               of               the               cut.

Spring               fleams               were               also               available.
               Arteriotomy               was               an               uncommon               procedure               which               was               thought               to               be               necessary               when               veins               felt               empty               relative               to               fullness               of               the               arteries.

The               artery               of               choice               was               a               superficial               temporal               artery               or               one               of               its               branches.

The               doctor               would               partially               cut               the               vessel               with               a               single               transverse               incision.

When               the               bleeding               was               complete               the               practitioner               would               sever               the               artery               completely               in               the               hope               that               the               ends               might               contract               into               the               tissue,               arresting               the               hemorrhage.

Afterwards               a               dry               lint               compress,               composed               of               shredded               linen,               and               a               roller               bandage               were               applied               to               the               wound.
               Local               bloodletting               consisted               of               leeches,               dry               cupping,               and               wet               cupping.

The               word               leech               comes               from               the               old               English               "laece"               meaning               physician.

The               1600's               veterinarian               was               known               as               a               "horse-leech".

The               treatment               so               was               popular               in               Mideval               Europe               that               the               medicinal               leech               nearly               became               extinct               by               the               mid               18th               century.

This               development               stimulated               the               population               to               begin               the               practice               of               leech               farming.
               The               medical               leech               is               an               annelid               of               the               Hirudinea               class               native               to               Sweden.

The               scientific               name               is               Hirudo               medicinalis.

The               Swedish               leech               averages               an               uptake               of               about               four               times               the               blood               of               the               American               leech,               which               makes               it               the               popular               candidate               for               hirudotherapy.

Leech               saliva               contains               the               anticoagulant               hiruden               (natural               heparin),               a               vasodilator,               and               an               anesthetic.

These               components               work               together               to               create               a               wound               that               is               bleeds               freely               and               painlessly               for               extended               periods               of               time.
               Captive               leeches               were               first               kept               in               glass               jars,               but               later               porcelain               jars               with               perforated               lids               became               the               norm.

The               spring               water               in               the               jars               was               frequently               changed               out               and               the               jar               was               given               a               cool               placement.
               Leeches               were               used               for               bloodletting               placement               where               cupping               glasses               or               horns               couldn't               go.

Sites               included               hemorrhoid               veins,               the               cervix               or               mouth               of               the               womb,               the               gums,               lips,               nose,               eyelids,               or               fingers.

When               leeches               were               to               be               applied               near               an               orifice,               a               cotton               plug               had               to               be               applied               to               prevent               the               animal               from               escaping               through               the               hole               of               the               nose,               ear,               eye,               anus,               or               cervix.

Leeches               near               an               orifice               required               constant               monitoring               as               they               could               escape               in               a               very               short               time.
               Ambrose               Paré               said               that               leeches               handled               with               bare               hands               become               angered               and               would               not               bite.

Rather,               use               a               clean               white               linen               cloth               and               let               the               leech               dry               for               30               minutes               before               use.

The               skin               had               to               be               prepared               to               encourage               leech               to               take               hold.

Common               procedures               included               scarifying               the               skin               or               smearing               it               with               blood,               milk,               or               milk               and               sugar.
               To               attach               a               single               leech,               the               tail               was               held               to               position               the               animal               over               the               prospective               site.

Multiple               leeches               were               applied               with               a               cupping               glass               inverted               over               the               site.

To               get               the               leech               to               suck               more               blood,               the               practitioner               would               cut               the               tail               off               after               attachment.

It               would               continue               sucking               because               the               blood               ran               right               out               of               the               opening.

To               remove               them,               people               used               salt,               ashes,               or               powder               of               aloe               on               their               heads.

To               gauge               the               amount               of               blood               removed               one               would               sprinkle               powdered               salt               on               them               and               they               would               bring               up               their               stomach               contents.
               The               wound               would               continue               to               bleed               for               a               while,               as               the               anticoagulant               lasts               hours.

After               removal               of               the               leech,               all               clots               must               be               removed               and               the               site               cleansed.

If               the               patient               were               bleeding               continuously               the               attendant               would               apply               a               half               bean               to               the               wound               until               it               sticks.

An               alternative               to               stem               the               flow               was               a               burnt               rag               and               ligature.
               Leeching               was               largely               abandoned               by               20th               century,               but               interest               in               it               was               revived               in               the               1960's.

There               was               an               old               time               artificial               leech,               which               consisted               of               a               pointed               lancet               in               a               glass               syringe               cylinder               or               "sucker".

The               devices               suffered               coagulation               problems,               as               the               blood               would               clot               before               drainage               was               complete.
               Cupping               was               done               with               a               glass,               gourd,               or               horn.

The               cupping               glass               was               also               known               as               a               cucurbitula,               which               means               gourd.

Glass               cups               were               dome-shaped,               often               wine               or               beer               glasses               and               could               be               designed               with               a               small               hole               in               the               bottom               for               attaching               a               hose               and               syringe,               allowing               for               manual               suction               control.


               The               hollow,               distal               section               of               an               animal               horn               was               useful.

The               wide               end               was               placed               on               the               skin               and               the               mouth               was               applied               to               the               smaller,               pointy               end               to               produce               suction.

Once               suction               was               established               wax               was               used               to               plug               the               hole.

The               favored               cupping               method               was               heat               applied               to               a               glass               or               gourd.
               Dry               cupping               was               done               over               intact               skin.

The               practitioner               would               sponge               the               site               with               warm               water               to               increase               vascularity               and               dry               it               with               a               towel.

The               cup               was               passed               over               the               spirit               heater               for               one               second,               taking               care               not               to               heat               the               edges               of               the               glass,               causing               blistering               of               the               skin.

The               air               would               cool,               developing               suction,               causing               the               skin               to               redden               and               swell.

The               purpose               of               cupping               was               to               draw               underlying               blood               and               fluid               away               from               the               site               of               inflammation,               to               the               skins'               surface               relieving               congestion               without               removing               fluid.

A               fingernail               under               the               edge               of               the               cup               was               sufficient               to               break               the               vacuum.
               Wet               cupping               would               often               take               place               after               dry               cupping.

Once               the               site               was               prepared               by               the               dry               cup               a               scarifier               was               used               to               cut               into               the               capillary               bed.

The               cup               was               then               reheated               and               applied               over               the               fresh               wound.

On               average               3-5               oz               of               blood               was               extracted               using               this               method,               a               much               smaller               quantity               of               blood               than               was               removed               through               general               bloodletting.

After               cup               removal               the               wound               was               dressed               with               lint               and               plaster.
               There               were               standardized               procedures               to               cupping.

For               instance,               the               incision               was               to               correspond               to               the               direction               of               the               muscular               fibers.

If               the               blades               were               set               too               deep               then               fat               protruded               through               the               skin               and               prevented               blood               flow.

The               intent               of               cupping               was               to               apply               it               to               a               fleshy               part               of               the               body               to               draw               out               "corrupt               blood               and               windy               matter."               It               was               thought               that               if               skin               was               scarified               before               cupping               it               drew               blood,               but               if               the               skin               were               intact               it               drew               spirit.
               Phlebotomy               was               used               to               treat               disease,               cancer,               trauma,               obesity,               and               mental               disturbance.

Severely               wounded               soldiers               were               bled               to               syncope.

Surgery               from               1100-1500               A.D.

was               crude.

Astrology               played               a               major               role               in               a               physicians'               practice               in               the               14th               and               15th               centuries.

There               was               thought               to               be               a               specific               relationship               between               the               zodiac               and               each               part               of               the               body.

Bloodletting               and               surgery               were               regulated               by               the               signs               of               the               Zodiac               and               the               positions               of               the               planets               as               dictated               in               the               phlebotomy               table               of               1480               A.D.

Bloodletting               was               performed               at               particular               times               for               specific               areas               of               the               body.
               As               medicine               and               religion               were               still               closely               linked,               priests               and               monks               were               the               primary               practitioners               of               bloodletting.

At               a               monastery               in               Scotland,               where               the               monks               bled               each               other               regularly,               a               find               at               the               monastery               was               a               blood               stratum               of               an               estimated               300,000               pints.

Then,               in               1163               the               Council               of               Tours               issued               a               church               edict               prohibiting               any               but               the               barber-surgeons               from               performing               bloodletting.

The               Council               stated               that,               "The               church               abhors               bloodletting."
               Barbers               duties               were               to               lance               veins               and               abscesses,               as               well               as               to               perform               tooth               extractions               and               amputations.

During               this               time               educated               doctors               avoided               surgery.

This               set               the               stage               for               later               conflict               when               surgery               became               respectable.

The               barber               pole               signified               a               barber               who               did               both               hair-cutting               and               surgery.

The               red               was               for               blood,               white               for               bandages,               and               the               pole               was               for               the               rod               squeezed               by               the               patient               during               extraction.
               Shaving               bowls               often               pulled               double               duty               as               a               blood               collection               vessel.

The               bowls               were               designed               with               a               semicircular               notch               after               1500               A.D.

This               design               modification               allowed               the               bowl               to               be               pressed               against               the               neck               or               antecubital               fossa.

The               contents               of               the               bowl               were               often               measured.

The               Barber-Surgeon               Company               flourished               in               England               for               many               years,               until               it               was               dissolved               in               1744.

There               was               a               clear               separation               between               barbers               and               surgeons               for               several               years               prior               to               the               dissolution.
               Surgery               was               brought               into               prominence               by               a               17th               century               French               Master               Barber-Surgeon               by               the               name               of               Ambrose               Paré.

He               became               known               as               the               Father               of               Surgery.

Paré               described               the               reasons               for               bloodletting               in               1634,               concluding               that               phlebotomy               was               necessary               in               five               respects.

The               first               was               to               lessen               the               abundance,               "as               in               plethoric               bodies               and               those               troubled               with               plentitude."               The               second               reason               was               to               divert               the               blood               to               another               location.

An               example               was               to               open               the               vein               of               the               right               arm               to               stay               bleeding               of               the               left               nostril.

Third               was               to               draw               allure,               or               draw               down               the               blood,               as               in               opening               the               ankle               vein               to               draw               down               menstrual               flow               in               women.

The               fourth               purpose               was               to               alter               the               blood,               or               introduce               another               quality               to               it.

This               was               linked               with               sharp               fevers,               the               objective               being               to               breathe               out               blood               that               has               been               heated               in               the               vessels,               and               cooling               the               remaining               blood.

The               fifth               and               final               reason               presented               was               to               prevent               illness.

The               doctors               were               particularly               busy               during               the               spring               and               autumn,               as               it               was               the               fashion               to               change               out               the               body               humors               for               the               season.
               Patient               preparation               included               a               "gentle               clyster"               or               suppository,               as               it               was               thought               that               the               mesenteric               vein               would               draw               impurities               into               the               blood               directly               from               the               bowel.

The               patient               was               bled               while               standing               or               sitting               up               until               they               fainted.

Babies               were               bled               till               their               lips               turned               blue.

Domestic               stock               were               bled               until               either               their               gums               turned               white               or               they               fainted.
               Anton               Van               Leeuwenhoek               discovered               "animalcules"               (microscopic               life)               in               1674.

Buchan               in               the               1784               edition               of               Domestic               Medicine               stated               that               blood               is               in               a               systemic               circuit.

Therefore,               he               contended               that               there               was               little               significance               in               the               site               chosen.
               In               the               U.S.

Benjamin               Rush,               MD               was               very               active               in               Philadelphia's               1793               yellow               fever               epidemic.

It               was               during               his               treatment               of               these               patients               that               he               developed               a               deadly               therapeutic               procedure               called               "heroic               therapy".

He               wrongly               believed               that               the               body               held               25               lbs               of               blood               and               20               lbs               of               that               could               be               safely               drained.

Under               this               assumption               he               routinely               bled               patients               of               up               to               75%               of               their               blood               volume.

He               was               admired               by               some               for               staying               at               such               personal               risk.

On               average               he               bled               more               than               100               patients               per               day.

In               1799               Dr.

Rush               treated               George               Washington               for               acute               laryngitis.

Washington               was               bled               heavily               four               times               in               two               days.

Rush               only               relented               when               Washington               requested               to               die               without               further               medical               intervention.

He               did.
               In               early               19th               century               England               bloodletting               reached               its               zenith,               as               the               public               was               convinced               of               the               necessity               for               all               of               the               population,               healthy               and               ill.

It               was               considered               preventative               medicine               and               very               routine.

It               was               said               that               folks               "bled               as               regularly               as               went               to               market."
               The               descriptions               of               the               time               were               vague,               the               terminology               confusing.

Some               examples               include               heart               veins,               breast               veins,               head               veins,               spitting               blood,               dropsy,               fits,               decay,               fever,               excitability,               quinsy,               pleurisy,               falling               sickness,               apoplexy,               and               madness.

Doctors               based               their               medical               therapies               on               personal               experience               and               impressions,               not               on               case               histories               or               statistics.

Bleeding               patients               gave               the               physician               a               sense               of               control               over               the               course               of               the               patients'               health.
               Physicians               used               an               antiphlogistic               approach               as               it               was               believed               that               redness,               heat,               and               swelling               were               abnormal               responses               to               be               treated.

"Laudable"               pus               was               thought               necessary               for               good               healing.

Bloodletting               was               thought               to               counteract               the               redness,               heat,               and               swelling               by               relieving               congestion               in               the               vessels.

This               method               was               used               widely               in               1830               and               subsequent               cholera               and               influenza               epidemics.

It               was               discovered               that               bloodletting               didn't               work               and               was               not               the               magic               bullet               in               curing               illness.

The               tide               began               to               turn.
               In               the               mid               1800's               Ignaz               Sammelweis               theorized               a               connection               between               physicians               conducting               bare               handed               autopsies               and               then               delivering               babies               without               washing               their               hands.

He               introduced               the               concept               of               antiseptic               handwashing               using               a               chlorine               wash.

John               Snow               proved               the               effectiveness               of               breaking               the               chain               of               infection               in               an               1854               cholera               outbreak               in               London.

He               tracked               the               infection               to               its               source,               a               well               contaminated               with               cholera               bacteria               through               human               waste.

He               was               the               first               to               exercise               biohazard               containment               by               removing               the               handle               of               the               pump.

Oliver               Wendell               Holmes               (1809-1894)               said,               "The               lancet               was               the               magicians'               wand               of               the               dark               ages               of               medicine."
               In               the               1858               edition               of               Practice               of               Physic               it               was               stated               that               the               object               of               general               blood-letting               was               to               diminish               the               whole               quantity               of               blood,               thus               lessening               the               force               of               the               hearts'               action.

The               object               of               local               bleeding,               most               times,               was               to               empty               the               engorged               and               loaded               capillaries               of               the               inflamed               part.

The               author               believed               topical               bloodletting               diverted               the               flow,               giving               the               blood               a               new               direction,               indirectly               relieving               inflammatory               congestion.

However,               phlebotomy               was               sometimes               performed               directly               from               the               affected               part.
               In               the               mid               19th               century               French               statisticians               compiled               patient               history               and               treatment               results.

It               was               determined               bloodletting               does               more               harm               than               good.

An               1860               author               wrote               "If               the               employment               of               the               lancet               was               abolished               altogether,               it               would               perhaps               save               annually               a               greater               number               of               lives               than               in               any               year               the               sword               has               ever               destroyed."
               In               the               end               of               the               19th               century               doctors               believed               illness               was               due               to               an               excess               or               deficiency               of               some               body               product.

There               was               little               that               doctors               could               do               for               patients               as               most               all               therapies               were               useless               and               many               were               harmful.

Cathartics               were               used               to               cleanse               the               bowels,               reducing               an               overexcited               nervous               system.

Diuretics               were               used               to               restore               system               balance.

Tonics               stimulated               a               depressed               nervous               system,               and               bloodletting               reduced               fluids               and               temperature.
               Louis               Pasteur               suggested               the               Germ               Theory               of               Disease               in               1862.

Robert               Koch               verified               the               Germ               Theory               and               put               forth               Koch's               Postulates               in               1875.

They               are               still               in               use               in               identifying               new               disease               today.

The               combination               of               Pasteur               and               Koch's               work               a               renaissance               in               therapies               occurred,               and               the               histologic               reaction               to               infection               (redness,               swelling,               fever)               became               a               secondary               issue               to               be               resolved.
               In               the               20th               century               the               practice               of               bloodletting               died               throughout               the               world.

In               1935               Randolph               said,               "With               alternating               periods               of               excess               and               moderation               it               is               about               the               only               remedy               that               has               held               its               own               throughout               our               history."
               In               the               present               day               phlebotomy               is               used               in               a               very               limited               fashion               in               regard               to               treatments.

Bloodletting               today               is               used               to               treat               polycythemia               vera,               hemochromatosis,               congestive               heart               failure,               pulmonary               congestion,               and               is               the               standard               of               care               in               hematological               diseases               and               disorders.

Blood               is               also               withdrawn               from               the               body               to               provide               blood               products               for               transfusion.
               The               primary               use               for               phlebotomy               in               contemporary               medicine               is               in               diagnosis               not               treatment,               although               blood               loss               for               diagnostic               testing               can               still               be               considerable.

The               current               equipment               includes               the               tourniquet,               syringe,               needle,               ETS,               butterfly,               and               the               capillary               lancet.

The               current               veins               of               choice               are               in               the               antecubital               region.

The               preferred               vein               is               the               median               cubital,               then               the               median               cephalic,               and               finally               the               basilic.

From               scientific               evaluation               the               body               is               known               to               respond               more               promptly               to               acute               blood               loss               than               to               chronic               loss               of               small               amounts.
               Leeches               are               used               today               to               withdraw               blood,               control               pain,               reduce               swelling,               and               keep               small               vessels               open.

They               are               most               commonly               used               in               microsurgical               procedures,               transplants,               and               skin               grafts.

There               is               even               a               modern               day               version               of               the               mechanical               leech,               which               was               created               in               2001               at               the               University               of               Wisconsin,               Madison.

It               has               a               glass               vial               attached               to               a               suction               cup               that               delivers               an               anticoagulant,               and               withdraws               blood               as               intended.

The               mechanical               leech               may               one               day               become               common               phlebotomy               equipment.
               The               purpose               of               the               mechanical               leech               is               to               make               patients               more               comfortable               with               treatment               and,               more               importantly,               to               prevent               infection               transfer               of               Aeromonas               hydrophila               directly               from               the               leech               gut               into               the               blood               stream               causing               septicemia.

This               has               been               a               concern               mainly               where               the               water               that               the               leeches               are               kept               in               was               not               changed               regularly.
               Leech               therapy               shows               long-term               benefits               in               pain               and               mobility               treatment,               while               further               side               effects               consist               of               slight               itching               and               possible               scarring               at               the               site               of               the               bite.

Oral               and               topical               medications               currently               in               use               for               pain               treatment               can               have               devastating               effects               on               the               stomach,               liver,               pancreas,               kidneys,               or               skin.

They               also               have               a               much               lower               incidence               of               pain               management               and               increased               mobility.
               It               has               been               said               that               it               is               amazing               that               such               a               drastic               procedure,               that               provided               little               relief,               was               practiced               for               so               long.

It               has               also               been               stated               that               "Our               current               efforts               to               treat               cancer               without               understanding               the               underlying               etiologic               factors               will               someday,               no               doubt,               appear               just               as               illogical."               Keep               evolving.

(McCormic,               2008)
               Works               Cited
               Bloodletting.

Burns,               S.B.

.

Retrieved               on               April               14,               2008.
               McCall,               R.E.

and               Tankersley,               C.M.

(2003).

Phlebotomy               Essentials,               Fourth               Edition.

Baltimore,               MD:               Lippincott               Williams               and               Wilkins.
               Multiple               Editors               (2006).

Mosby's               Dictionary               of               Medicine,               Nursing,               and               Health               Professions,               Seventh               Edition.

St.

Louis,               MO:               Elsevier.
               Pommerville,               Jeffery               C.

(2004).

Alcamo's               Fundamentals               of               Microbiology,               Seventh               Edition.

CANADA:               Jones               and               Bartlett               Publishers.
               Bloodletting               Over               the               Centuries.

Seigworth,               G.R.

MD.

Retrieved               on               April               13,               2008.
               Leech               Therapy               for               Pain               and               Venous               Congestion.

Walsh,               N.

Retrieved               on               April               14,               2008.






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