history of the Phleem/Fleam

            Among our collection of yesteryear’s medical oddities, the Maple Ridge Museum displays a fleam, otherwise known as a bloodletting knife. Today,  advancements in medical science have proven that the practice of bloodletting was almost always doing more harm than good, and we question how doctors of the past could have ever thought otherwise. However, it may surprise us to learn that bloodletting existed for many more centuries than it has been retired, and that technically, it still exists in the medical field in the modern day. 

            When we think of bloodletting, our minds tend to wander towards images of the European Middle Ages, or perhaps as recently as the Victorian era. In reality, bloodletting can be traced as far back as three thousand years ago, when it was first practiced in ancient Egypt, Greece, Rome, and Asia before it made its way North around the time of the Renaissance. 

Bloodletting was a very popular practice in historical medicine due to its association with the now disproven theory of the four humors, which was a theory that the body’s health relied on the balance between one’s blood, phlegm, black bile, and yellow bile. The logic behind bloodletting was that illness could be caused by a surplus of blood compared to the other humors, and so reducing the amount of blood in one’s system would bring the humors back into balance.

Not all illnesses are equally severe, and so different levels of bloodletting treatment were required. Most treatments only called for a few milliliters to be drained, whereas some more rigorous treatments could drain several ounces, or even cups in a single sitting. The design of the fleam, including the one displayed at the Maple Ridge Museum, reflects this variety, as the knife comes in a set of four differently sized blades to respond to the needs of different patients. 

The rounded tip of the fleam’s blade also has a rational explanation. While doctors of the faraway past clearly did not understand the need to keep blood inside your body, they did understand that open wounds were susceptible to infection. Thus, any bloodletting incisions needed to be clean, smooth, and easy to close back up. This acorn-like point to the blade was designed to create incisions smoothly, and in a shape that was easily stitched back together with a single figure-eight of thread. 

Bloodletting went out of fashion in the late 1800s as a result of studies that suggested it was resulting in avoidable fatalities.. Modern bloodletting, known as “phlebotomy therapy” is used to treat polycythemia, a disease that severely increases the risk of blood clots due to increased blood cell production, or hemochromatosis, a disorder that leads to an overproduction of iron which can damage one’s organs. This practice is performed with the use of medical leeches rather than the fleam, which is now a tool in permanent retirement. It seems that it’s purpose now is entirely educational, as a landmark for how far medical science has come.

This blog post was researched and written by Camryn Page, SFU.

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