Bleeding-edge technology in cardiology - or the mixed blessings of phlebotomy throughout the ages

As excess bleeding and the risk of upper gastrointestinal bleeding with antithrombotic regimens constitute a primary concern in modern day cardiology, how distinct is the connotation with bloodletting as a well-known and widespread therapy in the past when doctors, at first sight in season and out of season, confronted their poor patients with the advantages of tapping blood. Nevertheless in those days too, our predecessors relied on some sort of guideline, balanced and well thought out, as may follow from a textbook dating from the 1760s.1 Phlebotomy as a therapy has nowadays been driven back to the outskirts of critical care medicine and no longer seems to be worth mentioning. The long history attached to this peculiar practice, which dated to 1000 years BC, however, makes time travelling worthwhile as its usage has survived in modern times like an evolutionary path in the growth of idea. To find such a path that involves step by step progress, with pay-offs at each step, and with experience gained at each step to refine and improve the use of phlebotomy, may provide insight into the development of modern medicine. This paper is an attempt to define such a path.