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handled with the bare hand, they are angered, and become so stomachfull as that they will not bite; wherefore you shall hold them in a white and clean linen cloth, and apply them to the skin being first lightly scarified, or besmeared with the blood of some other creature, for thus they will take hold of the flesh, together with the skin more greedily and fully. To cause them to fall off, you shall put some powder of Aloes, salt or ashes upon their heads. If any desire to know how much blood they have drawn, let him sprinkle them with salt made into powder, as soon as they are come off, for thus they will vomit up what blood soever they have sucked.
     
    When Europeans colonized the New World, they took the practice of bloodletting with them. American physicians saw no reason to question the techniques taught by the great European hospitals and universities, so they also considered bloodletting to be a mainstream medical procedure that could be used in a variety of circumstances. However, when it was administered to the nation’s most important patient in 1799, its use suddenly became a controversial issue. Was bloodletting really a life-saving medical intervention, or was it draining the life out of patients?
    The controversy began on the morning of 13 December 1799, the day that George Washington awoke with the symptoms of a cold. When his personal secretary suggested that he take some medicine, Washington replied, ‘You know I never take anything for a cold. I’ll let it go just as it came.’
    The sixty-seven-year-old former president did not think that a sniffle and a sore throat were anything to worry about, particularly as he had previously suffered and survived far more severe sicknesses. He had contracted smallpox as a teenager, which was followed by a bout of tuberculosis. Next, when he was a young surveyor, he caught malaria while working in the mosquito-infested swamps of Virginia. Then, in 1755, he miraculously survived the Battle of Monongahela, even though two horses were killed beneath him and four musket balls pierced his uniform. He also suffered from pneumonia, was repeatedly afflicted by further bouts of malaria, and developed ‘a malignant carbuncle’ on his hip that incapacitated him for six weeks. Perversely, having survived bloody battlefields and dangerous diseases, this apparently minor cold contracted on Friday 13th would prove to be the greatest threat to Washington’s life.
    His condition deteriorated during Friday night, so much so that he awoke in the early hours gasping for air. When Mr Albin Rawlins, Washington’s estate overseer, concocted a mixture of molasses, vinegar and butter, he found that his patient could hardly swallow it. Rawlins, who was also an accomplished bloodletter, decided that further action was required. Anxious to alleviate his master’s symptoms, he used a surgical knife known as a lancet to create a small incision in the General’s arm and removed one-third of a litre of blood into a porcelain bowl.
    By the morning of 14 December there was still no sign of any improvement, so Martha Washington was relieved when three doctors arrived at the house to take care of her husband. Dr James Craik, the General’s personal physician, was accompanied by Dr Gustavus Richard Brown and Dr Elisha Cullen Dick. They correctly diagnosed cynanche trachealis (‘dog strangulation’), which we would today interpret as a swelling and inflammation of the epiglottis. This would have obstructed Washington’s throat and led to his difficulty in breathing.
    Dr Craik applied some cantharides (a preparation of dried beetles) to his throat. When this did not have any effect, he opted to bleed the General and removed another half a litre of blood. At 11 a.m. he removed a similar amount again. The average human body contains only 5 litres of blood, so a significant fraction was being bled from Washington at each session. Dr Craik did not seem concerned. He performed venesection again in the