Bryan Charles S
Department of Internal Medicine (Emeritus), University of South Carolina School of MedicineColumbiaSouth Carolina.
Proc (Bayl Univ Med Cent). 2019 Jun 10;32(3):372-376. doi: 10.1080/08998280.2019.1615331. eCollection 2019 Jul.
Bloodletting has been called William Osler's "blind spot," especially with respect to pneumonia. Also puzzling has been his endorsement of bleeding in selected cases of heatstroke. Recent clinical observations on pneumonia and, to a lesser extent, heatstroke lend support to Osler's rationale for bloodletting in these conditions. A 21st-century rationale now exists for all eight indications for systemic bloodletting listed by Osler in the first edition of his textbook, (1892): treatment of acute heart failure (seven of the eight indications) or rapid lowering of blood pressure (in subarachnoid hemorrhage accompanied by severe hypertension). These observations support the narrative that during Osler's lifetime, bloodletting became more "rational" largely on the basis of cumulative clinical experience.
放血疗法被称为威廉·奥斯勒的“盲点”，尤其是在肺炎方面。同样令人费解的是，他在某些中暑病例中支持放血。最近关于肺炎以及在较小程度上关于中暑的临床观察结果支持了奥斯勒在这些情况下进行放血的理论依据。现在，对于奥斯勒在其教科书第一版（1892年）中列出的全身放血的所有八个适应症，都有了21世纪的理论依据：治疗急性心力衰竭（八个适应症中的七个）或快速降低血压（在伴有严重高血压的蛛网膜下腔出血中）。这些观察结果支持了这样一种说法，即在奥斯勒的时代，放血疗法在很大程度上基于累积的临床经验而变得更加“合理”。
