Bloodletting, New Style

Oldtime physicians who bled their patients for whatever ailed them, from "the vapors" to the gout, did more harm than good. But modern medicine has not forgotten the ancient practice. A pair of New Orleans researchers reported to the American Heart Association last week that repeated small bleedings have proved effective in relieving the agonizing tightness of angina pectoris and other symptoms of coronary disease--ironically, an uncommon problem in the days of leeching and venepuncture.

Tulane University's Dr. George E. Burch and Dr. Nicholas P. DePasquale got the idea of bleeding their patients from the fact that victims of polycythemia (an excess of red cells in the blood) are especially prone to the pains of repeated angina attacks, and eventually to fatal shutdowns in the heart's arteries (coronary occlusions). Could it be that an excess of red cells makes the blood more viscous and more likely to clot? They thought it might.

Testing their theory was difficult because the blood's viscosity is not uniform in any one patient at any one moment : it probably hits momentary peaks in the coronary arteries, where it cannot be measured directly. As a guide to viscosity, Drs. Burch and DePasquale took readings with a hematocrit -- an instrument that measures the concentration of red cells in a centrifuged blood sample. The normal range is 40% to 50%. Most of their heart-disease patients had readings of up to 56%. Patient after patient obtained relief from repeated angina attacks, which cause fierce pain in the chest and left arm, along with an alarming feeling of suffocation. After the doctors bled them, removing about one-third of a pint of blood, the hematocrit level dropped into the normal range.

Incidental support for the doctors' theory came from a woman who had had frequent angina attacks, but got complete relief after she suffered an internal hemorrhage which dropped her hematocrit reading to 26%. She asked spontaneously: "Was that bleeding good for me?'' Drs. Burch and DePasquale think it was. Also, they argue, the relative freedom from angina and coronary disease enjoyed by women of menstruating age probably reflects the fact that their hematocrits read around 40%. After the menopause, women's hematocrits go up; so does their susceptibility to coronary disease and angina.

This type of heart disease is rare, the doctors note, where malnutrition and parasitic infestations cause anemia and keep the hematocrit scores down. It is common est among well-fed, "redblooded" peoples. Bleeding in moderation to cut the hematocrit score to a safe reading between 40% and 45%, the Tulane doctors suggest, may well be one answer.

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