{"id":46272,"date":"2019-12-13T11:21:14","date_gmt":"2019-12-13T10:21:14","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46272"},"modified":"2019-12-20T11:48:38","modified_gmt":"2019-12-20T10:48:38","slug":"jeffrey-aronson-when-i-use-a-word-phlebotomy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/12\/13\/jeffrey-aronson-when-i-use-a-word-phlebotomy\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Phlebotomy"},"content":{"rendered":"

\"\"<\/a>Phlebotomy is the process of letting blood, originally by incising a blood vessel and nowadays by puncturing it. Early papers on phlebotomy refer to the curious habit of <\/span>hepatic phlebotomy<\/span><\/a>, introduced by George Harley in the 1880s to relieve engorgement of the liver in acute hepatitis. But nowadays it refers only to obtaining blood from a peripheral vein.<\/span><\/p>\n

In his <\/span>Indogermanisches etymologisches W\u00f6rterbuch<\/span><\/i> (<\/span>Indo-European Etymological Dictionary<\/span><\/i>, 1959), Julius <\/span>Pokorny<\/span><\/a> listed several entries for the IndoEuropean root BHEL. The fourth entry in the sequence means to bloom or come into leaf. It has an metanalytic (letter reversal) form, BHL\u0112, with an o-grade form, BHL\u014c, and a zero-grade form, BHL\u018e.\u00a0<\/span><\/p>\n

From BHL\u014c we get words such as blow, bloom, and blossom, blade, and blood, the last from the idea that it spurts out like a blossom from its bud. And from BHL\u018e we get bless, which originally meant to mark with blood or sacrifice, and therefore to consecrate.<\/span><\/p>\n

Consonantal shift of BH to <\/span>\u03c6<\/span><\/i> (<\/span>ph<\/span><\/i>) or <\/span>f<\/span><\/i> gave blooming words in Greek and Latin. Greek \u03d5<\/span>\u1fe6<\/span><\/i>\u03bb\u03bf\u03bd<\/span>,<\/span><\/i> a race, tribe, or class, gives us phylum and phylogeny. Podophyllum, the name of a genus of plants from the Berberidaceae family, is thought to be a contraction of anapodophyllum, literally \u201chaving leaves like a duck’s foot\u201d.<\/span><\/p>\n

From the Latin word folium, a leaf, we get foil, folio, and foliage, portfolio, trefoil (the three-leaved clover or shamrock), quatrefoil (any four-leaved flower or shape), cinquefoil (the five leaved <\/span>Potentilla reptans <\/span><\/i>and<\/span> Comarum palustre<\/span><\/i>), and milfoil (the many-leaved <\/span>Achillea millefolium<\/span><\/i>). Flos a flower, gives us floral, floret, florid, florist, flour, flourish, and effloresce. The coin called a florin was originally stamped with a picture of a lily.<\/span><\/p>\n

The word phlebotomy is surprisingly old. It can be found in Attic Greek, \u03c6\u03bb\u03b5\u03b2\u03bf\u03c4\u03bf\u03bc\u1f77\u03b1, from \u03c6\u03bb\u1f73\u03c8, a vein, and \u03c4\u1f73\u03bc\u03bd\u03b5\u03b9\u03bd, to cut. In English it dates from the start of the 15<\/span>th<\/span> century. Pokorny and other sources do not mention the IndoEuropean origin of the Greek, but two associations suggest a possibility: first, the origin of the words phlegm, phlogiston, and the bright-coloured phlox from another variety of BHL\u014c, meaning to shine, flash, or burn; secondly, the connection with blood. I therefore suspect that \u03c6\u03bb\u1f73\u03c8 comes from one or other form of BHL\u0112.<\/span><\/p>\n

Over time the method of phlebotomy has changed. The <\/span>historical evidence<\/span><\/a> shows that until the 20<\/span>th<\/span> century phlebotomists would insert needles into peripheral veins pointing distally, away from the direction of the heart. The point of this is that, as William Harvey showed (Figure 1), blood flow in veins is from distal to proximal, with valves that prevent the blood from flowing backwards. If you insert a large needle into a small peripheral vein the needle will occlude the lumen and prevent blood flow; if the point of the needle faces proximally no blood will enter the needle, since the flow from distal to proximal will have been blocked; in contrast, if the point of the needle faces distally, the blood on its way back to the heart will find its way into the needle and flow easily.<\/span><\/p>\n

\"\"<\/p>\n

However, in the early 20<\/span>th<\/span> century the advent of finer needles and frequent use of the median antecubital vein reduced the importance of the direction in which the needle punctured the vein, and the proximal approach became routine. But if you are forced to use a small vein, size matters, and the distal approach remains the preferred method (<\/span>Figure 2<\/span><\/a>).\u00a0<\/span><\/p>\n

\"\"<\/p>\n

Venesection (cutting) and venepuncture (puncturing) are synonyms for the different meanings of phlebotomy. \u201cVenesection\u201d is first recorded in the <\/span>Oxford English Dictionary<\/span><\/i> in a citation from 1661 and \u201cvenepuncture\u201d from as late as 1923, although there are several earlier instances. For example in a paper published in The <\/em><\/span>BMJ<\/em><\/span><\/a> in 1910 the author, Colonel C Birt, wrote that \u201cwe obtained blood by venepuncture in 28 cases\u201d. He might have written \u201cphlebotomy\u201d instead, but his subject was \u201cPhlebotomus or Sandfly Fever\u201d, which may explain his preference for \u201cvenepuncture\u201d. Phlebotomus is a genus of sandflies of the family Psychodidae, vectors of diseases such as <\/span>leishmaniasis<\/span><\/a> and <\/span>sandfly fever<\/span><\/a>. The viruses they carry are called <\/span>phleboviruses<\/span><\/a>.<\/span><\/p>\n

Wondering which of these synonyms is used more commonly, I searched PubMed (Figure 3). Surprisingly, although in ordinary conversation we would generally talk about venepuncture, in written texts phlebotomy wins out by a long way.<\/span><\/p>\n

\"\"<\/p>\n

Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford’s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/p>\n

Competing interests:<\/strong> None declared.<\/p>\n

\"\"<\/p>\n","protected":false},"excerpt":{"rendered":"

Phlebotomy is the process of letting blood, originally by incising a blood vessel and nowadays by puncturing it. Early papers on phlebotomy refer to the curious habit of hepatic phlebotomy, […]<\/p>\n

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