circulation."[81] Thus, while bloodletting for other
diseases declined throughout the nineteenth century, it continued to be
advocated for treating apoplexy, pneumonia, and pulmonary edema.[82]

The merit of phlebotomy for those afflicted with congestive heart failure
was emphasized again in 1912 by H. A. Christian. This condition led to
engorgement of the lungs and liver and increased pressure in the venous
side of the circulation. Articles advocating bloodletting continued into
the 1920s and 1930s.[83]

Bloodletting is currently being tested as a treatment for those suffering
from angina or heart attacks. Blood is removed on a scheduled basis to
maintain the hematocrit (the percentage of red blood cells in the blood)
at a specified level. Keeping the hematocrit low has provided relief to
those being tested.[84] Other benefits of removing blood, including the
lowering of blood pressure, can be obtained by the use of antihypertensive
drugs. Thus the valid indications for bleeding are being supplanted by the
use of modern drugs that accomplish the same end.

By the twentieth century the lancet was replaced in some quarters by safer
devices for removing blood and injecting fluids into the bloodstream.
Heinrich Stern improved Strauss's special hyperdermic needle. In 1905
Stern designed a venepuncture or aspirating needle that was 7 cm long with
a silver cannula of 4 cm. Attached to the handle was a thumb-rest and a
tube for removing or adding fluids and a perforator within the cannula. He
recommended that the forearm be strapped above the elbow and that the
instrument be thrust into the most prominent vein. This streamlined vein
puncturing implement reduced the possibility of injecting air and bacteria
into the blood.[85] It was, and continues to be, used to withdraw blood
for study in the laboratory, to aid in diagnosis of disease, and to
collect blood for transfusing into those who need additional blood during
an operation or to replace blood lost in an accident or disease. The blood
is collected in a glass or plastic graduated container and stored under
refrigeration. The study of blood donors has, incidentally, given insights
into the physiology of bloodletting since the volume customarily removed
from a donor is about the same in volume as that taken by a bleeder (one
pint or 500 cc).[86]

The annual physical examination today includes taking a small amount of
blood from the finger or a vein in the elbow. This bloo