License to Heal: Examination of a Bloodletter in 1844
- ccconservacao
- 28 de jul. de 2025
- 7 min de leitura
Documents with Stories: Because Preservation is Also Sharing
A Document, a Profession
This is the first entry in the new series Documents with Stories, where I share material fragments that connect the past with the present of my work. These are documents I’ve come across during conservation or research activities and that, once preserved, also demand to be made visible. Because to preserve is also to recognise the value of what is forgotten – and to bring it back into public knowledge.
Between the pages of an old, handwritten medical notebook, I found a singular document: the Examination Record for Bloodletting of Francisco António Pereira, dated 7 February 1844. At first glance, it might seem like just another bureaucratic formality, one of those records that lend official weight to everyday acts. But on closer reading, it reveals itself to be a valuable testimony to a medical practice already on the decline by then: bloodletting. And even more, to the men who performed it, the knowledge they held, and the way the Portuguese State, in the mid-19th century, sought to regulate them.
The handwritten document, bearing multiple seals and signatures, describes an official examination held in the town of Alter do Chão, for a candidate residing in Vai Monte (now Vaiamonte), in the district of Portalegre. In the presence of a surgeon, an experienced bloodletter, a public health delegate, and a clerk, the examination combined theoretical questioning, practical demonstration, and secret voting. The result was positive: “A.A.A.” – unanimously approved.
But who was this man seeking to formalise his work? And what does this exam tell us about the place of popular medicine, empirical practice, and public health regulation in 19th-century Portugal?
Bloodletters and Barbers: The Long History of a Profession
The figure of the barber-bloodletter has medieval roots. For centuries, it was to these men – more practical than learned – that communities turned for basic health care: cutting hair, shaving beards, applying cupping glasses, extracting teeth, draining abscesses, or performing bloodletting. In many villages, the barber was at once a minor surgeon, nurse, adviser, and practitioner of everyday medicine.
Their authority rested primarily on experience: learning by observation, repetition, and oral transmission, passed down within a craft-based lineage. Only later came attempts to regulate and distinguish the different categories of “healers”: physicians, with university training; surgeons, with technical instruction; and empirical practitioners – among them, the bloodletters.
By the 18th and 19th centuries, with the advancement of medical science and the professionalisation of public health, these traditional forms of knowledge were increasingly questioned. Still, the social reality was more complex than the theory. In many rural regions of Portugal, bloodletters remained indispensable. Where there were no doctors or hospitals, empirical knowledge prevailed – and official exams like the one taken by Francisco António Pereira served to legitimise this practice in the eyes of the State.
Who’s Who in the Examination Record
On 7 February 1844, several individuals gathered in the town of Alter do Chão to carry out the official examination of Francisco António Pereira, a resident of the village of Vai Monte. This examination was not merely a technical validation ritual – it was a formal, public and participatory act that sought to balance practical knowledge with institutional control.
Presiding over the examination was Dr. Nicolau (?) Carvalho, Delegate of the Royal Public Health Council for the district of Portalegre. In addition to the Delegate, the examiners present were António Xavier da Fonseca, surgeon, and José Luís Sardinha, bloodletter – a pair that clearly illustrates the tension and complementarity between academic and empirical knowledge. The clerk responsible for recording the proceedings was Cândido Carlos Souza Zagallo Cordeira.
The choice of examiners says much about how the practice of bloodletting was legitimised: it was necessary to demonstrate competence before representatives of two worlds – official science and traditional practice. It was also a recognition that craft knowledge was not the sole preserve of academic institutions. What mattered was the ability to apply knowledge in real, everyday contexts.
The Examination: Questions, Practice, and Approval
The document describes, in the sober tone typical of notarial records, the unfolding of the examination. Francisco António Pereira was questioned by both examiners:
“on the more specific knowledge, theoretical and practical, of the said [bloodletting], and on the method of bloodletting and application of cupping glasses.”
He answered the questions and carried out a practical demonstration, the details of which are not recorded, but the outcome is clear: once the demonstration was concluded, he was asked to leave the room, and a secret ballot was held. All three votes were favourable → “A.A.A.”. Unanimously approved.
This procedure combines formal rigour with elements that today seem almost ceremonial: a secret vote by three evaluators, the candidate’s absence during deliberation, the solemn language of the official record. It is a remnant of a professional culture in transition, where oral knowledge and experience coexisted with the first steps of official certification.
It is also noteworthy that cupping glasses are explicitly mentioned among the exam topics – a technique used since Antiquity, and, like bloodletting, based on the idea of balancing the body’s humours. These are practices we now consider obsolete, but at the time they still held a certain prestige: increasingly questioned by modern physicians, yet still widely used and, as this case shows, officially recognised and taught.
The Document as an Instrument of Legitimacy
The record is an impressive object. Handwritten in a clear and confident hand, it features seals, signatures, and stamps with great formality. The signatures appear at the end of the text, listing all participants: the health delegate, the examiners, the examinee, and the clerk. The delegate is the only one preceded by the title “Doctor”.
Details from the Bloodletting Examination Record (1844), with white embossed seals and the stamp of the Civil Government of Portalegre; the signatures of those present.
There are four white embossed seals on the paper: two round ones, one with the coat of arms of the Kingdom flanked by flags and the inscription “THESOURO PUBLICO” [Public Treasury], the other with interlaced “CP” initials and the caption “CREDITO PÚBLICO” [Public Credit]. The two oval seals, with laurel branches, bear the inscriptions “XL” and “40”. A stamped ink mark reads “Gov. C. de P. Alegre” – Civil Government of Portalegre – and a watermark on the reverse reads “CREDITO PUBLICO”, visible under light.
Everything in this record points to a structure of validation: the authority of the written word, the seal of the State, the formality of the process. Francisco António Pereira was not merely someone who knew how to bleed patients, he was now, officially, authorised to do so.
This document is a clear example of how health practices, even in seemingly marginal or rural areas, were integrated into a broader logic of public administration and fiscal oversight. For empirical knowledge to be accepted, it needed the State’s stamp of approval.
A Changing Profession: Between Empirical Knowledge and Scientific Medicine
In Portugal in 1844, the practice of bloodletting was already an ancient tradition, but one not free from controversy. The theory of the four humours, which for centuries had justified the removal of blood as a method of healing, was gradually being replaced by new physiological, anatomical, and microbiological approaches. Medical schools were beginning to look upon bloodletting and related techniques, such as cupping or the use of leeches, with suspicion. But the transition was slow and uneven.
In major urban centres, medicine based on university training and scientific method was beginning to consolidate. In rural towns and villages, however, the landscape was different. Empirical medicine persisted, not out of ignorance, but out of necessity. There were few doctors, and access to healthcare often depended on figures like the bloodletter, who combined practical knowledge, community presence, and, in many cases, tacit recognition by the population. Francisco António Pereira’s official examination reflects this reality: formalising what already existed in practice.
The regulation of the bloodletter’s profession was not new. As early as 1822, discussions were underway about requiring examination certificates, oversight by senior surgeons, and minimum criteria for practising. From the 1830s onward, with the reorganisation of public health services and the creation of Royal Health Councils, these requirements became more frequent, particularly in areas distant from direct supervision by the capital. Bloodletters could thus continue to practise, provided they were examined and officially recognised.
This hybrid model, combining practical training, official assessment, and community standing, allowed the profession to survive until the mid-19th century. But it could not withstand the consolidation of scientific medicine. As medical schools gained prestige and public health became a matter of state, the space for traditional practitioners gradually diminished. Some became barbers or empirical dentists; others abandoned the trade. The 1844 examination is, therefore, also a portrait of an ending cycle.
From Book to Memory: A Material Trace of Local Knowledge
The Examination Record for Bloodletting of Francisco António Pereira did not survive in isolation. It was found inside a handwritten medical notebook, possibly once owned by the examinee himself and later passed down from generation to generation, evolving from bloodletters to trained physicians. This volume will be the focus of a future entry in this series. The fact that the record and the book were kept together is no coincidence: the document formally attests to the knowledge preserved and transmitted in the book. One served as a tool for learning; the other, for validation.
There is something deeply moving about the preservation of this record. A sheet carefully signed, sealed, stamped, kept for decades as proof of competence, of belonging to a profession, of a solemn moment of recognition. Today, more than a technical document, it is a fragment of lived history. It gives us access to a time when healing was a gesture shared between tradition and science, between the knowledge of the hand and the authority of the State.
Recovering documents like this one also means recovering the lives inscribed in them. In a country where so much knowledge was oral, informal, passed from generation to generation, the survival of a written record with this level of detail and formality is a rare opportunity. It allows us to look back not with distance, but with historical empathy.
Ultimately, it reminds us of the importance of preserving such testimonies, and of valuing them not only through conservation, but through sharing.
References:
Costa, N. C. (2022). Os sangradores no Portugal medievo até ao seu lento desaparecimento, em momento de forte afirmação da enfermagem, no final do século XIX [Dissertação de mestrado, Escola Superior de Enfermagem de Coimbra]. http://web.esenfc.pt/?url=EU15r5gI
Costa, N. C., & Queirós, P. J. P. (2023). As funções, a formação e a extinção dos sangradores em Portugal. Revista de Enfermagem Referência, 6(2). https://doi.org/10.12707/RVI22060