In the 19th century, Reginald Southey, an English physician, pioneered the use of small tubes (subsequently named Southey's tubes) in the lower legs and feet for the treatment of severe fluid overload. Doctors pushed the tiny rubber tubes, each about an inch long, through the skin and allowed them to drain. According to one report, they could remove up to 40 pounds of fluid in two days.
An important cardiology text published in 1932 recommended a procedure called paracentesis, the drainage of excess fluid from the abdomen through a needle.
Digitalis, extracted from the foxglove plant, was first described as a treatment for heart failure in 1785, when it was discovered to be the active ingredient in a folk recipe for a dropsy treatment.
The treatment of patients with heart failure and fluid overload underwent a huge advance with the introduction of diuretic medicines. The early diuretic medicines, in wide use in the 1940s, contained mercury (mercurial diuretics) and were associated with substantial toxicity. Thiazide diuretics were introduced in the 1950s, and in the 1960s loop diuretics became available. Only in the mid-20th century did the practice of bloodletting go into decline.
Despite their benefits, diuretic medicines sometimes stop working effectively -- a syndrome referred to as diuretic resistance. When this happens, patients are sometimes given larger doses of diuretics, but larger doses are more likely to have adverse side effects and may even increase the risk of death in heart failure patients.