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Instruments Used by Physicians

Physicians bled patients using a number of different techniques beautifully illustrated in early texts (11,12). After applying a tourniquet, the physician would cut a vessel, usually a vein, with a thumb lancet that he carried in a small case (13). Spring lancets accomplished the same purpose when a blade was cocked and then released over a superficial vessel (14). Multiple bladed scarificators (15-17) were also used to collect blood in pewter bowls with rings measured in ounces (which distinguished them from porringers) (18,19). Fleams were knives containing multiple blades, one of which was placed over a vein and struck with a fleam stick (20). (Some would argue that early veterinarians primarily used this type of bleeder).

Beautiful "wet" cupping sets were manufactured with syringes to help draw out blood (21,22) after scarificators had made their multiple incisions (23). "Dry" cupping was also popular in the same period though not meant to draw blood. Cupping glasses were heated with an alcohol lamp and then placed over the skin. As the cup cooled, it created a vacuum which, according to the theory, brought blood to the surface to act as a counterirritant -- discomfort was produced in one place to reduce pain in another (24-26).

Bloodletting - It's Good for You!

One of the reasons that the practice of bleeding continued for so long is that this procedure actually is beneficial in some circumstances, including the fluid overload of heart failure. Early physicians, however, did not have the physiological understanding to be able to distinguish which conditions had a medical indication so that this procedure was used for almost everything including agitated psychoses, when a drop in blood pressure resulted in the desired sedation (27). Indications for bloodletting were outlined by Joseph Pancoast in "A Treatise on Operative Surgery" (1844):

The opening of the superficial vessels for the purpose of extracting blood constitutes one of the most common operations of the practitioner. The principal results, which we effect by it, are 1st. The diminution of the mass of the blood, by which the overloaded capillary or larger vessels of some affected part may be relieved; 2. The modification of the force and frequency of the heart's action; 3. A change in the composition of the blood, rendering it less stimulating; the proportion of serum becoming increased after bleeding, in consequence of its being reproduced with greater facility than the other elements of the blood; 4. The production of syncope, for the purpose of effecting a sudden general relaxation of the system; and, 5. The derivation, or drawing as it is alleged, of the force of the circulation from some of the internal organs, towards the open outlet of the superficial vessel. These indications may be fulfilled by opening either a vein or an artery.

11-12) Traite Complet de L'Anatomie de L'Homme (1866-1871), by Bourgery, et al.

Bleeding techniques in the mid 19th century are beautifully illustrated by Bourgery as small thumb lancets were used in different areas of the body to treat different problems.

13) Thumb Lancet Array

Note the beautiful materials that were used in these thumb lancet cases: tortoise shell shagreen, mother of pearl, silver, and gold. The lancets themselves usually had tortoise shell guards though mother of pearl was used in the higher quality sets.

14) Presentation Silver Spring Lancet, by Samuel Jackson, Baltimore

This is an unusual silver spring lancet that was presented to H. Brooke, MD from Dr. Worthington, who graduated from the University of Maryland School of Medicine (my alma mater).

15-17) Scarificators

Multiple small blades were cocked and then released to make small incisions that bled, the procedure called "wet cupping". Characteristically, the French scarificators were round and the British were square, while Tiemann in New York produced a unique type with a handle. Collin manufactured the pictured French scarificator, and a lovely brushed brass one was made by Arnold.

18-19) Bleeding bowl, 18th century

This hallmarked British pewter bleeding bowl has rings to determine the amount of blood withdrawn in ounces.

20) Fleam and Fleam Stick

The physician would place the blade of the appropriate size over a vein and then would tap with the turned fleam stick to draw blood. The pictured fleam stick has a number of marks indicating previous use.

21-22) Wet Cupping, Illustrated

Physicians rarely performed minor procedures such as bleeding. In "The Leech Woman" (1660), by Quirijn van Brekelenkam, the patient is having a session of "wet" cupping as blood is collected in a bleeding bowl. This procedure is also nicely shown here in Bourgery.

23) Wet Cupping Set by Collin, 19th Century

This is a characteristic French set; once the wounds were made, the blood was drawn out by suction.

24-26) Dry Cupping Set by Arnold, 19th Century

In this British set, alcohol is placed in the small lamp (or sterling "teapot"), the wick is lit, and the cup is heated. As the air cools, a suction is created.

27) Bleeding by Psychiatrists

Psychiatrists employed bleeding to obtain the sedative effects resulting from a reduction in blood pressure.

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11) Venesection, arm

13) Thumb Lancets

14) Silver Spring Lancet

15) Scarificators, Heister (1743)

19) Bleeding Bowl with Rings

20) Fleam and Fleam Stick

21) "The Leech Woman" (1660)

23) Wet Cupping Set

25) Arnold Cupping Set

27) Bleeding in Psychiatry