Bloodletting, the removal of blood from the body, has been practiced in
some form by almost all societies and cultures. At various times,
bloodletting was considered part of the medical treatment for nearly every
ailment known to man. It was also performed as punishment or as a form of
worship to a Superior Power or Being. It still retains therapeutic value
today, although only for an extremely limited range of conditions. In
early attempts to extract blood from the body, the skin was penetrated in
various places with a sharp instrument made of stone, wood, metal,
bristle, or any other rigid material. When it was recognized that a vein
visible on the surface of the skin as a blue-green stripe contained blood,
the vein was incised directly. To facilitate "breathing a vein" and to
provide greater safety, more refined and sharper instruments were devised.
As theories supporting bloodletting grew more complex, so too did the
instruments.
Spontaneous forms of bleeding, including nosebleed, menstruation, and
those instances produced by a blow to any part of the body, apparently
inspired the earliest human bloodletters. The Egyptians claimed that the
hippopotamus rubbed its leg against a sharp reed until it bled to remove
excess blood from its body.[1] The Peruvians noted that a bat would take
blood from the toe of a sleeping person when the opportunity presented
itself. A deer, and goat, would pick a place near its diseased eye for
relief.[2] The methods employed by animals increased interest in using
artificial methods for letting blood in man.
The devices man has employed to remove blood from the body fall into two
major categories: (1) those instruments used for general bloodletting,
that is, the opening of an artery, or more commonly a vein, and (2) those
instruments used in local bloodletting. Instruments in the first category
include lancets, spring lancets, fleams, and phlebotomes. Associated with
these are the containers to collect and measure the blood spurting from
the patient. In the second category are those instruments associated with
leeching and cupping. In both of these methods of local bloodletting, only
the capillaries are severed and the blood is drawn from the body by some
means of suction, either by a leech or by an air exhausted vessel.
Instruments in this category include scarificators, cupping glasses,
cupping devices, and many artificial leeches invented to replace the
living leech.
Much effort and ingenuity was expanded, especially in the eighteenth and
nineteenth centuries, to improve the techniques of bloodletting. In the
eighteenth century, delicate mechanical spring lancets and scarificators
were invented to replace the simpler thumb lancets and fleams. In the
nineteenth century, as surgical supply companies began to advertise and
market their wares, many enterprising inventors turned their hand to
developing new designs for lancets and scarificators, pumps, fancy cupping
sets, rubber cups, and all manner of cupping devices and artificial
leeches. If we also consider treatments related to bloodletting, in which
blood is transferred from one part of the body to another, without actual
removal from the body, then we can add the many inventions devoted to dry
cupping, irritating the body, and exhausting the air around limbs or even
the entire body. Although many physicians continued to use the traditional
instruments that had been used for centuries, many others turned eagerly
to the latest gadget on the market.
Bloodletting instruments, perhaps the most common type of surgical
instrument little more than a century ago, are now unfamiliar to the
average person. When one sees them for the first time, one is often amazed
at their petite size, careful construction, beautiful materials, and
elegant design. One marvels at spring lancets made of silver, thumb
lancets with delicate tortoise shell handles, and sets of hand-blown cups
in the compartments of a mahogany container with brass and ivory latches
and a red plush lining. Those finding such instruments in their attic or
in a collection of antiques, even if they can determine that the
instruments were used for bloodletting, often have no idea when the
instruments were made or how they were used. Frequently a veterinary
spring lancet or fleam is mistaken for a human lancet, or a scarificator
for an instrument of venesection. Almost nothing has been written to
describe these once common instruments and to place them in historical
context. Historians who study the history of medical theory usually ignore
medical practice, and they rarely make reference to the material means by
which a medical diagnosis or treatment was carried out. It is hoped that
this publication will fill a need for a general history of these
instruments. This history is pieced together from old textbooks of
surgery, medical encyclopedias, compilations of surgical instruments,
trade catalogs, and the instruments themselves.
The collection of instruments at the National Museum of History and
Technology of the Smithsonian Institution contains several hundred pieces
representing most of the major types of instruments. Begun in the late
nineteenth century when medical sciences were still part of the Department
of Anthropology, the collection has grown steadily through donations and
purchases. As might be expected, it is richest in bloodletting instruments
manufactured in America in the nineteenth century. One of its earliest
acquisitions was a set of four flint lancets used by Alaskan natives in
the 1880s. A major source for nineteenth-century instruments is the
collection of instruments used by the members of the Medical and
Chirurgical Faculty of Maryland, a medical society founded in 1799. The
Smithsonian collection also includes patent models of bloodletting
instruments submitted to the U.S. Patent Office by nineteenth-century
inventors and transferred to the Smithsonian in 1926.
Because we have made an effort to survey every major type of instrument
related to bloodletting, it is hoped that this publication will serve as a
general introduction to bloodletting instruments, and not merely a guide
to the Smithsonian collection. With this goal in mind, the catalog of
bloodletting instruments has been preceded by chapters surveying the
history of bloodletting and describing, in general terms, the procedures
and instruments that have been used since antiquity for venesection,
cupping, leeching, and veterinary bloodletting. In the course of our
research we have consulted several other collections of bloodletting
instruments, notably the collections of the Wellcome Museum of London, the
Armed Forces Institute of Pathology, the College of Physicians in
Philadelphia, the Institute of the History of Medicine at the Johns
Hopkins University, the Howard Dittrick Medical Museum in Cleveland, and
the University of Toronto. Illustrations from these collections and
references to them have been included in the cases where the Smithsonian
collection lacks a particular type of instrument.