BLEEDING.
Fashion, capricious everywhere, is especially so in surgery and
medicine. Smoking we are now taught to regard as a pernicious
practice, to be abhorred as James the First abhorred it. Yet Dr.
Archer, and Dr. Everard in his "Panacea, or a Universal Medicine,
being a discovery of the wonderful virtues of Tobacco" (1659), warmly
defended the habit, and for long it was held by the highest
authorities to be an efficacious preservative against disease. What
would schoolboys now say to being flogged for _not_ smoking? Yet
Thomas Hearne, in his diary (1720-21) writes--"Jan. 21, I have been
told that in the last great plague in London none that kept
tobacconists' shops had the plague. It is certain that smoking was
looked upon as a most excellent preservative. In so much, that even
children were obliged to smoak. And I remember that I heard formerly
Tom Rogers, who was yeoman beadle, say, that when he was that year,
when the plague raged, a school-boy at Eton, all the boys of that
school were obliged to smoak in the school every morning, and that he
was never whipped so much in his life as he was one morning for not
smoaking."
Blood-letting, so long a popular remedy with physicians, has, like
tobacco-smoking for medicinal purposes, fallen into disuse and
contempt. From Hippocrates to Paracelsus, who, with characteristic
daring, raised some objections to the practice of venesection, doctors
were in the habit of drawing disease from the body as vintners extract
claret from a cask, in a ruddy stream. In the feudal ages bleeding was
in high favour. Most of the abbeys had a "flebotomaria" or
"bleeding-house," in which the sacred inmates underwent bleedings (or
"minutions" as they were termed) at stated periods of the year, to the
strains of psalmody. The brethren of the order of St. Victor underwent
five munitions annually--in September, before Advent, before Lent,
after Easter, and at Pentecost.
There is a good general view of the superstitions and customs
connected with venesection, in "The Salerne Schoole," a poem of which
mention continually occurs in the writings of our old physicians. The
poem commences with the following stanza:--
"The 'Salerne Schoole' doth by these lines impart
All health to England's king, and doth advise
From care his head to keepe, from wrath his hart.
Drink not much wine, sup light and soon arise,
When meat is gone long sitting breedeth smart;
And afternoon still waking keep your eies.
. . . . .
Use three physicians still--first Doctor _Quiet_,
Next Doctor _Merriman_ and Doctor _Dyet_.
"Of bleeding many profits grow and great
The spirits and sences are renew'd thereby,
Thogh these mend slowly by the strength of meate,
But these with wine restor'd are by-and-by;
By bleeding to the marrow commeth heate,
It maketh cleane your braine, releeves your eie,
It mends your appetite, restoreth sleepe,
Correcting humors that do waking keep:
All inward parts and sences also clearing,
It mends the voice, touch, smell, and taste, and hearing.
"_Three special months_, _September_, _Aprill_, _May_,
There are in which 'tis good to ope a vein--
In these three months the moon beares greatest sway,
Then old or young, that store of blood containe,
May bleed now, though some elder wizards say,
Some daies are ill in these, I hold it vaine;
September, Aprill, May have daies apeece,
That bleeding do forbid and eating geese,
And those are they, forsooth, of May the first,
Of t'other two, the last of each are worst.
"But yet those daies I graunt, and all the rest,
Haue in some cases just impediment,
As first, if nature be with cold opprest,
Or if the Region, Ile, or Continent,
Do scorch or freez, if stomach meat detest,
If Baths you lately did frequent,
Nor old, nor young, nor drinkers great are fit,
Nor in long sickness, nor in raging fit,
Or in this case, if you will venture bleeding,
The quantity must then be most exceeding.
"When you to bleed intend, you must prepare
Some needful things both after and before:
Warm water and sweet oyle both needfull are,
And wine the fainting spirits to restore;
Fine binding cloths of linnen, and beware
That all the morning you do sleepe no more;
Some gentle motion helpeth after bleeding,
And on light meals a spare and temperate feeding
To bleed doth cheare the pensive, and remove
The raging furies bred by burning love.
"Make your incision large and not too deep,
That blood have speedy yssue with the fume;
So that from sinnews you all hurt do keep.
Nor may you (as I toucht before) presume
In six ensuing houres at all to sleep,
Lest some slight bruise in sleepe cause an apostume;
Eat not of milke, or aught of milke compounded,
Nor let your brain with much drinke be confounded;
Eat no cold meats, for such the strength impayre,
And shun all misty and unwholesome ayre.
"Besides the former rules for such as pleases
Of letting bloud to take more observation;
. . . . .
To old, to young, both letting blood displeases.
By yeares and sickness make your computation.
First in the spring for quantity you shall
Of bloud take twice as much as in the fall;
In spring and summer let the right arme bloud,
The fall and winter for the left are good."
Wadd mentions an old surgical writer who divides his chapter on
bleeding under such heads as the following:--1. What is to limit
bleeding? 2. Qualities of an able phlebotomist; 3. Of the choice of
instruments; 4. Of the band and bolster; 5. Of porringers; 6.
_Circumstances to be considered at the bleeding of a Prince._
Simon Harward's "Phlebotomy, or Treatise of Letting of Bloud; fitly
serving, as well for an advertisement and remembrance to all
well-minded chirurgians, as well also to give a caveat generally to
all men to beware of the manifold dangers which may ensue upon rash
and unadvised letting of bloud," published in the year 1601, contains
much interesting matter on the subject of which it treats. But a yet
more amusing work is one that Nicholas Gyer wrote and published in
1592, under the following title:--
"The English Phlebotomy; or, Method and Way of Healing by Letting of
Bloud."
On the title-page is a motto taken from the book of Proverbs--"The
horse-leach hath two daughters, which crye, 'give, give.'"
[Illustration: _THE FOUNDERS OF THE MEDICAL SOCIETY OF LONDON_]
The work affords some valuable insight into the social status of the
profession in the sixteenth century.
In his dedicatory letter to Master Reginald Scot, Esquire, the author
says that phlebotomy "is greatly abused by vagabund horse-leaches
and travailing tinkers, who find work almost in every village through
whom it comes (having in truth neither knowledge, nor witte, nor
honesty), the sober practitioner and cunning chirurgian liveth basely,
is despised, and accounted a very abject amongst the vulgar sort." Of
the medical skill of Sir Thomas Eliot, and Drs. Bulleyn, Turner,
Penié, and Coldwel, the author speaks in terms of warm eulogy; but as
for the tinkers aforementioned, he would regard them as murderers, and
"truss them up at Tyborne."
Gyer, who indulges in continual reference to the "Schola Salerni,"
makes the following contribution to the printed metrical literature on
Venesection:--
"_Certaine very old English verses, concerning the veines
and letting of bloud, taken out of a very auncient paper
book of Phisicke notes_:--
"Ye maisters that usen bloud-letting,
And therewith getten your living;
Here may you learn wisdome good,
In what place ye shall let bloud.
For man, in woman, or in child,
For evils that he wood and wild.
There beene veynes thirty-and-two,
For wile is many, that must he undo.
Sixteene in the head full right,
And sixteene beneath I you plight.
In what place they shall be found,
I shall you tell in what stound.
Beside the eares there beene two,
That on a child mote beene undoe;
To keep his head from evil turning
And from the scale withouten letting.
And two at the temples must bleede,
For stopping and aking I reede;
And one is in the mid forehead,
For Lepry or for sawcefleme that mote bleede.
Above the nose forsooth is one,
That for the frensie mote be undone.
Also when the eien been sore,
For the red gowt evermore.
And two other be at the eien end.
If thy bleeden them to amend.
And the arch that comes thorow smoking,
I you tell withouten leasing.
And at the whole of the throat, there beene two,
That Lepry and straight breath will undoo.
In the lips foure there beene,
Able to bleede I tell it be deene,
Two beneath, and above also
I tell thee there beene two.
For soreness of the mouth to bleede,
When it is flawne as I thee reede.
And two in the tongue withouten lie,
Mote bleede for the quinancie.
And when the tongue is aught aking,
For all manner of swelling.
Now have I tolde of certaine,
That longer for the head I weene,
And of as many I will say,
That else where there beene in fay.
In every arme there beene fife,
Full good to blede for man and wife,
_Cephalica_ is one I wis,
The head veyne he cleaped is,
The body above and the head;
He cleanseth for evil and qued.
In the bought of the arme also,
An order there must he undoo;
Basilica his name is,
Lowest he sitteth there y wis;
Forsooth he cleanseth the liver aright,
And all other members beneath I twight.
The middle is between the two,
Corall he is clipped also
That veine cleanseth withouten doubt;
Above and beneath, within and without.
For Basilica that I of told,
One braunched veine ety up full bold,
To the thomb goeth that one braunch;
The cardiacle he wil staunch,
That there braunch full right goeth,
To the little finger withouten oth;
_Saluatell_ is his name,
He is a veine of noble fame;
There is no veine that cleanseth so clene,
The stopping of the liver and splene.
Above the knuckles of the feet,
With two veines may thou meet,
Within sitteth _Domestica_,
And without _Saluatica_.
. . . . .
All the veines thee have I told,
That cleanseth man both yong and old.
If thou use them at thy need,
These foresaid evils they dare not dread;
So that our Lord be them helping,
That all hath in his governing.
So mote it be, so say all wee,
Amen, amen, for charitee."
To bleed on May-day is still the custom with ignorant people in a few
remote districts. The system of vernal minutions probably arose from
that tendency in most men to repeat an act (simply because they have
done it once) until it has become a habit, and then superstitiously to
persevere in the habit, simply because it is a habit. How many aged
people read certain antiquated journals, as they wear exploded
garments, for no other reason than that they read the same sort of
literature, and wore the same sort of habiliments, when young. To miss
for once the performance of a periodically recurring duty, and so to
break a series of achievements, would worry many persons, as the
intermitted post caused Dr. Johnson discomfort till he had returned
and touched it. As early as the sixteenth century, we have Gyer
combating the folly of people having recourse to periodic
venesections. "There cometh to my minde," he says, "a common opinion
among the ignorant people, which do certainly beleeve that, if any
person be let bloud one yere, he must be let bloud every yere, or else
he is (I cannot tell, nor they neither) in how great danger. Which
fonde opinion of theirs, whereof soever the same sprong first, it is
no more like to be true, than if I should say: when a man hath
received a great wound by chaunce in any part of his body, whereby he
loseth much bloud; yet after it is healed, he must needs have the like
wounde againe there the next yeare, to avoid as much bloud, or els he
is in daunger of great sickness, yea, and also in hazard to lose his
life."
The practitioners of phlebotomy, and the fees paid for the operation,
have differed widely. In the middle of the last century a woman used
the lancet with great benefit to her own pocket, if not to her
patients, in Marshland, in the county of Norfolk. What her charge was
is unknown, probably, however, only a few pence. A distinguished
personage of the same period (Lord Radnor) had a great fondness for
letting the blood (at the point of an amicable lancet--not a hostile
sword) of his friends. But his Lordship, far from accepting a fee, was
willing to remunerate those who had the courage to submit to his
surgical care. Lord Chesterfield, wanting an additional vote for a
coming division in the House of Peers, called on Lord Radnor, and,
after a little introductory conversation, complained of a distressing
headache.
"You ought to lose blood then," said Lord Radnor.
"Gad--do you indeed think so? Then, my dear lord, do add to the
service of your advice by performing the operation. I know you are a
most skilful surgeon."
Delighted at the compliment, Lord Radnor in a trice pulled out his
lancet-case, and opened a vein in his friend's arm.
"By-the-by," asked the patient, as his arm was being adroitly bound
up, "do you go down to the House to-day?"
"I had not intended going," answered the noble operator, "not being
sufficiently informed on the question which is to be debated; but you,
that have considered it, which side will you vote on?"
In reply, Lord Chesterfield unfolded his view of the case; and Lord
Radnor was so delighted with the reasoning of the man (who held his
surgical powers in such high estimation), that he forthwith promised
to support the wily earl's side in the division.
"I have shed my blood for the good of my country," said Lord
Chesterfield that evening to a party of friends, who, on hearing the
story, were convulsed with laughter.
Steele tells of a phlebotomist who advertised, for the good of
mankind, to bleed at "threepence per head." Trade competition has,
however, induced practitioners to perform the operation even without
"the threepence." In the _Stamford Mercury_ for March 28, 1716, the
following announcement was made:--"Whereas the majority of
apothecaries in Boston have agreed to pull down the price of bleeding
to sixpence, let these certifie that Mr Clarke, apothecary, will bleed
anybody at his shop _gratis_."
The readers of Smollett may remember in one of his novels the story of
a gentleman, who, falling down in his club in an apoplectic fit, was
immediately made the subject of a bet between two friendly bystanders.
The odds were given and accepted against the sick man's recovery, and
the wager was duly registered, when a suggestion was made by a more
humane spectator that a surgeon ought to be sent for. "Stay,"
exclaimed the good fellow interested in having a fatal result to the
attack, "if he is let blood, or interfered with in any way, the bet
doesn't hold good." This humorous anecdote may be found related as an
actual occurrence in Horace Walpole's works. It was doubtless one of
the "good stories" current in society, and was so completely public
property, that the novelist deemed himself entitled to use it as he
liked. In certain recent books of "ana" the incident is fixed on
Sheridan and the Prince Regent, who are represented as the parties to
the bet.
Elsewhere mention has been made of a thousand pounds _ordered_ to be
paid Sir Edmund King for promptly bleeding Charles the Second. A
nobler fee was given by a French lady to a surgeon, who used his
lancet so clumsily that he cut an artery instead of a vein, in
consequence of which the lady died. On her death-bed she, with
charming humanity and irony, made a will, bequeathing the operator a
life annuity of eight hundred livres, on condition "that he never
again bled anybody so long as he lived." In the _Journal
Encylopédique_ of Jan. 15, 1773, a somewhat similar story is told of a
Polish princess, who lost her life in the same way. In her will, made
_in extremis_, there was the following clause:--"Convinced of the
injury that my unfortunate accident will occasion to the unhappy
surgeon who is the cause of my death, I bequeath to him a life annuity
of two hundred ducats, secured by my estate, and forgive his mistake
from my heart: I wish this may indemnify him for the discredit which
my sorrowful catastrophe will bring upon him."
A famous French Maréchal reproved the clumsiness of a phlebotomist in
a less gratifying manner. Drawing himself away from the bungling
operator, just as the incision was about to be made, he displayed an
unwillingness to put himself further in the power of a practitioner,
who, in affixing the fillet, had given him a blow with the elbow in
the face.
"My Lord," said the surgeon, "it seems that you are afraid of the
bleeding."
"No," returned the Maréchal, "not of the bleeding--but the bleeder."
Monsieur, brother of Louis XIV., had an insuperable aversion to the
operation, however dexterous might be the operator. At Marly, while at
table with the King, he was visited with such ominous symptoms, that
Fochon, the first physician of the court, said--"You are threatened
with apoplexy, and you cannot be too soon blooded."
But the advice was not acted on, though the King entreated that it
might be complied with.
"You will find," said Louis, "what your obstinacy will cost you. We
shall be awoke some of these nights to be told that you are dead."
The royal prediction, though not fulfilled to the letter, soon proved
substantially true. After a gay supper at St. Cloud, Monsieur, just as
he was about to retire to bed, quitted the world. He was asking M. de
Ventadour for a glass of liqueur sent him by the Duke of Savoy, when
he dropped down dead. Anyhow Monsieur went out of this life thinking
of something nice. The Marquis of Hertford, with all his
deliberation, could not do more.
The excess to which the practice of venesection was carried in the
last century is almost beyond belief. The _Mercure de France_ (April,
1728, and December, 1729) gives the particulars of the illness of a
woman named Gignault. She was aged 24 years, was the wife of an
hussar, and resided at St. Sauge, a town of the Nivernois. Under the
direction of Monsieur Theveneau, Seigneur de Palmery, M.D., of St.
Sauge, she was bled three thousand nine hundred and four times in nine
months (_i. e._ from the 6th of September, 1726, to the 3rd of June,
1727). By the 15th of July, in the same year, the bleedings numbered
four thousand five hundred and fifty-five. From the 6th of September,
1726, to the 1st of December, 1729, the blood-lettings amounted to
twenty-six thousand two hundred and thirty. Did this really occur? Or
was the editor of the _Mercure de France_ the original Baron
Munchausen?
Such an account as the above ranges us on the side of the German
physician, who petitioned that the use of the lancet might be made
penal. Garth's epigram runs:--
"Like a pert skuller, one physician plies,
And all his art and all his skill he tries;
But two physicians, like a pair of oars,
Conduct you faster to the Stygian shores."
It would, however, be difficult to imagine a quicker method to destroy
human life than that pursued by Monsieur Theveneau. A second adviser
could hardly have accelerated his movements, or increased his
determination not to leave his reduced patient a chance of recovery.
"A rascal," exclaimed a stout, asthmatic old gentleman, to a
well-dressed stranger on Holborn Hill--"a rascal has stolen my hat. I
tried to overtake him--and I'm--so--out of breath--I can't stir
another inch." The stranger eyed the old gentleman, who was panting
and gasping for hard life, and then pleasantly observing, "Then I'm
hanged, old boy, if I don't have your wig," scampered off, leaving his
victim bald as a baby. M. Theveneau was the two thieves in one. He
first brought his victim to a state of helplessness, and then "carried
out his little system." It would be difficult to assign a proper
punishment to such a stupid destroyer of human life. Formerly, in the
duchy of Wurtemberg, the public executioner, after having sent out of
the world a certain number of his fellow-creatures, was dignified with
the degree of doctor of physic. It would not be otherwise than well to
confer on such murderous physicians as M. Theveneau the honorary rank
of hangman extraordinary.
The incomes that have been realized by blood-letting alone are not
less than those which, in the present day, are realized by the
administration of chloroform. An eminent phlebotomist, not very many
years since, made a thousand per annum by the lancet.
About blood-letting--by the lancet, leeches, and cupping (or _boxing_,
as it was called in Elizabeth's days, and much later)--the curious can
obtain many interesting particulars in our old friend Bulleyn's works.
To open a vein has for several generations been looked on as beneath
the dignity of the leading professors of medicine or surgery. In some
cases phlebotomy was practised as a sort of specialty by surgeons of
recognised character: but generally, at the close of the last century,
it was left, as a branch of practice, in the hands of the apothecary.
The occasions on which physicians have of late years used the lancet
are so few, that it is almost a contribution to medical gossip to
bring up a new instance. One of the more recent cases of a notability
being let blood by a physician, was when Sir Lucas Pepys, on Oct. 2,
1806, bled the Princess of Wales. On that day, as her Royal Highness
was proceeding to Norbury Park, to visit Mr. Locke, in a barouche
drawn by four horses, the carriage was upset at Leatherhead. Of the
two ladies who accompanied the Princess, one (Lady Sheffield) escaped
without a bruise, but the other (Miss Cholmondley) was thrown to the
ground and killed on the spot. The injuries sustained by the Princess
were very slight, but Sir Lucas Pepys, who luckily happened to be in
the neighbourhood at the time of the accident, bled her on his own
responsibility, and with his own hand.