Phlebotomy: The Ancient Art of Bloodletting
By Graham Ford

The practice of bloodletting seemed logical when the foundation of all medical treatment was based on the four body humors: blood, phlegm, yellow bile, and black bile. Health was thought to be restored by purging, starving, vomiting or bloodletting.

The art of bloodletting was flourishing well before Hippocrates in the fifth century B.C. By the middle ages, both surgeons and barbers were specializing in this bloody practice. Barbers advertised with a red (for blood) and white (for tourniquet) striped pole. The pole itself represented the stick squeezed by the patient to dilate the veins.

Bloodletting came to the U. S. on the Mayflower. The practice reached unbelievable heights in the 18th and early 19th centuries. The first U.S. president, George Washington, died from a throat infection in 1799 after being drained of nine pints of blood within 24 hours. The draining of 16-30 ounces (one to four pints) of blood was typical. Blood was often caught in a shallow bowl. When the patient became faint, the "treatment" was stopped. Bleeding was often encouraged over large areas of the body by multiple incisions. By the end of the 19th century (1875-1900), phlebotomy was declared quackery.

A variety of devices were used to draw blood:

• The lancet was first used before 5th Century B.C. The vein was manually perforated by the practitioner. Many shallow cuts were sometimes made.

Spring loaded lancet

• Spring loaded lancets came into use during the early 18th Century. The device was cocked and a "trigger" fired the spring-driven blade into the vein.
  
• The fleam was heavily used during the 18th and 19th centuries. Many varieties exist. Sometimes a wooden "fleam stick" was used to hit the back of the blade and drive it into the vein. (Ouch!) The fleam was often used by veterinarians.

Scarificator

• The scarificator, a series of twelve blades, was also in vogue during the 18th Century, This device was cocked and the trigger released spring-driven rotary blades which caused many shallow cuts. The scarificator seems more merciful than the other blood-letting instruments.

Blood was caught in shallow bowls. During the 17th to 19th centuries, blood was also captured in small flint glass cups. Heated air inside the cups created a vacuum causing blood to flow into the cup - a handy technique for drawing blood from a localized area. This practice was called cupping.

Flint cup

The data above is based on Antique Medical Instuments by C. Keith Wilbur, M.D. (1987). For more details, see Bloodletting Instruments by A. Davis and T. Appel (1983).  

Graphics from the Truax, Green & Co. (Chicago) Price List:  Spring Lancet #5125. $.70; Scarificator #5126, $3.25; and Plan Glass Cupper #5142, $.08.

ONLINE INFORMATION:  The UCLA Biomedical Library has a multi-page exhibit on bloodletting including graphics of bloodletting devices.  Bloodletting Antiques by Douglas Arbittier, M.D. features fast-loading thumbnails of devices, leach bowls and cupping sets. For other ancient devices, see Greek and Roman Surgical Instruments, part of the Asclepion, a University of Indiana site devoted to the study of ancient medicine.

HISTORY OF BLOODLETTING

• CNN:  Bloodletting attracts daily patients in India, June 27, 1998
• Dittrick Medical History Museum Cupping and Bloodletting Exhibit
• George Washington and 18th Century Medicine Bloodletting
• Wikipedia Bloodletting Article
• Bloodletting and the Four Humors Illustrated article on Collecting Medical Antiques
• Bloodletting - Science Museum UK
• PBS - Red Gold : "The Epic Story of Blood" -Bloodletting History and Instruments
• New England Journal of Medicine: Being Sick 200 Years Ago - Missoulian - *

And YES there are people who still practice Phlebotomy! - Phlebotomy.com

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