Leeching

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Figure 16.—Advertisement for phlebotomy and cupping instruments. Note the rubber cups. (From George Tiemann & Co.,American Armamentarium Chirurgicum, New York, 1889. SI photo 76-13542.)

After 1860, interest in inventing new scarificators declined as wet cupping decreased in popularity. The improved cups and scarificators, while they had achieved a limited success, had still failed to supplant the common octagonal scarificator and the plain glass cup. As interest in wet cupping declined, medical attention shifted to the therapeutic virtues of dry cupping. Dry cupping offered even greater opportunities for inventors, who sought means to bring the effects of the vacuum to more areas of the body for greater lengths of time.

Dry Cupping

Dry cupping, in its simplest form, was said to act as a “revulsive” or “derivant.” By the nineteenth century these once hotly debated terms had become nearly interchangeable in discussions of cupping. In cupping for revulsive purposes, one cupped on a distant part to relieve excess of blood in the affected part. In applying cupping as a “derivant,” one cupped closer to the affected part. In either case, the source of pain was presumed to be somewhere below the skin, and the pain was relieved by bringing blood away from the affected part to the surface of the body. Thus, one nineteenth-century cupper concluded, revulsion was only derivation at a distant point.[153]

If dry cupping was applied for ten minutes or longer so that the capillaries burst, the action of the cups was said to be that of a counter-irritant. According to ancient medical theory, the counter-irritant was a means of relieving an affected part by deliberately setting up a secondary inflammation or a running sore in another part. Counter-irritations were traditionally produced in a number of ways, among them, blisters, cautery, setons, moxa, and dry cupping.[154]

One of the most popular counter-irritation devices commonly associated with cupping instruments in catalogs of surgical goods, was Baunscheidt’sLebenswecker, sold by most American surgical supply houses in the second half of the nineteenth century. TheLebenswecker, or “Awakener of Life,” was the mainstay of the mystical medical system known asBaunscheidtismus, after the founder of the device, Carl Baunscheidt of Prussia (1809-1860).[155]The system apparently gained much notoriety in Germany, England, and America, for Baunscheidt’s book went through ten German editions and several British and American editions. At least two Americans patented improvements on theLebenswecker.[156]The device was made of ebony, about 250 mm long, and contained a coiled spring attached to a handle. At the other end of the spring was a place about 20 mm in diameter, with about thirty projecting needles. By pushing upon the handle, one sent the needles into the skin. The ability of the instrument to create blisters was enhanced by the application of Baunscheidt’s special oil to the irritation (Figure17).

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Figure 17.—Venus and Adonis with marks showing where Baunscheidt’sLebensweckershould be applied. (From Carl Baunscheidt,Baunscheidtismus, by the Inventor of the New Curing Method, Bonn, 1859(?). Photo courtesy of NLM.)

Dry cupping stimulated much theoretical debate in the nineteenth century as well as a number of physiological experiments.[157]Although physicians generally agreed that dry cupping had curative value if employed properly, they disagreed widely on when to employ the remedy, and on the manner in which the remedy operated. Did application of cups affect only the surface vessels, or could cupping affect the entire nervous system, and through the nerves, the action of the secretory organs? Were the effects of dry cupping of only a temporary nature, or were they permanent? An interesting series of investigations in Europe and America sought to ascertain the value of dry cupping in checking the absorption of poison. An American, Dr. Casper Wistar Pennock, replying to investigations performed by Martin Barry, an Edinburgh physician residing in Paris, carried out an impressive series of physiological experiments in 1827, in which he administered strychnine and arsenic under the skin of dogs and rabbits and then cupped over the wounds. He concluded that while dry cupping prevented almost certain death from the poisons, once the cups were removed, death would ensue, unless the poisons were surgically removed.[158]

Interest in dry cupping led to attempts to apply the therapeutic effects of the operation to larger areas of the body than could be accommodated by a cup. In France, Victor-Théodore Junod (1809-1881) adapted cupping to entire limbs. Shortly after receiving his degree in medicine in 1833, Junod presented at the Academy of Sciences his apparatus, known thereafter as Junod’s boot. Junod believed that actual extraction of blood was a dangerous remedy and that the benefits of bleeding might as easily be obtained by his “derivative method,” which withdrew blood from the general circulation but allowed it to be returned at will. Junod’s boot and Junod’s arm, which sold for as much as $25.00 apiece,[159]were constructed of metal and secured against the limb by a silk, and later a rubber, cap. To the boot was attached a flexible tube, stopcock, pump, and if desired, a manometer for measuring the vacuum produced. In chronic illnesses, Junod recommended that the boot be applied for an hour. So much blood was withdrawn from the circulation by use of the apparatus that the patient might easily faint. To explain how his boot worked, Junod invented a theory that he called “hemospasia,” meaning the drawing of blood.[160]This was typical of a number of attempts to introduce sophisticated terminology into discussions of traditional remedies. Junod’s arm and boot were widely available through American surgical supply companies. As late as 1915, Heinrich Stern, previously mentioned as a latter-day proponent of bloodletting, had no doubt that application of the boot to the foot would relieve congested states of the abdominal viscera.[161](Figure18.)

Americans patented a number of modifications of the arm and boot, and in addition they patented a number of whole body devices called “depurators.” Junod had introduced such a device along with his boot—a metal casing in which a patient would be placed leaving only his face showing. The air inside would then be exhausted by means of a gigantic syringe. In America such “depurators” may have been regarded more as quackery than as a legitimate extension of cupping, for despite the fact that Americans patented some twenty of these devices, surgical supply houses did not sell them and little was written about them.

In the last decade of the nineteenth century, Dr. August Bier, professor at the University of Bonn, developed another sophisticated theory supporting the use of blood-suction devices, known as the theory of hyperemia, meaning “excess of blood.” According to the doctrine, lesions are always accompanied in nature by hyperemia, “the most widespread of auto-curative agents.”[162]If we, therefore, wish to imitate nature, we create an artificial hyperemia. Bier recommended several means of increasing the blood supply of an affected part, including hot-air baths, suction devices such as Junod’s boot, and dry cupping. Several American surgical suppliers sold Bier’s Hyperemic Cups in the early twentieth century. These were glass cups, of a great variety of shapes and sizes including some with curved rims, each fitted with a rubber tube and bulb for exhausting the air. A major function of these cups was to collect wound secretions from boils or furuncles.[163]

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Figure 18.—Junod’s boot applied to a baby in the cradle. (From Victor Theodore Junod,A Theoretical and Practical Treatise on Maemespasia. London, 1879. Photo courtesy of NLM.)

Breast Cupping

Related to cupping by its technology is the practice of drawing milk from the breasts by means of breast pumps. Mothers with underdeveloped or inflamed breasts posed a frequent problem for the nineteenth-century physician, who treated them with either large doses of tartar emetic, a strong purgative, or with cupping.[164]Breast pumps were small glass cups with fluted edges made to accommodate the nipple. While some surgeons, as the American Samuel Gross, recommended using a bottle with a long neck in which the air had been rarified by means of hot water,[165]most breast pumps were exhausted by mechanical means. For reasons of modesty, the pumps were usually designed so that the woman could draw her breasts herself. Perhaps the simplest design of a breast pump was a glass cup having a long spout extending in such a way that the woman could perform suction herself. Such all-glass cups were illustrated in the eighteenth century.[166]A few, reputedly made centuries earlier, are found in the Wellcome Historical Medical Museum. Early in the nineteenth century, breast pumps, just as glass cups for bleeding, were attached to brass syringes, and were often included among the variety of cups in cupping sets provided with syringes. Read’s and Weiss’s patent syringe as well as Thomas Machell’s cupping device were adapted for breast pumping. With the invention of vulcanized rubber, the breast pump was frequently attached to a large rubber bulb. A glass protuberance was often added to pumps exhausted by syringes or rubber bulbs, in order to collect the milk so that it could be fed to the infant. In the 1920s some breast pumps were attached to electric motors.[167]Breast pumps have continued to be employed up to the present day. Of all instruments employing the principle of the cupping device, breast pumps were the most frequently patented. From 1834 to 1975, more than 60 breast pumps were patented, the majority in the period from 1860 to 1920.[168]

The Decline of Cupping

Cupping died out in America in the early twentieth century, but its disappearance was gradual and scarcely noticed. Some of the most complex of cupping devices were invented in a period when most physicians regarded cupping as ineffectual. Patents for cupping devices continued to be issued as late as 1916 when Joel A. Maxam of Idaho Springs, Colorado, patented a motorized pump, which by means of various sizes of cups, could subject a part of the patient’s body to either a prolonged suction or a prolonged compression.[169]One of America’s last advocates of bloodletting, Heinrich Stern, writing in 1915, also advocated the use of an electrical suction pump to evacuate cups. With an electric motor, he declared, one could prolong hyperemia for 15, 30, or more minutes.

Stern also invented a theory to account for the therapeutic effects of his inventions, namely, the theory of phlebostasis. Instead of pumping air out of a device, Stern pumped air into a device, for the same purpose of removing a portion of blood from the general circulation. His “phlebostate,” manufactured by Kny-Scheerer of New York, was quite similar to a sphygmomanometer. It consisted of a set of cuffs that fit about the thighs, rubber tubes, a manometer, and a suction bulb or an electric force pump. For stubborn cases, such as migraine headaches, Stern recommended using the cuffs for 30 minutes or more. To facilitate the application of the cuffs, Stern invented a “phlebostasis chair,” one of the most complex “cupping” devices ever made. Like an electric chair, the phlebostasis chair was supplied with cuffs for both arms and legs. Air was pumped into the cuffs by means of an electric motor. According to Stern, compression of the upper segment of both arms withheld 300 cc of blood from circulation, while compression of the thighs withheld as much as 600 cc.[170]

In addition to these sophisticated devices, simple cupping, especially dry cupping, continued well into the 1930s. Although cupping was no longer generally recommended by physicians, most surgical companies advertised cups, scarificators, and cupping sets in the 1920s and even the 1930s. The last bastions of cupping in the United States were the immigrant sections of large cities. In the lower East Side of New York, in particular, cupping was still flourishing in the 1920s. By then cupping was no longer performed by the physician, but had been relegated back to the lowly barber, who advertised in his shop window, “Cups for Colds.”[171]

Leeches

The word “leech” derives from the Anglo-Saxonloece, “to heal.” Thus, the Anglo-Saxon physician was called a “leech” and his textbook of therapeutic methods a “leechdom.” The animal itself was already known to the ancients under its Latinnamehirudino. It appears, however, that the introduction of leeches into Western medicine came somewhat later than that of phlebotomy or cupping, for Hippocrates made no mention of them. The earliest references to the use of leeches in medicine are found in Nicander of Colophon (2nd centuryB.C.) and in Themison (1st centuryB.C.). Thereafter they were mentioned by most Greek, Roman, and Arabic medical writers.[172]

The leech is a fresh-water parasitic invertebrate belonging to the Phylum Annelida. On one end of its worm-like body is a large sucker by which the animal fastens itself to the ground, and at the other end is a smaller sucker, in the middle of which is a chitinous mouth that makes a triangular puncture. As items ofmateria medica, leeches were described in dispensatories, or compilations of medicaments, and sold by apothecaries, both to physicians and directly to patients. The species most commonly used for bleeding wasHirudo medicinalis, indigenous to the streams and swamps of Central and Northern Europe, and known in commerce as the Swedish or German leech. It was 50-75 mm long, with a dull olive green back and four yellow longitudinal lines, the central two broken with black. Somewhat less popular was the Hungarian leech, indigenous to Southern Europe. In addition, there was an American species of leech,Hirudo decora, which was gathered principally from the lower Delaware River, but, since it drew much less blood than the Swedish leech, it was regarded as greatly inferior.[173]Most American physicians imported their leeches. In the late nineteenth century, one could buy Swedish leeches for $5.00 per hundred.[174]

Leeches were gathered in the spring of the year either by means of a pole net, or, more primitively, by wading into the water and allowing the leeches to fasten themselves onto the legs. Sometimes horses and cattle were driven into the water to serve as bait for the leeches.[175](Figure19.)

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Figure 19.—Lithograph published in London in 1814 showing three women gathering leeches by a stream. (NMHT 320033.08; SI photo 76-7741.)

Leeching, like other forms of bloodletting, enjoyed a revival in the early nineteenth century, particularly in France, where the doctrines of heroic medicine preached by Broussais[176]led to an increase of leech usage from about 3 million in 1824 to 41.5 million in 1833.[177]Leechers, although not as high in status as professional cuppers, practiced in many large cities, and numerous tracts were written on the care and breeding of leeches. “Leech farms” were unable to increase the leech supply to meet the rising demand, and most leechers complained of the scarcity and great expense of the little animals.[178]

Leeching and cupping each had their advocates. The major advantage of the leech over the cup was that the leech could be employed on almost any part of the anatomy, including around the eyes, in the mouth, the anus, and the vagina. In fact, leeching the internal membranes enjoyed quite a vogue in the early nineteenth century. Leeches were applied to the larynx and the trachea for bronchitis and laryngitis and for relieving the cough of phthisis. For inflammations of the conjunctiva (the membrane lining the eyelids) they were applied to the nasal membrances of the adjacent nostril, and for inflammations of the ear they were applied to the meatus of the ear and behind the ear. The French popularized the practice of leeching the anus to treat inflammations of the mucous membranes of the bowel. To prevent leeches from getting lost in the body cavities, Jonathan Osborne, a British physician, recommended in 1833 that a thread should be passed through the leech’s tail. In addition, he invented a device, which he called a “polytome,” specifically for introducing leeches into the rectum.[179]In the mid-nineteenth century, special leech tubes were widely sold for applying leeches to internal membranes.[180]

A second advantage of leeches over cupping was that leeches could extract blood more readily. Not only was dexterity not required in order to apply a leech, but also it was soon noticed that leech bites continued to bleed even after the leech let go, while scarificator incisions often coagulated before any blood was obtained. In 1884 it was shown by John Berry Haycroft, a Birmingham chemist, that this phenomenon was due to an anti-coagulant, now called “hirudin,” that the leech injected into the blood.[181]

To apply a leech, the animal was first dried with a bit of linen, and the skin of the patient was prepared by washing with warm water and then shaving. To direct it to the right spot, the leech was often placed in a small wine glass that was inverted over the area to be bitten. Since leeches were sometimes perversely unwilling to bite, they were enticed by the placement of a bit of milk or blood on the patient’s skin. Small children were given one or two leeches, and adults 20 or more. Broussais employed up to 50 leeches at one time.[182]The leech was usually allowed to drop off of its own accord when it had satiated itself, which took about an hour. Sometimes the tail of the leech was cut off so that it would continue to suck. Once used, leeches could not be reused for several months unless they were made to disgorge their meal by dropping them in salt water or weak vinegar. A healthy leech drew one or two fluid drachms of blood, and as much would flow after the leech had dropped off. Thus a good Swedish leech could remove about an ounce of blood. This quantity could be increased by employing a cupping glass over the bite.[183]

Leeches were kept in a glass container of water covered with gauze or muslin and placed in a cool, dark room. The water had to be changed frequently, as much as every other day in summer. Pebbles or moss were placed in the bottom of the vessel to aid the leech in removing the slimy epidermis that it shed every four or five days. In the nineteenth century leeches were often sold in drug stores from large, elegant containers with perforated caps. Actually, only the day’s supply of the pharmacist’s leeches was kept in the attractive storefront jars; the rest were kept out of sight. While most leech jars were simple white crockery pieces with “leeches” lettered in black on the front, some leech jars were over two feet tall and decorated with elegant floral and scroll work. Among the most ornate leech jars were those made in Staffordshire, England.[184](Figure20.)

Artificial Leeches

One of the characteristics of nineteenth-century technology was the attempt to replace natural materials and processes by imitations and mechanisms. Considering the properties of the natural leech, it is no wonder that very early in the nineteenth century inventors began to seek a mechanical substitute. The disadvantages of the leech were many.Wrote one inventor of an artificial leech:

In the first place the appearance of the animal is repulsive and disgusting, and delicate and sensitive persons find it difficult to overcome their repugnance to contact with the cold and slimy reptile. This is especially the case when it is a question of their application about or within the mouth. Then again, their disposition to crawl into cavities or passages results sometimes in very annoying accidents. Another source of annoyance is that they are often unwilling to bite—the patience of all concerned being exhausted in fruitless efforts to induce them to take hold.The expense, too, of a considerable number is by no means trifling.[185]

The expense, too, of a considerable number is by no means trifling.[185]

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Figure 20.—Staffordshire leech jars, 19th century.(NMHT 263554 [M-11504]; SI photo 73-4231.)

In addition, leeches were often difficult to obtain, and the rural physician could not easily carry them about. Leech bites could have unfortunate consequences, for many times the bleeding could not be stopped. For these and other reasons, several inventors in Europe and America sought to create a mechanical or artificial leech.[186]Such artificial leeches are often difficult to distinguish from cupping devices, because both sorts of instruments employed some form of scarification and suction. Artificial leeches however, were usually adaptable to small areas of the anatomy, and the puncture wound generally attempted to imitate a leech bite.

Perhaps the earliest instrument offered as asubstitute for leeches was Sarlandière’s “bdellometer,” from the Greekbdello, “leech.” Sarlandière, a French manufacturer, introduced his instrument in 1819 and, incidentally, had the prototype sent to New Orleans. The bdellometer consisted of a glass bell with two protruding tubes, one perpendicular for performing scarification, and the other oblique, for attaching the aspirating pump. A plug could be removed to allow air to enter the bell after the operation was completed, and a faucet allowed for drainage of blood without having to remove the apparatus from the body. A curvedcannulacould be attached to the bdellometer for bleeding in the nasal passages, the mouth, the vagina, and the rectum. For internal bloodletting, the disk, with lancets, normally used for scarification, was replaced by a small brush of hog bristles.[187]Sarlandière’s bdellometer attracted sufficient attention in America to be included in the numerous editions of Robley Dunglison’s medical dictionary,[188]but it was ultimately no more successful than the complicated cupping devices discussed in the previous chapter.

A second French invention, also given a pretentious name, was Damoiseau’s “terabdella” (meaning “large leech”), or pneumatic leech. This invention, introduced some time before 1862, met with skepticism at the outset on the part of the reviewers at the French Academy of Medicine. It consisted of two pistons attached to a plate to be placed on the floor and held down by the feet of the operator. Each piston was connected by a tube to a cup, and the whole apparatus was operated by means of a hand lever connected with both pistons. More a cupping device than an artificial leech, the terabdella met with little success beyond the French province where Damoiseau practiced.[189](Figure21.)

Perhaps the most successful of the mechanical leeches was known as Heurteloup’s leech, after its inventor, the Frenchman, Charles Louis Heurteloup (1793-1864). Sold in most late nineteenth-century surgical catalogs for as much as $15.00, the device consisted of two parts, one a spring scarificator that made a small circular incision (about 5 mm in diameter) and the other, a suction pump, holding an ounce of blood, whose piston was raised by means of a screw. For the treatment of eye ailments, one of the major purposes for which the device was invented, it was applied to the temples.[190]A similar two-part mechanical leech was sold under the name “Luer’s Leech.”

One of the most interesting leech substitutes, sold by George Teimann & Co. as its “Patent Artificial Leech,” employed ether in exhausting the glass “leeches.” Patented by F. A. Stohlmann and A. H. Smith of New York in 1870, the “leech” consisted of a glass tube, either straight or with a mouth on the side so that the tube would hang somewhat like a living leech. To expel air from the tube, a few drops of ether were placed in it, after which it was immersed to its mouth in hot water until the ether vaporized. The tube was then applied to the skin and allowed to cool, thus sucking blood from a wound made by the scarificator, a long metal tube that was rotated to make a circular incision. One of the patentees explained the advantages of the device:

In all previous attempts at an artificial leech the vacuum has been produced by the action of a piston. This renders the instrument too heavy to retain its position, and necessitates its constantly being held. This precludes the application of any number at once, even if the cost of half-a-dozen such instruments were left out of the account. But in the case of this leech, the tubes, being exceedingly light, attach themselves at once, remaining in position until filled; and as the cost of them is but a few cents, there is no limit to the number which may be applied.[191]

To take the place of leeches in the uterus, quite a number of uterine scarificators were sold. These were generally simple puncturing instruments without spring mechanisms. If insufficient blood flowed from the scarification, Thomas’s Dry Cupper, a widely available vulcanite syringe, could be inserted into the vagina to cup the cervix before puncturing.[192]At least one attempt was made to combine puncture and suction in a device for uterine application. This was Dr. William Reese’s “Uterine Leech,” introduced in 1876. It consisted of a graduated glass cylinder 190 mm long and 12 mm in diameter containing a piston and a rod with a spear point. The rod was surrounded by a spring that withdrew the blade after it punctured the cervix. Several American companies, including George Tiemann & Co., offered the device for sale.[193]

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Figure 21.—Damoiseau’s terabdella. (From Damoiseau,La Terabdelle ou machine pneumatique, Paris, 1862. Photo courtesy of NLM.)

Despite all the efforts to find a suitable substitute, the use of natural leeches persisted until thepractice of local bloodletting gradually disappeared in America. By the 1920s leeches were difficult to find except in pharmacies in immigrant sections of large cities like New York or Boston. One of the last ailments to be regularly treated by leeches was the common black eye. Leeches commanded rather high prices in the 1920s, if they could be found at all. One Brooklyn pharmacist, who deliberately kept an old-fashioned drugstore with the motto “No Cigars, No Candy, No Ice Cream, No Soda Water, But I Do Sell Pure Medicines,” wrote in 1923:

Here in this atmosphere free from the lunch room odor my armamentarium consists of drugs and preparations from the vegetable, mineral and animal kingdoms. Among the latter are leeches, prominently displayed in a number of glass jars in different parts of the store, including one in the show window. Anything moving, anything odd, arouses the curiosity of the public, and my reputation as a “leecher” has spread far beyond the “City of Churches.” Besides, this leech business is also profitable, as they are retailed at $1.00 per head without any trouble; in fact patients are only too glad to be able to obtain them.[194]

The same theories and practices that prevailed for human medicine were applied to the treatment of animals. Not only were horses routinely bled, they were also cupped and leeched.[195]Manuals of veterinary medicine gave instructions for the bleeding of horses, cows, sheep, pigs, dogs, and cats.[196]

There was one major difference between bleeding a man and bleeding a horse or cow, and that was the amount of strength required to open a vein. The considerable force needed to pierce the skin and the tunic of the blood vessel made the operation much more difficult to perform than human phlebotomy.[197]As in the case of cupping, the simplest instruments, those most often recommended by experts, were not easy to use by those without experience. Although a larger version of the thumb lancet was sometimes employed, most veterinarians opened the vein of a horse with a fleam, that is, an instrument in which the blade (commonly double beveled) was set at right angles to the blade stem. These are enlarged versions of the fleam employed in human bloodletting. The fleams sold in the eighteenth and nineteenth centuries consisted of one or more blades that folded out of a fitted brass shield. In the late nineteenth century fleams with horn shields were also sold. The largest blades were to be used to open the deeper veins and the smaller blades to open the more superficial veins.

To force the fleam into the vein, one employed a bloodstick, a stick 35-38 cm long and 2 cm in diameter. The blade was held against the vein and a blow was given to the back of the blade with the stick in such a way that the fleam penetrated but did not go through the vein. Immediately the fleam was removed and a jet of blood came forth that was caught and measured in a container. When enough blood had been collected, a needle would be placed in the vein to stop the bleeding.

Horses were most frequently bled from the jugular vein in the neck, but also from veins in the thigh, the fold at the junction of breast and forelegs, the spur, the foreleg, the palate, and the toe.

Since applying the bloodstick required a degree of skill, the Germans attempted to eliminate its use by adapting the spring lancet to veterinary medicine. The common veterinary spring lancet (which sometimes was also called a “fleam” or “phleme”) was nothing but an oversized version of the brass, nob end spring lancet used on humans. Sometimes the lancet was provided with a blade guard that served to regulate the amount of blade that penetrated the skin. Although the veterinary spring lancet was quite popular in some quarters, the French preferred the simple foldout fleam as a more convenient instrument.[198](Figure22.)

Figure 22.—Knob end spring lancet used on humans compared to a knob end lancet used on horses and cattle. Note the blade guard on the veterinary spring lancet. (NMHT 302606.09 and NMHT 218383 [M-9256]: SI photo 76-7757.)

In contrast to the few attempts made to modify the human spring lancet, there were a large number of attempts to modify the veterinary spring lancets. Veterinary spring lancets can be found with a wide assortment of shapes and a wide variety of spring mechanisms. In the enlarged knob end spring lancet, pushing upon the lever release simply sent the blade forward into the skin. By a more complex mechanism, the blade could be made to return after it was injected, or the blade could be made to sweep out a curve as do the blades of the scarificator. Perhaps one of the earliest attempts to introduce a more complex internal mechanism into the veterinary spring lancets is found in John Weiss’s “patent horse phlemes” of 1828. The first model invented by Weiss was constructed on the principleof the common fleam and bloodstick. As in the knob end spring lancet, the spring acted as a hammer to drive the blade forward. In a second improved “horse phleme,” Weiss mounted the blade on a pivot so that the blade swept out a semicircle when the spring was released.[199]

The Smithsonian collection contains a number of different types of veterinary spring lancets. Perhaps this variety can best be illustrated by looking at the two patent models in the collection. The first is an oval-shaped lancet patented in 1849 by Joseph Ives of Bristol, Connecticut.[200]By using a wheel and axle mechanism, Ives had the blade sweep out an eccentric curve. The lancet was set by a detachable key (Figure23).

The second patent lancet was even more singular in appearance, having the shape of a gun. This instrument, patented by Hermann Reinhold and August Schreiber of Davenport, Iowa, in 1880, featured a cocking lever that extended to form a coiled spring in the handle portion of the gun. Also attached to the cocking lever was an extended blade withratchetcatches, so that by pulling on the cocking lever, the blade was brought inside the casing and the spring placed under tension. Pushing upon the trigger then shot the blade into the vein.[201](Figure24.)

The Conservation Analytical Laboratory of the Smithsonian Institution analyzed selected bloodletting instruments and one drawing from the Museum’s collection. Instruments were chosen on the basis of their unique appearance and as representative examples of the major types of instruments in the collection. Six lancets and cases, two scarificators, and one pen and ink drawing were analyzed.

Figure 23.—Patent model, J. Ives, 1849.(NMHT 89797 [M-4292]: SI photo 73-4211.)

Figure 24.—Patent model, Reinhold and Schreiber, 1880.(NMHT 89797 [M-4327]; SI photo 73-4210.)

X-ray fluorescence analysis, response to a magnet, reaction to nitric acid, and the Vickers pyramid hardness test were among the methods of analysis used that involved no damage to the objects.

The instrument for X-ray fluorescence analysis has been modified to permit analysis of selected areas on the objects. This instrument produces, detects, and records the object’s X-ray fluorescence spectrum, which is characteristic of its composition. X-rays produced by a target in the instrument strike the object and cause it, in turn, to fluoresce, or emit, X-rays. This fluorescence is detected by a silicon crystal in the detector and dispersed into a spectrum, which is displayed on anoscilloscopescreen. The entire spectrum—from 0 to 40 Ke V—can be displayed or portions of it can be expanded and displayed at an apparently higher resolution that permits differentiation between closely spaced fluorescent peaks, such as those from iron and manganese. The spectrum may be transferred from the oscilloscope to a computer for calculation of the percentage of composition and for comparison with spectra of other samples. During analysis the objects can be supported and masked by sheets of plexiglas or metal foils to limit the radiation to a certain area of the object. Masks also prevent scattering of radiation off other parts of the object and off the instrument itself, which otherwise might be detected and interpreted as less concentrated components in the object.

Brass was the most common metal used in the fabrication of eighteenth- and nineteenth-century lancets and scarificators. Upon analysis the brass was found to contain 70%-75% copper, 20%-30% zinc, and other trace elements. The blades, cocking levers, and button releases of lancets and scarificators were found to be made of ferrous metal (iron or steel). In addition to the typical brass pieces, a number of “white metal” pieces were analyzed. (The term “white metal” is used to designate any undetermined silver-colored metal alloy.) Those white metal pieces dating from the eighteenth century (a Swiss or Tyrolean fleam and an English veterinary spring lancet) were found to be composed entirely of ferrous metal. The hardness of the fleam metal indicated that it was carburized sufficiently to be made of steel. Two of the spring lancets, dating from the late nineteenth century, were found to be made of a silver-copper composition that was not rich enough in silver to be sterling silver. These lancets were probably typical of the lancets advertised as silver in the late nineteenth-century trade catalogs. About 1850 an alloy imitating silver began to be widely used in the making of surgical instruments. This was German silver or nickel-silver, an alloy containing no silver at all, but rather copper, zinc, and nickel. A patent model scarificator dating from 1851 was found to contain about 63% copper, 24% zinc, and 13% nickel. This alloy is presently called “nickel-silver 65-12” alloy. The French made scarificators out of their own version of nickel-silver that was called “maillechort.” The French circular scarificator was found to contain copper (55%-70%), nickel (10%-20%), zinc (20%-30%), and tin (less than 10%). The cases in which the lancets and scarificators were carried were covered with leather, despite the fact that several appeared to be covered with paper. X-ray analysis revealed that several cases contained tin, leading to the possibility that a tin salt was used in the dye-mordant for leather. The clasps on the cases were made of brass. One case was trimmed in gold leaf.

The most difficult item to analyze was the pen and ink drawing in black and red of a bloodletting man purported to be a fifteenth-century specimen (1480) from South Germany. The text is in German (Figure25).

The watermark of the paper—a horned bull (ox) with crown—is believed to have appeared in 1310 and was used widely for two hundred years. The paper was heavily sized and no feathering of the black ink or red paint appears.

The paper fluoresced only faintly under ultraviolet light and much less brightly than new paper, leading to the conclusion that the paper is not modern. Various stains on the paper fluoresce yellow, which also indicates a considerable history for the document.

The guard strip is vellum. Red stains on this strip may have been made by blood.

The inks (brown and red) may have come from different sources or been applied at different times because of their various compositions and densities. Iron and lead were found in an area of writing on the left foot. Iron is typical of an iron gall ink. Some of the lighter lines contain graphite. The red lines contain mercury and lead suggesting a mixture of vermilion and red lead.

Analysis of the ink and paper indicates that the document has had a varied history and seems not to have been a deliberate production intended to simulate age.

Several systems of catalog numbers have been employed for instruments in the collections. The earliest instruments were originally collected by the Division of Anthropology and were given a six-digit number in the division catalog (referred to as “Anthropology”). Later objects in the collections have been given a six-digit National Museum of History and Technology (NMHT) accession number, which serves for all items obtained from one source at a given date. Before 1973, the Division of Medical Sciences used a system of numbering individual items by M numbers (e.g., “M-4151”). Since 1973, individual items have been distinguished by adding decimal numbers to the accession numbers (e.g., “308730.10”). Objects on loan have been marked as such and given a six-digit number. Other institutional abbreviations are as follows: SI = Smithsonian Institution; USNM = the former United States National Museum; NLM = National Library of Medicine.

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