Bloodletting Instruments in the National Museum of History and Technology Part 6

[Ill.u.s.tration: FIGURE 20.--Staffords.h.i.+re 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 a subst.i.tute for leeches was Sarlandiere's "bdellometer," from the Greek _bdello_, "leech."

Sarlandiere, a French manufacturer, introduced his instrument in 1819 and, incidentally, had the prototype sent to New Orleans. The bdellometer consisted of a gla.s.s 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 curved cannula could be attached to the bdellometer for bleeding in the nasal pa.s.sages, the mouth, the v.a.g.i.n.a, and the r.e.c.t.u.m. For internal bloodletting, the disk, with lancets, normally used for scarification, was replaced by a small brush of hog bristles.[187] Sarlandiere'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] (Figure 21.)

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 subst.i.tutes, sold by George Teimann & Co. as its "Patent Artificial Leech," employed ether in exhausting the gla.s.s "leeches." Patented by F. A. Stohlmann and A. H. Smith of New York in 1870, the "leech" consisted of a gla.s.s 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 v.a.g.i.n.a 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 gla.s.s 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]

[Ill.u.s.tration: 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 subst.i.tute, the use of natural leeches persisted until the practice 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-fas.h.i.+oned 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 gla.s.s 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]

Veterinary Bloodletting

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 bra.s.s s.h.i.+eld. In the late nineteenth century fleams with horn s.h.i.+elds 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 bra.s.s, n.o.b 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] (Figure 22.)

[Ill.u.s.tration: FIGURE 22.--k.n.o.b end spring lancet used on humans compared to a k.n.o.b 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 a.s.sortment of shapes and a wide variety of spring mechanisms. In the enlarged k.n.o.b end spring lancet, pus.h.i.+ng 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 principle of the common fleam and bloodstick. As in the k.n.o.b 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 ill.u.s.trated 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 (Figure 23).

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 c.o.c.king lever that extended to form a coiled spring in the handle portion of the gun. Also attached to the c.o.c.king lever was an extended blade with ratchet catches, so that by pulling on the c.o.c.king lever, the blade was brought inside the casing and the spring placed under tension. Pus.h.i.+ng upon the trigger then shot the blade into the vein.[201] (Figure 24.)

Physical a.n.a.lysis of Artifacts

The Conservation a.n.a.lytical Laboratory of the Smithsonian Inst.i.tution a.n.a.lyzed 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 a.n.a.lyzed.

[Ill.u.s.tration: FIGURE 23.--Patent model, J. Ives, 1849. (NMHT 89797 [M-4292]: SI photo 73-4211.)]

[Ill.u.s.tration: FIGURE 24.--Patent model, Reinhold and Schreiber, 1880.

(NMHT 89797 [M-4327]; SI photo 73-4210.)]

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

The instrument for X-ray fluorescence a.n.a.lysis has been modified to permit a.n.a.lysis 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 an oscilloscope screen. 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 s.p.a.ced 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 a.n.a.lysis 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.

Bra.s.s was the most common metal used in the fabrication of eighteenth- and nineteenth-century lancets and scarificators. Upon a.n.a.lysis the bra.s.s was found to contain 70%-75% copper, 20%-30% zinc, and other trace elements.

The blades, c.o.c.king levers, and b.u.t.ton releases of lancets and scarificators were found to be made of ferrous metal (iron or steel). In addition to the typical bra.s.s pieces, a number of "white metal" pieces were a.n.a.lyzed. (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 a.n.a.lysis 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 bra.s.s. One case was trimmed in gold leaf.

The most difficult item to a.n.a.lyze 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 (Figure 25).

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 doc.u.ment.

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.

a.n.a.lysis of the ink and paper indicates that the doc.u.ment has had a varied history and seems not to have been a deliberate production intended to simulate age.

Catalog of Bloodletting Instruments

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 inst.i.tutional abbreviations are as follows: SI = Smithsonian Inst.i.tution; USNM = the former United States National Museum; NLM = National Library of Medicine.

[Ill.u.s.tration: FIGURE 25.--Bloodletting manikin. (NMHT 243033 [M-10288]; SI photo 76-13536.)]