Part 11

[118] JOHN WEISS, _An Account of Inventions and Improvements in Surgical Instruments Made by John Weiss, 62, Strand_, 2nd edition (London, 1831), pages 12-13. A Mr. Fuller introduced a similar improvement, which Weiss claimed Fuller had pirated from him. The only difference between Weiss's Improved Scarificator and Fuller's Improved Scarificator was that the blades in Weiss's were arch shaped and those of Fuller's crescent shaped. The cupper, Knox, preferred the crescent blades because they gave a sharper cut. In any case, most nineteenth-century scarificators were made with crescent-shaped blades. On Fuller's scarificator, see BAYFIELD, op. cit. [note 87], pages 99-100; and, SEERIG, op. cit. [note 111], pages 604-605 and plate 56.

[119] _Extract du Catalogue de la maison Charriere_ (Paris, 1843), page 30; KNOX, op. cit. [note 2], pages 39, 40.

[120] This statement is based on the perusal of a wide variety of nineteenth-century trade catalogs. See "List of Trade Catalogs Consulted."

[121] KNOX, op. cit. [note 2], page xii.

[122] Ibid., pages 14-15.

[123] HILLS, op. cit. [note 101], page 266.

[124] BAYFIELD, op. cit. [note 87], page 116.

[125] KNOX, op. cit. [note 2], pages 53-64.

[126] Ibid., page 68.

[127] HERO OF ALEXANDRIA, _The Pneumatics of Hero of Alexandria_, translated by Bennet Woodcroft (London, 1851).

[128] GURLT, op. cit. [note 1], volume 2, page 565 and plate X.

[129] BRAMBILLA, op. cit. [note 106], page 42, mentioned but did not picture a cup with air pump. One of the earliest illustrations of a cup with pump is found in SAVIGNY, op. cit. [note 106], plate 7.

[130] MAPLESON, op. cit. [note 90], page 63.

[131] KNOX, op. cit. [note 2], page 32.

[132] JOHN READ, _A Description of Read's Patent Syringe Pump_ (London, no date). See also JOHN READ, _An Appeal to the Medical Profession on the Utility of the Improved Patent Syringe_, 2nd edition (London, ca. 1825).

[133] WEISS, op. cit. [note 118], page 87; CHAS. TRUAX, GREENE & CO., _Price List of Physicians' Supplies_, 6th edition (Chicago, 1893), pages 989-1010.

[134] "Notice sur l'acupuncture et sur une nouvelle espece de ventouse armee de lancettes, inventee par A.-P. Demours," _Journal universal des sciences medicales_, volume 15 (1819), pages 107-113; BAYFIELD, op. cit. [note 87], pages 73-81.

[135] THOMAS MACHELL, "Description of an Apparatus for Cupping, Dry Cupping, and Drawing the Breasts of Females; With some Observations Respecting Its Use," _London Medical and Physical Journal_, volume 42 (1819), pages 378-380; BAYFIELD, op. cit. [note 87], pages 81-89.

[136] BAYFIELD, op. cit. [note 87], pages 92-93.

[137] ROBERT J. DODD, "Improved Cupping Apparatus," _The American Journal of the Medical Sciences_, new series, volume 7 (1844), page 510. See also patent specifications, U.S. patent 3537.

[138] Patent specifications, U.S. patent 68985.

[139] HILLS, op. cit. [note 101], page 261.

[140] GILLESPIE, op. cit. [note 93], page 29.

[141] FRANCES FOX, JR., "A Description of an Improved Cupping Glass, with Which from Five to Eight Ounces of Blood May Be Drawn, with Observations," _The Lancet_, volume 12 (1827), pages 238-239. KNOX, op. cit. [note 2], pages 36-37, recommended these glasses especially for use on young ladies who feared scars left by cupping. One of the "glass leeches" fixed below the level of the gown could draw all the blood necessary.

[142] See JOHN GORDON, "Remarks on the Present Practice of Cupping; With an Account of an Improved Cupping Glass," _The London Medical Repository_, volume 13 (1820), pages 286-289. J. WELSH, "Description of a Substitute for Leeches," _The Edinburgh Medical and Surgical Journal_, volume 11 (1815), pages 193-194; P. MOLONEY, "A New Cupping Instrument," _Australia Medical Journal_, new series, volume 1 (1879), pages 338-340. At least two American patents were given for improved cups, one to C. L. Myers in 1884 (U.S. patent 291388) and one to Jaime Catuela in 1922 (U.S. patent 1463458).

[143] SAVIGNY, op. cit. [note 106], plate 18, illustrated in 1798 "elastic bottles" that could be attached to glass cups for drawing the breasts; however, not until Charles Goodyear's discovery of the vulcanization process in 1838 was rubber widely used in cupping. An American surgeon, Samuel Gross, wrote in 1866 that the glass cup with a bulb of vulcanized rubber was the "most elegant and convenient cup, by far." See SAMUEL GROSS, _A System of Surgery_, 4th edition, 2 volumes (Philadelphia, 1866), volume 1, page 451.

[144] GEORGE TIEMANN & CO., _American Armamentarium Chirurgicum_ (New York, 1889), page 825.

[145] For one listing of the disadvantages of the common scarificator, see BLATIN, "Scarificator nouveau," _Bulletin de l'Academie Royale de Medecine_, volume 11 (1845-1846), pages 87-90. Blatin patented a new scarificator in 1844 that supposedly overcame the difficulties he listed.

[146] JAMES COXETER, "New Surgical Instruments," _The Lancet_ (November 15, 1845), page 538; JAMES COXETER & SON, _A Catalogue of Surgical Instruments_ (London, 1870), page 48. Coxeter sold his scarificator for 2 pounds, 2 shillings, while he offered his "best scarificator, with old action" for two pounds.

[147] GREAT BRITAIN PATENT OFFICE, _Subject-Matter Index of Patents of Invention_, 1617-1852, 2 volumes (London, 1957); U.S. PATENT OFFICE, _Subject Matter Index of Patents for Invention (Brevets d'invention) Granted in France from 1791 to 1876 Inclusive_ (Washington, 1883).

[148] CHARRIERE [firm], _Cinq notices reunies presentees a MM. les membres des jurys des expositions francaises de 1834, 1839, 1844, et 1849, et de l'exposition universelle de Londres en 1851_ (Paris, 1851), page 56.

[149] MAISON CHARRIERE, ROBERT ET COLLIN, SUCCESSEURS, [Catalogue generale] (Paris, 1867), pages 42, 44, and plate 9.

[150] Patent specifications, U.S. patent 4705; TIEMANN & CO., op. cit. [note 144], page 115. Tiemann was awarded an earlier patent for a scarificator in 1834 (unnumbered U.S. patent, 26 August 1834), which seems to have employed a coiled spring similar to that found in the Charriere scarificator. The fifth U.S. patent for a scarificator was issued in 1846 to A. F. Ahrens of Philadelphia (U.S. patent 4717) for a circular scarificator in which all the blades were attached to a movable plate.

[151] Patent specifications, U.S. patent 5111.

[152] Patent specifications, U.S. patent 8095.

[153] DYCE DUCKWORTH, "On the Employment of Dry-Cupping," _The Practitioner: A Monthly Journal of Therapeutics_, volume 2 (1869), page 153.

[154] Ibid., page 155. For more information on counter-irritation, see BROCKBANK, op. cit. [note 88]. Blisters were substances (including mustard and cantharides) that when applied to the skin, occasioned a serous secretion and the raising of the epidermis to form a vesicle. Cautery was the application of a red-hot iron to the skin. A seton was a long strip of linen or cotton thread passed through the skin by a seton needle. Each day a fresh piece of thread was drawn through the sore. Moxa were cones of cotton wool or other substances which were placed upon the skin and burned.

[155] CHARLES BAUNSCHEIDT, _Baunscheidtismus, by the Inventor of the New Curing Method_, 1st English edition, translated from the 6th German edition by John Cheyne and L. Hayman (Bonn., 1859?).

[156] The patent models are in the Smithsonian collection. See "Catalog" herein. The Aima Tomaton, a device invented and manufactured by Dr. L. M'Kay, was yet another American variation on the Lebenswecker. See L. M'KAY, _Aima Tomaton: Or New Cupping and Puncturing Apparatus_ (Rochester, 1870). An example can be found in the collection of the Armed Forces Institute of Pathology.

[157] See DUCKWORTH, op. cit. [note 153]; ISAAC HOOVER, "An Essay on Dry Cupping," _Transactions of the Belmont Medical Society for 1847-48-49-50_ (Bridgeport, 1851), pages 30-32; MARSHALL HALL, _Practical Observations and Suggestions in Medicine_ (London, 1845), pages 51-53; and B. H. WASHINGTON, "Remarks on Dry Cupping," _The New Jersey Medical Reporter and Transactions of the New Jersey Medical Society_ (1852-53), pages 278-281.

[158] CASPER WISTAR PENNOCK, "Observations and Experiments on the Efficacy and Modus Operandi of Cupping-Glasses in Preventing and Arresting the Effects of Poisoned Wounds," _The American Journal of Medical Sciences_, volume 2 (1828), pages 9-26. For a discussion of the debate over absorption, see KNOX, op. cit. [note 2], pages 21-24.

[159] TIEMANN, op. cit. [note 144], pages 116, 800.

[160] VICTOR-THEODORE JUNOD, _A Theoretical and Practical Treatise on Hemospasia_, translated by Mrs. E. Howley Palmer (London, 1879).

[161] HEINRICH STERN, _Theory and Practice of Bloodletting_ (New York: Rebman Co., 1915), pages 71-72.

[162] AUGUST BIER, _Hyperemia as a Therapeutic Agent_ (Chicago, 1905), page 21.

[163] WILLY MEYER and VICTOR SCHMIEDEN, _Bier's Hyperemic Treatment_, 2nd edition (Philadelphia, 1909).

[164] HALLER, op. cit. [note 88; see also note 72], page 585.

[165] GROSS, op. cit. [note 143], volume 2, page 906.

[166] Such a breast pump was illustrated by HEISTER (1719), op. cit. [note 17], plate 14. All glass breast pumps were probably more typical of the eighteenth than the nineteenth century. In the nineteenth century the glass tube was replaced by a flexible tube with a mouthpiece.

[167] For example, see THE J. DURBIN SURGICAL SUPPLY CO., _Standard Surgical Instruments_ (Denver, 1929), page 59.

[168] Data on the numbers of breast pumps patented was obtained from the files of the U.S. Patent Office in Arlington, Virginia.

[169] Patent specifications, U.S. patent 1179129. For other illustrations of late nineteenth- and early twentieth-century patents for cupping devices, see HALLER, op. cit. [note 88].

[170] STERN, op. cit. [note 85], page 74.

[171] MABELLE S. WELSH, "'Cups for Colds': The Barber, the Surgeon and the Nurse," _The American Journal of Nursing_, volume 19 (1918-19), pages 763-766. See also HALLER, op. cit. [note 88], and J. EPSTEIN, "The Therapeutic Value of Cupping: Its Use and Abuse," _New York Medical Journal_, volume 112 (1920), pages 584-585.

[172] THORNDIKE, op. cit. [note 3], page 477. For bibliography on leeching, see BROCKBANK, op. cit. [note 88]; MERAT, "Sangsue," _Dictionnaire des sciences medicales_, volume 49 (1820), pages 520-541; G. CARLET AND EMILE BERTIN, "Sangsue," _Dictionnaire encyclopedique des sciences medicales_, 3rd series, volume 6 (1878), pages 660-681; and the _Index Catalogue of the Library of the Surgeon-General's Office_, U.S. Army.

[173] ALFRED STILLE AND JOHN M. MAISCH, _The National Dispensatory_, 2nd edition (Philadelphia, 1880), page 713; JAMES THACHER, _The American Dispensatory_, 2nd edition (Boston, 1813), page 230; C. LEWIS DIEHL, "Report on the Progress of Pharmacy," _Proceedings of the American Pharmaceutical Association_, volume 25 (1876), page 205.

[174] W. H. SCHIEFFELIN & CO., _General Prices Current_ (New York, 1887), page 39.

[175] DIEHL, op. cit. [note 173]; JOHN C. HARTNETT, "The Care and Use of Medicinal Leeches in 19th Century Pharmacy and Therapeutics," _Pharmacy in History_, volume 14 (1972), page 133.

[176] Broussais offered the following explanation for the effectiveness of leeching. Congestion of blood vessels in a healthy person gives rise to a sympathetic irritation in the mucous surfaces of bodily orifices. Equilibrium may be restored naturally by hemorrhage through the nose. Without this release of blood, congestion builds up into an inflammation. Local bloodletting relieves the congestion when applied on a portion of the skin corresponding to the inflamed organ. Broussais's favorite remedy was the application of leeches to the stomach and head. For this purpose he ordered hundreds of leeches daily. See F.J.V. BROUSSAIS, _A Treatise on Physiology Applied & Pathology_, translated by John Bell and R. La Roche, 2nd American edition (Philadelphia, 1828), page 414, and Castiglioni, op. cit. [note 40], page 609.

[177] THORNDIKE, op. cit. [note 3], page 477. See also KARL-OTTO KUPPE, _Die Blutegel in der Aerztlichen Praxis_ (reprint, Stuttgart: Hippocrates-Verlag, 1955), pages 9-11.

[178] HARTNETT, op. cit. [note 175], page 132.

[179] JONATHAN OSBORNE, "Observations on Local Bloodletting, and on Some New Methods of Practicing It," _Dublin Journal of Medical and Chemical Science_, volume 3 (1833), pages 334-342.

[180] See, for example, MAISON CHARRIERE, ROBERT ET COLLIN, op. cit. [note 149], page 42 and plate 9.

[181] JOHN BERRY HAYCRAFT, "On the Coagulation of the Blood," 9 pages, extracted from _Proceedings of the Royal Society of London_, volume 231 (1884).

[182] THORNDIKE, op. cit. [note 3], page 477. MERAT, op. cit. [note 172], page 528, cited an extreme case in which a woman suffering from peritonitis was given a total of 250 leeches in 24 hours. She died soon after.

[183] STILLE AND MAISCH, op. cit. [note 173], page 715; THACHER, op. cit. [note 173], page 231.

[184] HARTNETT, op. cit. [note 175], page 132; J. K. CRELLIN, op. cit. [note 33], pages 127-134.

[185] ANDREW H. SMITH, "An Artificial Leech," _Medical Record_, volume 4 (1869-70), page 406.

[186] In addition to the references below, articles on artificial leeches include DR. MONTAIN, "Considerations therapeutiques sur l'emploi du pneumo-derme, nouvel instrument destine a remplacer les sangsues et les ventouses," _Bulletin General de therapeutique_, volume 11 (1836), pages 311-315; J. J. TWEED, "A Description of the Apparatus for Employing the Mechanical Leeches," _Medical Times_, volume 21 (1850), pages 36-37; and SAMUEL THEOBALD, "An Improved Method of Applying the Artificial Leech," _American Journal of Medical Science_, new series, volume 70 (1875), pages 139-142.

[187] SARLANDIERE, "Ventouse," _Dictionnaire des sciences medicales_, volume 57 (Paris, 1821), pages 174-178; PAULET, "Bdellometre," _Dictionnaire encyclopedique des sciences medicales_, series 1, volume 8 (Paris, 1868), pages 632-633; L. GRESELY, "Dissertation sur les sangsues, le nouveau scarificateur, et sur leur emploi en medecine" (Paris: Faculty of Medicine, 1820), dissertation no. 202.

[188] ROBLEY DUNGLISON, _Medical Lexicon: A New Dictionary of Medical Science_, 3rd edition (Philadelphia, 1842). The bdellometer was listed in later editions of this dictionary throughout the nineteenth century.

[189] DAMOISEAU, _La terabdelle ou machine pneumatique operant a volonte la saignee locale et la revulsion aux principales regions du corps humains_ (Paris, 1862), 60 pages. See also GAUJOT and SPILLMAN, op. cit. [note 49], pages 194-195.

[190] L. WECKER, "De la sangsue artificielle (modele du baron Heurteloup), et de son emploi dans le traitment des maladies des yeux." _Bulletin general de therapeutique medicale et chirurgicale_, volume 62 (1862), pages 107-116. For price information, see CASWELL, HAZARD & CO. (W. F. Ford), _Illustrated Catalogue of Surgical Instruments and Appliances_ (New York, 1874), page 18. An example of Heurteloup's leech as well as a larger, modified Heurteloup's leech can be found in the collection of the Armed Forces Institute of Pathology.

[191] SMITH, op. cit. [note 185], page 406; TIEMANN, op. cit. [note 144], page 116; Patent specifications, U.S. patent 100210. An example of this artificial leech can be found in the collection of the Armed Forces Institute of Pathology.

[192] TIEMANN, op. cit. [note 144], page 506.

[193] WILLIAM REESE, "Uterine Leech and Aspirator," _Medical Record_, volume 11 (1876), page 596.

[194] OTTO RAUBENHEIMER, "Leeches--How to Dispense Them," _Journal of the American Pharmaceutical Association_, volume 12 (1923), page 339. THORNDIKE, op. cit. [note 3], page 477, notes that in 1927, leeches still could be had in Boston for 75c apiece. In Cleveland they were still obtainable in the 1950s.

[195] _Dictionnaire usuel de chirurgie et de medicine veterinaire_, 2 volumes (Paris, 1835-36), articles "Ventouses" and "Sangsues."

[196] Ibid., article "Saignee."

[197] _Encyclopedie methodique: Medecine_, volume 9 (Paris, 1816), page 478.

[198] _Dictionnaire usuel_, op. cit. [note 195], volume 2, page 605.

[199] WEISS, op. cit. [note 118], page 100, plate 27.

[200] Patent specifications, U.S. patent 6240.

[201] Patent specifications, U.S. patent 236084.

LIST OF TRADE CATALOGS CONSULTED

Aloe, A. S. Company. _Illustrated and Priced Catalogue of Surgical Instruments, Physicians' Supplies and Hospital Furnishings._ 6th edition. St. Louis, 1891.

----. _Catalogue of Superior Surgical Instruments and Physicians' and Surgeons' Supplies._ 6th Edition. St. Louis, 1895.

Becton, Dickinson & Co. _Trade Catalogue of Gold, Silver and Plated Instruments for Surgeons and Veterinarians._ New York, 1904.

----. [Catalogue.] Rutherford, N.J., 1911.

----. _Illustrated Catalog of Druggists, Surgical, and Veterinary Specialties._ Rutherford, N.J., 1917.

Caswell, Hazard & Co., W. F. Ford. _Illustrated Catalogue of Surgical Instruments and Appliances._ New York, 1874.

Ch. Dubois. _Catalogue illustre des instruments de chirurgie._ Paris, 1884.

Charles Lentz & Sons. _Illustrated Catalogue and Price List of Surgical Instruments._ 3rd edition. Philadelphia, ca. 1888.

Charles Henry Truax. _The Mechanics of Surgery, Comprising Detailed Descriptions, Illustrations and List of the Instruments, Appliances and Furniture Necessary in Modern Surgical Arts._ Chicago, 1899.

Codman and Shurtleff. _Illustrated Catalogue of Surgical Instruments and Appliances._ Boston, 1879.

----. _Illustrated Catalogue of Surgical Instruments and Appliances._ Boston, 1886.

----. _Illustrated Catalogue of Surgical Instruments and Appliances._ Boston, 1890.

Coxeter, J., & Son. _Surgical Instruments Catalogue._ London, 1870.

Down Bros. _Catalogue of Surgical Instruments and Appliances._ London, 1885.

Dubois, Ch. See Ch. Dubois.

Durbin, J., Surgical Supply Co. (Catalogue.) Denver, 1929.

Feick Bros. _Illustrated Catalogue and Price List of Surgical Instruments._ Pittsburgh, 1896.

Fred Haslam & Co. _Standard Surgical Instruments._ Brooklyn, 1922.

Fr. Lindstaedt. _Illustrirter Catalog chirurgischer Instrumente._ Bremen, 1882.

George Tiemann & Co. _American Armamentarium Chirurgicum._ New York, 1879.

----. _The American Armamentarium Chirurgicum._ New York, 1882.

----. _The American Armamentarium Chirurgicum._ New York, 1889.

Haslam & Co. See Fred Haslam & Co.

John Reynders & Co. _Illustrated Catalogue and Price List of Surgical Instruments, Orthopaedical Apparatus, Trusses, etc._ 5th edition. New York, 1884.

John Weiss. _An Account of Inventions and Improvements Made by John Weiss._ 2nd edition. London, 1831.

John Weiss & Son. _Weiss and Son's Catalogue of Surgical Instruments for 1836._ London, 1836.

----. _A Catalogue of Opthalmic Instruments and Appliances, etc._ London, 1863.

----. _A Catalogue of Opthalmic Instruments and Appliances._ Manchester, 1898.

Kennedy, J. E., & Co. _Illustrated Catalogue of Surgical Instruments and of Allied Lines._ New York, 1917.

Kny-Scheerer Co., The. _Illustrated Catalogue of Surgical Instruments._ 3 volumes. New York, 1899.

----. _Illustrated Catalogue of Surgical Instruments._ 16th edition. New York, no date (20th century).

Krohne & Sesemann. _Catalogue of Surgical & Orthopedic Instruments._ London, 1878.

Lentz & Sons. See Charles Lentz & Sons.

Lindstaedt, Fr. See Fr. Lindstaedt.

Maison Charriere, Robert et Collin, Successeurs. [Catalogue.] Paris, 1867.

----. _Catalogue generale illustre._ Paris, 1879.

----. _Catalogue generale illustre._ Paris, 1885.

----. _Catalogue generale illustre._ Paris, 1890.

----. _Catalogue generale illustre._ Paris, 1894.

Maison Luer (H. Wulfing-Luer). _Catalogue generale Illustre._ Paris, ca. 1904.

Mathay Hospital Supply Co. _Surgical Instruments._ Los Angeles, ca. 1937.

Maison Mathieu. _Arsenal Chirurgical._ 15th edition. Paris, ca. 1905.

Matthews Bros. _A Catalogue of Surgical Instruments._ London, ca. 1875.

Maw, S., Son & Thompson's. _Surgical Instruments, etc._ London, 1882.

Obstetrical Society of London. _Catalogue and Report of Obstetrical and Other Instruments Exhibited at the Converzatione of the Obstetrical Society of London_, 1867.

Pittsburgh Physicians' Supply Co. _Illustrated Catalogue._ Pittsburgh, 1908.

Reiner, H. _Catalog medicinisch-chirurgischer Instrumente und Apparate._ Vienna, 1885.

Reynders, John, & Co. See John Reynders & Co.

Robert et Collin. See Maison Charriere.

Scheffelin, W. H., & Co. _General Prices Current._ New York, 1887.

Sharp and Smith. _Surgical Instruments._ 16th edition. Chicago, ca. 1892.

Shepard & Dudley. _Descriptive Catalogue._ New York, 1873.

Tiemann, George, & Co. See George Tiemann & Co.

Truax, Charles Henry. See Charles Henry Truax.

Truax, Green & Co. _Price List of Physicians Supplies._ 6th edition. Chicago, 1893.

Weiss & Son. See John Weiss & Son.

W. H. Wigmore. _Surgical, Dental and Veterinary Instruments._ Philadelphia, no date (pre-1895).

W. Windler. _Preis-Verzeichniss der Fabrik chirurgischer Instrumente und Bandagen._ Berlin, 1888.

Figures 26-124

[Illustration: FIGURE 26.--Reproduction of a Greek vase showing a 5th century B.C. medical "clinic." Original is in the Louvre. Patient is about to undergo venesection in the arm. Bronze bleeding bowl catches the blood. (NMHT 233055 [M-9618]; SI photo 73-4216.)]

[Illustration: FIGURE 27.--Bloodletting man from a New York almanac, 1710. (From Daniel Leeds, _The American Almanack for the Year of Christian Account, 1710_. Photo courtesy of the Library of Congress.)]

[Illustration: FIGURE 28.--Phlebotomy manikin in Johannes de Ketham _Fascicules Medicinae_. Venice, 1495. (From the Dibner Library of the History of Science and Technology, NMHT.)]

[Illustration: FIGURE 29.--Lionel Wepfer, a 17th century traveler, described the Indian method of bloodletting as follows: "The patient is seated on a stone in the river, and one with a small bow shoots little arrows into the naked body of the patient, up and down, shooting them as fast as he can and not missing any part. But the arrows are guarded, so that they penetrate no farther than we commonly thrust our lancets; and if by chance they hit a vein which is full of wind, and the blood spurts out a little, they will leap and skip about, shewing many antic gestures, by way of rejoicing and triumph." (From Lionel Wepfer, _A New Voyage and Description of the Isthmus of America_, London, 1699. Photo courtesy of NLM.)]

[Illustration: FIGURE 30.--Flint lancets used by native doctors in Alaska, 1880s. (Anthropology Catalog 127758; SI photo 73-4208).]

[Illustration: FIGURE 31.--Instruments and technique of phlebotomy: Fig. 1 shows an arm about to be bled. A ligature has been applied to make the veins swell. The common veins bled--cephalic, basilic, and median--are illustrated. Fig. 2 shows several types of incisions. Fig. 3 is a fleam, Fig. 4 a spring lancet, and Fig. 5 a "French lancet." (From Laurence Heister, _A General System of Surgery_, London, 1759. Photo courtesy of NLM.)]

[Illustration: FIGURE 32.--Replica of a barber-surgeon's signboard dated 1623. Top left corner shows a phlebotomy being performed. (NMHT 215690 [M-7343]; SI photo 44681.)]

[Illustration: FIGURE 33.--Instruments for bleeding from the arm, 1708: A, a serviette to cover the patient's clothing; B, a cloth ligature to place around the arm; C, a lancet case; D, a lancet; E and F, candles to give light for the operation; G, a baton or staff for the patient to hold; H, I, and K, basins for collecting blood; L and M, compresses; N, a bandage to be placed over the compress; P, _eau de la Reine d'Hongrie_ that can be used instead of vinegar to revive the patient if he faints; Q, a glass of urine and water for the patient to drink when he revives; R, S, T, implements for washing the hands and the lancets after the operation. (From Pierre Dionis, _Cours d'operations de chirurgie demontrees au Jardin Royal_, Paris, 1708. Photo courtesy of NLM.)]

[Illustration: FIGURE 34.--Two 18th century trade cards advertising lancets. (Photo courtesy of Wellcome Institute, London.)]

[Illustration: FIGURE 35.--Lithograph, London, 1804, showing a phlebotomy. (On loan from Armed Forces Institute of Pathology; SI photo 42579.)]

[Illustration: FIGURE 36.--18th-century cutler's illustrations for making lancets. Note the variations in the shape of the lancet blades. (From Jean Jacques Perret, _L'Art du Coutelier_, Paris, 1772. Photo courtesy of NLM.)]

[Illustration: FIGURE 37.--Thumb lancet, 16th century. (From Leonardo Botallo, _De Curatione per Sanguinis Missionem_, Antwerp, 1583. Photo courtesy of NLM.)]

[Illustration: FIGURE 38.--Typical 19th-century thumb lancets, engraved "S. Maw, London." (NMHT 139980 [M-4151]; SI photo 73-4230.)]

[Illustration: FIGURE 39.--Typical 19th-century brass spring lancet and case. The case is stamped "Traunichtessticht," which translates, "Watch out, it stabs." (NMHT 308730.10; SI photo 74-4088.)]

[Illustration: FIGURE 40.--Spring lancets, dated 1775. (Held by Rhode Island Medical Society; SI photo 73-5762.)]

[Illustration: FIGURE 41.--Fleam, 16th century. (From Leonardo Botallo, _De Curatione per Sanguinis Missionem_, Antwerp, 1583. Photo courtesy of NLM.)]

[Illustration: FIGURE 42.--Hand-forged fleam with hand-carved wooden case, 17th and 18th century, Swiss or Tyrolean. (NMHT 233570 [M-9666]; SI photo 59139-E.)]

[Illustration: FIGURE 43.--Fleam made by E. Dalman, London. Note unusual curved shape to blade. (From the original in the Wellcome Museum by courtesy of the Trustees, photo L. 1346.)]

[Illustration: FIGURE 44.--Silver spring lancet in case. Case is lined with white silk and rose plush and has a gold leaf border. (NMHT 321687.02; SI photo 76-7752.)]

[Illustration: FIGURE 45.--Unusual spring lancet with extra blade, engraved "M.A. Prizzi," 18th century. (NMHT 320033.06; SI photo 76-7763.)]

[Illustration: FIGURE 46.--Unusual spring lancet in hand-carved wooden case, 18th century. Note the large blade and blade guard regulated by a screw. (NMHT 321.697.12; SI photo 76-9114.)]

[Illustration: FIGURE 47.--George Tiemann & Co.'s spring lancet, late 19th century. (NMHT 163863 [M-5141]; SI photo 73-5644.)]

[Illustration: FIGURE 48.--Patent model spring lancet, patented by J.W.W. Gordon in 1857. Back view. (NMHT 89797 [M-4298]; SI photo 73-10319.)]

[Illustration: FIGURE 49.--Patent model spring lancet, patented by J.W.W. Gordon in 1857. Front view. (NMHT 89797 [M-4298]; SI photo 73-10318.)]

[Illustration: FIGURE 50.--Wet cupping for a headache. (From Frederik Dekkers, _Exercitationes Practicae Circa Medendi Methodum_, Leyden, 1694. Photo courtesy of NLM.)]