William Buchan, “Of Bleeding” [*]
No operation of surgery is so frequently necessary as bleeding; it ought therefore to be very generally understood. But though practised by Midwives, Gardeners, Blacksmiths, &c. we have reason to believe that very few know when it is proper. Even physicians themselves have been so much the dupes of fashion in this article, as to render it the subject of ridicule. It is however an operation of great importance, and must, when seasonably and properly performed, be of singular service to those in distress. Bleeding is proper at the beginning of all inflammatory fevers, as pleurisies, peripneumonies, &c.
It is likewise proper in all topical inflammations, as those of the intestines, womb, bladder, stomach, kidnies, throat, eyes, &c. as also in the asthma, sciatic pains, coughs, head-achs, rheumatisms, the apoplexy, epilepsy, and bloody-flux. After falls, blows, bruises, or any violent hurt received either externally or internally, bleeding is necessary. It is likewise necessary for persons who have had the misfortune to be strangled, drowned, suffocated with foul air, the fumes of metal, or the like.
In a word, whenever the vital motions have been suddenly stopt from any cause whatever, except in swoonings, occasioned by mere weakness or hysteric affections, it is proper to open a vein. But in all disorders proceeding from a relaxation of the solids, and an impoverished state of the blood, as dropsies, cacochymies, &c. bleeding is improper.
Bleeding for topical inflammations ought always to be performed as near the part affected as possible. When this can be done with a lancet, it is to be preferred to any other method, but where a vein cannot be found, recourse must be had to leeches or cupping.
The quantity of blood to be let must always be regulated by the strength, age, constitution, manner of life, and other circumstances relating to the patient. It would be ridiculous to suppose that a child could bear to lose as much blood as a grown person, or that a delicate lady should be bled to the same extent as a robust man.
From whatever part of the body blood is to be let, a bandage must be applied betwixt that part and the heart. As it is often necessary, in order to raise the vein, to make the bandage pretty tight, it will be proper in such cases, as soon as the blood begins to flow, to slacken it a little. The bandage ought to be applied at least an inch, or an inch and half, from the place where the wound is intended to be made.
Persons not skilled in anatomy ought never to bleed in a vein that lies over an artery or a tendon, if they can avoid it. The former may easily be known from its pulsation or beating, and the latter from its feeling hard or tight like a whip-cord under the finger.
It was formerly a rule, even among those who had the character of being regular practitioners, to bleed patients in certain diseases till they fainted. Surely a more ridiculous rule could not be proposed. One person will faint at the very sight of a lancet, while another will lose almost the whole blood of his body before he faints. Swooning depends more upon the state of the mind than of the body; besides, it may often be occasioned or prevented by the manner in which the operation is performed.
Children are generally bled with leeches. This though sometimes necessary, is a very troublesome and uncertain practice. Is it impossible to know what quantity of blood is taken away by leeches; besides, the bleeding is often very difficult to stop, and the wounds are not easily healed. Would those who practice bleeding take a little more pains, and accustom themselves to bleed children, they would not find it such a difficult operation as they imagine.
Certain hurtful prejudices with regard to bleeding still prevail among the country people. They talk, for instance, of head-veins, heart-veins, breast-veins, &c. and believe that bleeding in these will certainly cure all diseases of the parts from whence they are supposed to come, without considering that all the blood-vessels arise from the heart, and return to it again; for which reason, unless in topical inflammations, it signifies very little from what part of the body blood be taken.
But this, though a foolish prejudice, is not near so hurtful as the vulgar notion, that the first bleeding will perform wonders. This belief makes them often postpone the operation when necessary, in order to reserve it for some more important occasion, and when they think themselves in extreme danger they fly to it for relief, whether it be proper or not; bleeding at certain stated periods or seasons has likewise bad effects.
It is likewise a common notion that bleeding in the feet draws the humours downwards, and consequently cures diseases of the head and other superior parts; but we have already observed that, in all topical affections, the blood ought to be drawn as near the part as possible. When it is necessary however to bleed in the foot or hand, as the veins are small, and the bleeding is apt to stop too soon, the part ought to be immersed in warm water, and kept there till a sufficient quantity of blood be let.
We shall not spend time in describing the manner of performing this operation. That will be better learned by example than precept. Twenty pages of description would not convey so just an idea of the operation as seeing it once performed by an expert hand. Neither is it necessary to point out the different parts of the body from whence blood may be let, as the arm, foot, forehead, temples, neck, &c. These will readily occur to every intelligent person, and the foregoing observations will be sufficient for determining which of them is most proper upon any particular occasion. In all cases where the intention is only to lessen the general mass of blood, the arm is the most commodious part of the body in which the operation can be performed. [1]
Notes
[*] William Buchan, The Domestic Medicine, Or a Treatise on the Prevention and Cure of Diseases by Regimen and Simple Medicines, 2 vols. (London 1808), 2:201–4. Back.
[1] Concerning the surgery itself, see Ludwig Cron, Der bey dem Ader-lassen und Zahn-ausziehen sicher-geschwind-glücklich und recht qualificirte Candidatus Chirurgiae oder Barbier-Geselle (Leipzig 1717), plates following pp. 32, 66, 76, 90.
The four instruments customary for bleeding surgery were (1) the fleam (probably a corruption from “phlebotomy”), a blooding iron; (2) the lancet, blooding lancet (always sharp on both sides); (3) the spring-box, a small cask of iron, brass, or steal in which a blooding iron or lancet is affixed and pulled back against a steel spring; when the spring is released, the lancet is plunged downward (into the vein); and (4) the arcus, or blooding arc, essentially a tiny bow for positioning and plunging the lancet (nos. 1–4 in illustration):
Here illustrations of a man and two womenn being bled from the arm (third illustration: Petrus Mainoto, Medicina [1771–1800]; Herzog Anton Ulrich-Museum; Museums./Signatur FBaretta AB 2.5):
Here illustrations (1) of a woman being bled from the lower leg and (2) of a family at the bedside of a patient being bled, the woman assisting the physician by holding the saucer capturing the blood (second illustration by Daniel Nikolaus Chodowiecki, Ich half dem Wundarzt und hielt das Becken um das Blut aufzufangen. [1787]; Herzog Anton Ulrich-Museum; Museums./Signatur DChodowiecki AB 3.731):
Translation © 2018 Doug Stott