Bleeding you well

bleeding of the eyesMore from Lorenz Heister’s surgical textbook Chirurgie, published in 1718, on which I have written before. The practice of bloodletting, also known as phlebotomy, was a staple treatment for millennia and still had influential advocates at the end of the nineteenth century.  Most people will be aware that doctors used to bleed their patients, but fewer will be aware of exactly where and how they did it.

How and where to cut a vein

Taking blood from the arm, where veins run near the surface of the skin, was the commonest practice, but enthusiastic bloodletters had a variety of other options.

Take, for instance, the practice of bleeding the veins of the eye.  Heister writes: 

It is well known from Inspection, and the Writings of Anatomists, that there are two Veins run one on each Side the Nose through the Canthi Majores, or inner Corners of the Eyes, which proceed partly from the Forehead, and partly from the Eyes, and do, like the frontal Vein, discharge their Blood, down into the external jugular Veins. ‘Tis bleeding, in these canthal Veins that has been universally approved by Dionis, and the Generality of Oculists, for Inflammations and other Disorders of the Eyes; but upon no other Foundation, in my Opinion, than that of bleeding in the Forehead and Temples. However, when you are to phlebotomise in these Corners of the Eyes, you must first make a Stricture about the Neck, and after your Incision the Patient must incline his Head, that a sufficient Quantity of Blood may be discharged from the Orifice without running into his Mouth, and then you apply a thick triangular Compress with Bandage.

All very scientific.  Similarly, if you were suffering from a quinsey (an abscess behind the tonsil), the phlebotomist might consider bleeding your tongue.bleeding the tongueIt is very often found of no small Service in a Quinsey, or other Inflammatory Disorder of the Neck, to bleed in the two small Veins which run under the Tip or End of the Tongue; especially if a larger Vein has been opened before either in the Neck, Foot, or Arm, whereby the inspissated and stagnating Blood may be gradually evacuated. To bleed in these Veins, a Stricture being made upon the Neck as before, you then elevate the Apex of the Tongue with your left Hand, while with the Lancet in your right, you circumspectly open first one, and then the other on each Side; because the Apertion of one only will hardly ever discharge Blood enough to give any considerable Relief. When you judge a sufficient Quantity of Blood has run out of the Mouth into your Vessel, remove the Ligature from the Neck; upon which the Flux usually stops of itself; but if it should still continue, let the Patient take a little Vinegar, or Frontiniac Wine in his Mouth, or else you may apply a Bit of Vitriol or Alum, or a Compress dipt in some styptic Liquor, till the Haemorrhage ceases, which can never be dangerous even without such Topics; for if there be not a good large Quantity of Blood discharged in the inflammatory Disorders of these Parts, the Apertion of these Veins will be of little or no Signification.

I can see the rationale for using a vinegar mouthwash after such an operation – it might be helpful from the point of view of preventing infection – but I suspect it would sting a bit.  But that’s not the worst of it.  How about this treatment for an inflamed penis:bleeding penisBleeding in the Vena dorsalis Penis usually surpasses the Benefit of all Remedies whatever in abating inflammatory Disorders of this Member. This large Vein, which runs along the Back or upper Side of the Penis, being generally pretty much distended, and conspicuous in an Inflammation of this Part, may be incised about the middle or back Part of the Penis, and kept bleeding till the Member becomes flaccid, and a sufficient Quantity of Blood be discharged, proportionable to the Urgency of the Symptoms; which done, you must apply a Compress, and the Bandage proper for the Penis, as we shall direct in the third and last Part of our Surgery. But you must carefully endeavour to avoid injuring the Arteries or Nerves which enter the Penis near this Vein; as also not to make your Bandage too strict; for by these Means the Inflammation and Symptoms may turn out worse than before.

Ouch.  Before you get too smug about the superiority of modern medicine, bear this in mind: evacuating the blood from the penis is still the usual treatment for cases of priapism (persistent erection).

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