Transfusion, Cupping, and Counterirritation

Early transfusions were based on the notion that receiving blood could be yet another way in which to help balance the humours.   

Grosser und gantz neugewundener Lorbeer-Krantz, oder Wund Artzney (1705) by Matthaus Purmann
Blood had also been revered by the medical community for its curative and sometimes magical power, and some seventeenth century physicians had other goals in mind for its use based on the concept of “vitalism,” which was the belief that an individual or animal’s personality could perhaps be transferred by way of its blood. This is an illustration of a transfusion from a docile lamb to perhaps an over aggressive man.
nineteenth century transfusion apparatus by Dr. Roussel
The first recorded “transfusion” was in 1492 in Rome, and the purpose was to rejuvenate Pope Innocent VIII through the transfusion of blood from three healthy boys. Unfortunately, the three boys succumbed as did the Pope, followed by the rapid departure of the attending physician, Giacomo di San Genesio. This particular device can be viewed at the School of Medicine in Paris on dispaly in their medical museum.
Harper’s Weekly magazine (July 4, 1874)
Illustration of a person to person transfusion in Paris.
Exercitationes practicae (1694) by Frederik Dekkers
Unfortunately physicians were rarely able to address internal problems surgically, so in addition to bleeding and purging, counter-irritation and cupping became popular in the seventeenth and eighteenth centuries to readjust the internal environment, and presumably stabilize imbalanced humours.
Blundell’s blood transfusion apparatus (ca 1870) by Savigny
Thoracoscopy/Transfusion set by Arnold & Sons
This set was used for any number of purposes regarding the removal and introduction of fluids in the 19th century.
nineteenth century cuppng sets
(left): Arnold and Sons, (right): Charrière and Collin, (bottom): silver teapot burner, twelfth century Persian spouted cupping glass, two cupping glasses, and a cupping tin
early cuppng horns (eighteenth and nineteenth centuries)
Traité complet de l’anatomie de l’homme (1866-1871), second edition by JM Bourgery, Claude Bernard, and NH Jacob
Another form of counter-irritation involved the use of the seton needle, which was a lancet inserted under the skin usually behind the neck, and left there to form a draining tract. The purpose was to reduce internal inflammations and poisons by their external discharge, the area kept open to drain pus by a silk or cotton thread, and sometimes by the use of a hot cautery.
seton needle by Tiemann (ca. 1860)
French seton needle and clamp (ca. 1840)
a cased Southey set
These hollow tubes were inserted into edematous areas to help remove fluid.
Hyperemic Treatment (1908) by Willy Meyer MD, and Prof. Dr. Victor Schmieden
These physicians logically proposed a form of treatment that, unfortunately, was based on erroneous physiology and therefore was not therapeutic. Their (correct) conclusion was that the best way to cure infection was to increase circulation to diseased tissue. To reach that end, they advocated either the placement of a tourniquet above the affected parts to cause reddening, or the use of suction devices to increase blood to those areas of the body. This illustrates Bier’s hyperemic treatment for tuberculosis of the elbow.
Hyperemic Treatment (1908) by Willy Meyer MD, and Prof. Dr. Victor Schmieden
an illustration of hyperemic treatment in foot and neck therapy for tuberculosis

Bloodletting

Following the application of a tourniquet, physicians withdrew blood using a number of instruments including a thumb lancet that might be carried in a small case, a single bladed spring-loaded lancet, or perhaps a multiple bladed scarificator.

red figure aryballos of a doctor bleeding a patient (fifth century B.C.)
Traité complet de l’anatomie de l’homme (1866-1871) by J.M. Bourgery, Bernard, and Jacob
bloodletting from the upper and lower extremities
Traité complet de l’anatomie de l’homme (1866-1871) by J.M. Bourgery, Bernard, and Jacob
bloodletting from the head and neck
oil by Naiveu Matthijs (1647-1726)
a female patient having her pulse taken while being bled
portable cased thumb lancets
(from left clockwise) leather, shagreen (fish skin), ivory, ebony, mother of pearl, tortoiseshell, gold, and silver
mid nineteenth century barber/bleeding bowls
(left): ceramic, (middle): eighteenth century pewter bleeding bowl with measured rings, (right): brass with several levels
Don Quixote, engraving by Francis Hayman (1755)
Don Quixote wore a bleeding bowl as his "Helmet of Mambrino." Author Miguel de Cervantes (1547-1616) was the son of a surgeon and may have gotten the idea of using a bleeding bowl in his famous character’s costume from the time he spent with his father.
George Washingtion in his last illness (ca. 1800), unknown artist
President Washington died within 24 hours of the onset of a sore throat (perhaps Haemophilas influenzae) despite the best efforts of his physicians, Drs. James Craik and Elisha Dick, who made the following statement in Times of Alexandria: “Some time in the night of Friday, the 13th inst., having been exposed to rain on the preceding day, General Washington was attacked with an inflammatory affection of the upper part of the windpipe, called in technical language, cynanche trachealis. The disease commenced with a violent ague, accompanied with some pain in the upper and fore part of the throat, a sense of stricture in the same part, a cough, and a difficult rather than painful deglutition, which were soon succeeded by fever and a quick and laborious respiration. The necessity of blood-letting suggesting itself to the General, he procured a bleeder in the neighborhood, who took from the arm in the night, twelve or fourteen ounces of blood...Discovering the case to be highly alarming, and foreseeing the fatal tendency of the disease, two consulting physicians were immediately sent for, who arrived, one at half past three and the other at four in the afternoon. In the interim were employed two copious bleedings..."
daguerreotype of a patient being bled (ca. 1859)
Vestiges of early bleeding can be seen today in barbershops since the barber pole is a symbol of early phlebotomy. Patients in early England would squeeze a pole to improve the flow of blood while they were being phlebotomized. The poles were subsequently stained red with blood, and when not in use, they were hung outside the door of barber-surgeons with the blood-stained white linen tourniquet wrapped around. This was the genesis of the red and white pole characteristically hung outside barbershops today.

Leeches

The word leech is derived from the Old English word “laece,” or doctor, and Syrian physicians reportedly first used leeches for bleeding as early as 100 B.C.  This was a painless and efficient way of drawing blood since the leech excretes several hormones including one to anesthetize the bite, one to dilate vessels to insure flow, and a third, hirudin, to act as an anticoagulant.  

hirudo medicinalis
Hirudo medicinalis, or the European leech, was plentiful in swamps and thousands were imported into the United States from Europe following the work of French physician Broussais, who advocated the use of this little parasite to restore imbalanced humors in almost every imaginable disease, both physical and mental.
a dissected leech from The Doctor, A Medical and Philosophical Penny Magazine (April 30, 1834)
nineteenth century leech advertisement by J & A Churchill, New Burlington Street, London, W.
leech carriers
Leeches were transported in pewter or silver carriers, placed on various predetermined areas of the body, and were often directed toward difficult to reach places such as the mouth, larynx, ear, conjunctiva, rectum, and vagina by way of small glass leech tubes. (top left to right) glass, silver, and pewter pot a sansues by Niolas Bolceroise (1790–1810); (bottom) small glass leech tube
Staffordshire ceramic leech jar (ca. 1830)
blown glass leech container
Staffordshire ceramic leech jar by Samuel Alcock and Co. (ca. 1840)

Diagnostic Instruments

Physicians have used instrumentation from the earliest times to aid in their investigation of diseases, and similar interest in documenting the vital signs remains important in modern diagnosis. 

treatise on the pulse by Wang Shu-ho (fourth century)
Ancient Chinese physicians made pulse diagnosis an important part of traditional Chinese medicine. There were twenty-eight different pulse patterns to be determined at eighteen different locations, six on each wrist occupying three different positions. It took between five and ten years of supervision in order to learn this diagnostic tool, and few “masters” were able to reach the highest levels of proficiency.
jade Chinese pulse rest (second century)
The Visit of the Physician (The Love Sick) (1657) by Frans van Mieris the Elder
Physicians often determined the proper extent of their bloodletting by changes in the pulse of their patient.
Marey's sphygmograph (ca. 1860)
This is the first mechanical device used for the determination of the pulse.
illustrated use of the Marey's sphypmograph
Dudgeon's sphygmograph (ca. 1890)
This was a later version of the Marey's sphygmograph used for measurement of the pulse.
two minute nurse's hour glass (nineteenth century)
percussor and pleximeter by Hilliard of Edinburgh (mid nineteenth century)
Leopold Auenbrugger (1722-1809) grew up in Vienna in the middle of the eighteenth century and was the son of an innkeeper who had tapped on barrels to determine the level of the fluid by noting different pitches as the quantity changed. He played the flute and, with his ear for sound, Auenbrugger employed this tapping technique to help evaluate respiratory function in his patients. The percussor tapped on the pleximeter and gave the examiner different sounds to determine if there was underlying fluid. Percussion remains an important part of the modern physical examination.
percussor/pleximeter by Aitken of York (mid nineteenth century)
This is a rare combination of a percussor and pleximeter.
mural painting of René Laënnec listening to a patient at the Necker Hospital by Theobald Chartran (1849-1907)
The discovery of the stethoscope, Greek for “I look into the chest,” is credited to Rene Laennec (1781-1826), a French physician who invented this instrument after examining a patient in 1816. In order to listen to her chest and at the same time preserve decorum, Laennec rolled up twenty-four sheets of paper and was surprised to find that the sounds were transmitted with more intensity than by simply placing his ear against his patient’s chest.
Dr. Laennec's wood and brass stethoscope (ca. 1820)
evolution of the stethoscope after Laennec
(left to right): rare cherry and ivory transition Laennec/Piorry (ca. 1830), ebony and ivory Piorry (ca. 1840), cased ivory monaural stethoscope by Maw (ca. 1860), aluminum stethoscope by Collin (ca. 1900), silk and ebony flexible stethoscope (ca. 1840), Cammann type by Leach and Green (ca. 1860)
(top) flexible stethoscope and (bottom) hearing horn
The stethoscope evolved into a more convenient “flexible” type made of woven silk, and are often confused with conversation tubes, though the former are usually less than eighteen inches in length and had ear pierces that were either straight or flat, but not curved.
mid to late nineteenth century thermometers
(Top): L’Utile, and Faichney in a mother-of-pearl case (likely for use by a nurse), (middle): Immisch, bottom: bent and axillary types by Tiemann

Early Methods of Diagnosis

 When early physicians had little more to offer than herbs, potions, and minor surgical procedures, the art of physical diagnosis played a very important role in the practice of medicine.  

Etruscan bronze model of a sheep's liver (third century B.C.)
Since the liver was felt to be the center of life, the source of blood, and the residence of the soul, it was not surprising that animal livers were examined by priests in order to help determine the causes of disease. To Babylonian physicians, a small left lobe of the liver meant weakness and disease, while others looked to variations in the surface of the organ for guidance.
Chinese doctor's lady (early 20th century)
The number of differential diagnoses was limited, however, because early social customs interfered with direct patient contact by physicians. Some Eastern cultures considered physical examination inappropriate, and female patients were required to point out areas of discomfort on ivory “doctors’ ladies.” There is some debate regarding the use of these manikins in ancient Chinese history since there is no documentation.
Feldtbüch der Wundartzney (1517) by Hans von Gersdorff
Uroscopy, or “water casting,” was the practice of diagnosing disease through the examination of urine and its varying colors, consistency, smell, and sometimes taste. Uroscopy was taught as early as the second century by Galen, and remained an important part of medical diagnosis for the next fifteen hundred years. One of the earliest representations of uroscopy was by Hans von Gersdorff (1456-1517) when he illustrated urine being examined by twin brothers, the Saints Cosmas and Damien.
The Physician (1653) by Gerrit Dou
The image of a doctor holding up a flask of urine to the light for evaluation came to represent the practice of medicine, or physic, in medical art from the earliest woodcuts, and continued into the eighteenth century.
uroscopy flask (eighteenth century)
Fasciculo Medicina (1493) by Johannes de Ketham
Physicians frequently used uroscopy wheels for diagnostic purposes in order to compare the color of urine in various illnesses.

Physical Diagnosis

 

     "Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone can you become expert. Medicine is learned by the bedside and not in the classroom. Let not your conceptions of the manifestations of disease come from words heard in the lecture room or read from the book. See, and then reason and compare and control. But see first."

                                                          William Osler, MD (1919)

(Chapter Sections below, additional Pictures left) 

dageurreotype of a physician with a monaural stethoscope (ca. 1850)

Bleeding

     "...daily experience satisfies us that bloodletting has a most salutary effect in many diseases, and is indeed the foremost among all the general remedial means..."

                                                                Sir William Harvey (1847)

In the fifth century B.C., Hippocrates established a unified theory regarding the etiology of various diseases that subsequently influenced medical care for centuries.  In his proposed rules of harmony, he taught that all body systems were represented by four humours which were naturally balanced and that disease was a result of an interruption in those relationships. Bleeding has been practiced since the time of the Egyptians, and was a way of balancing those humours. 

(Chapter Sections below, additional Pictures left)

Essex style ceramic leech jar (nineteenth century)
This jar represents the high point in the manufacture of leech containers.
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