The Control of Bleeding

The most dangerous peri-operative complication related to surgery was uncontrolled bleeding, so that hemostasis has always been an critical and challenging problem. There were a number of inventive ways in which surgeons attempted to control the loss of blood.  

Traité complet d’anatomie de l’homme, 2nd ed. (1866–1871) by J.M. Bourgery, Claude Bernard, and N.H. Jacob
Certainly no device in the history of medicine has been more popular for the control of bleeding than the tourniquet. The application of pressure to control blood loss is a natural reaction, though it was not until 1674 that Morell reported the use of a field tourniquet when he attached a cord to a wooden rod, and twisted it to achieve hemostasis. Here illustrated are the two most common methods of controlling blood loss in the nineteenth century.
Petit tourniquet
Jean-Louis Petit invented this very screw device as as way of managing bleeding in 1718; similar devices are still in use today.
arterial tourniquet by Both (ca. 1830)
This large tourniquet would have been used to control abdominal bleeding or following the amputation of a lower extremity.
arterial tourniquet by Fli Loollini (ca. 1860)
This is a smaller tourniquet to be used on the upper extremity.
Feldtbüch der Wundartzney (1517) by Hans von Gersdorff
One of the earliest and one of the most feared techniques of hemostasis was the cautery. While there was almost instant hemostasis, this technique also provided the patient with a degree of wound sterilization.
cased set of cauteries by Mariaud (ca. 1860)
This is a cased set of mid eighteenth century cauteries by Mariaud, each to be used for a different part of the body.
bullet cautery (ca. 1860)
This instrument was to be used specifically to cauterize a gunshot wound.
Illustrated Manuel of Operative Surgery by Bernard & Huette (1855)
Another of the many contributions by the great sixteenth century French surgeon Ambroise Pare was his use of the ligature for the control of bleeding. Here are a number of early suturing techniques.
assorted sizes of catgut
Catgut was one of several animal materials that has been used as suture material through the nineteenth century.

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.

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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