Scarification, Venesection V Leeching
The scarificator was introduced to the process of bloodletting in the early nineteenth century and was known as the new ‘mechanical leech’. The small box-like machine held a line of matching blades that could be activated with the flick of the top bar to make neat multiple incisions of circa 3mm depth.
Henry Clutterbuck* (1767–1856) a doctor trained at the United Borough Hospitals advised within his book on scarification in the 1840s “There is one objection, however, to the use of leeches in children, which deserves attention; namely, the terror they sometimes occasion, with a continuance of angry feelings for an hour or two, while the operation lasts. This is a
cause of aggravation in many brain affections of children, where the sensibility and irritability of the system are already greatly in excess. In such cases, therefore, scarification with cupping is often preferable to leeches; and, still more, venesection, if it be practicable, as it often is, either in the arm or neck. By this, not only is the irritation here spoken of avoided, but the disease itself more effectually relieved.” Relief might have been given, but the instruments carried infection. It was not until twenty five years later that antiseptic sterilisation procedures would be introduced by Joseph Lister (1827-1912) that would limit the transfer of bacteria from patient to patient via a blade.
Injuries Sustained within St Thomas’ Hospital
Over the natural bacteria of a leech bite, any indelicate use of a bloodletting instrument could also inevitably damage an artery. Mother to be Eleanor Hughes, age 25 was admitted to St Thomas’ Hospital on March 3rd 1834 as a patient of Dorcas Ward (with doors that led into the Old Operating Theatre). She was placed under the care of surgeon Mr Frederick Tyrrell (1793-1843) who within her Case Notes wrote that she was “Of healthy habits, but occasionally suffering from headaches, for which she has been bled several times. Is in the first weeks of pregnancy, and in being bled this morning the brachial artery [the main artery of the arm] was wounded. The hemorrhage was commanded by compression above the puncture; but she became very faint from the loss of eight or ten ounces of blood, and became extremely hysterical”. Mary’s unexpected severed artery was closed by a “ring tourniquet … a metal ring, having a diameter larger that of the limb and a width to about an inch; the circumference is tapped at one point to admit a screw, to the inner extremity of which a pad is fixed … when applied, this instrument makes pressure only on two parts; by the pad on the site of the artery, and by the portion of the ring … opposed to the artery: thus it does not interfere with the lateral Circulation”. Of the tourniquet, that had no doubt been kept on site for such accidents, Tyrrell reported that it often dislodged from her arm. Fortunately Eleanor, although it was five weeks later, on April 16th left hospital “presented cured” with no mention of any further headache treatment.
The Art of Cupping
Hospital physicians or surgeons would prescribe cupping as part of a patient’s treatment. The process would be undertaken by a professional Cupper who used a naked flame to burn the oxygen from the inside of a set of small glasses, the created vacuum allowed a swift placement to the patient’s skin and the flesh would be drawn upward. If ‘wet cupping’ was prescribed, the process involved removal of the dry cup but then to use a fleam or lancet to make an incision repeating the cup placement. Blood was drawn upward to the correct ounce requirement and the filled glass removed quickly and carefully by the Cupper.
For the year 1823 St Thomas’ Hospital Apothecary Accounts listed payment for the services of Cupper “Coleby cupping for 950 patients £95.00” showing a fees paid at one pound for each patient’s treatment. He is again listed that same year under “Surgery Bills” as “Colby for Cupping 133 Patients £13.6s” indicating, also as for leeching, that the Apothecary’s treatment was more expensive, likely due to being a course of several weeks treatment over the shorter required for surgical patients.
* Dr Henry Clutterbuck had from 1778 trained at the United (Borough) Guy’s and St Thomas’ Hospitals. He founded the Medical and Chirurgical Review medical newsletter in 1795
Apothecary and Surgery Bills for St Thomas’ Hospital 1791-1845. London Metropolitan Archives.
Clutterbuck, Henry. 1840. Scarification: On the Proper Administration of Blood-Letting, for the Prevention and Cure of Disease. Published London.
South, John Flint. 1836. “Surgeon Frederick Tyrrell.” In St Thomas Hospital Reports, Vol I: 20—22.
To cite this post : Karen Howell, “The Humoral Management of Blood: Cupping, Bloodletting and Staunching- PART 2”, Museum Highlights (blog on oldoperatingtheatre.com), September 21st, 2017.
Karen Howell was trained at Chelsea College of Art as a video and installation artist and undertook postgraduate work at Central St Martins School of Art, London. Throughout her training she has always had the history of medicine as a core interest. It was only after joining the museum that she undertook her museum studies training at Leicester University becoming then the Curator of the Old Operating Theatre Museum and Herb Garret.