BLOODLETTING INSTRUMENTS - Smithsonian Institution Libraries

NUMBER 41
protective mechanism to aid blood clotting. If the
volume of blood lost does not exceed 30 to 40
percent, systolic, disastolic, and pulse pressures rise
again after approximately 30 minutes as a result
of various compensatory mechanisms.^^
If larger volumes than this are removed, the organism
is usually unable to survive unless the loss is
promptly replaced. Repeated smaller bleedings may
produce a state of chronic anemia when the total
amount of blood and hemoglobin removed is in
excess of the natural recuperative powers.
When to Bleed
Selecting a time for bleeding usually depended on
the nature of the disease and the patient's ability
to withstand the process. Galen's scheme, in contrast
to the Hippocratic doctrine, recommended
no specific days.^* Hippocrates worked out an elaborate
schedule, based on the onset and type of
disease, to which the physician was instructed to
adhere regardless of the patient's condition.
Natural events outside the body served as indicators
for selecting the time, site, and frequency
of bloodletting during the Middle Ages when astrological
influences dominated diagnostic and
therapeutic thought. This is illustrated by the fact
that the earliest printed document relating to medicine
was the "Calendar for Bloodletting" issued
in Mainz in 1457. This type of calendar, also used
for purgation, was known as an Aderlasskalender,
and was printed in other German cities such as
Augsburg, Nuremberg, Strassburg, and Leipzig.
During the fifteenth century these calendars and
Pestblatter, or plague warnings, were the most
popular medical literature. Sir William Osier and
Karl Sudhoff studied hundreds of these calendars.^s
They consisted of a single sheet with some astronomical
figures and a diagram of a man (Aderlassmann)
depicting the influence of the stars and the
signs of the zodiac on each part of the body, as well
as the parts of the anatomy suitable for bleeding.
These charts illustrated the veins and arteries that
should be incised to let blood for specific ailments
and usually included brief instructions in the margin.
The annotated bloodletting figure was one of
the earliest subjects of woodcuts. One early and
well known Aderlassmann was prepared by Johann
Regiomontanus (Johannes Miiller) in 1473. It contained
a dozen proper bleeding points, each suited
for use under a sign of the zodiac. Other Aderlassmanner
illustrated specific veins to be bled. The
woodcut produced by the sixteenth-century mathematician,
Johannes Stoeffer, illustrated 53 points
where the lancet might be inserted.^^
"Medicina astrologica" exerted a great influence
on bloodletting. Determining the best time to bleed
reached a high degree of perfection in the late
fourteenth and fifteenth centuries with the use of
volvella or calculating devices adopted from astronomy
and navigation. These were carried on a
belt worn around the waist for easy consultation.
Used in conjunction with a table and a vein-man
drawing, the volvella contained movable circular
calculators for determining the accuracy, time,
amount, and site to bleed for an illness. The dangers
of bloodletting elicited both civic and national
concern and control. Statutes were enacted that
required every physician to consult these tables
before opening a vein to minimize the chance of
bleeding improperly and unnecessarily. Consultation
of the volvella and vein-man was more important
than an examination of the patient.^^ (Figure
3.)
For several centuries, almanacs were consulted to
determine the propitious time for bleeding. The
"woodcut anatomy" became a characteristic illustration
of the colonial American almanac. John
Foster introduced the "Man of Signs," as it was
called, into the American almanac tradition in his
almanac for 1678, printed in Boston. Other examples
of early American almanacs featuring illustrations
of bleeding include Daniel Leed's almanac
for 1693, printed in Philadelphia, and John Clapp's
almanac for 1697, printed in New York.
As in many of the medieval illustrations, the
woodcut anatomy in the American almanac consisted
of a naked man surrounded by the twelve
signs of the zodiac, each associated with a particular
part of the body (the head and face with Aries,
the neck with Taurus, the arms with Gemini, etc.).
The directions that often accompanied the figure
instructed the user to find the day of the month in
the almanac chart, note the sign or place of the
moon associated with that day, and then look for
the sign in the woodcut anatomy to discover what
part of the body is governed by that sign. Bloodletting
was usually not specifically mentioned, but
it is likely that some colonials still used the "Man