Bleeding & Blistering Cups

From: civilwarvirtualmuseum.org

Examples of a metal bleeding cup used to withdraw blood from patients for various ailments and a glass cupping device used to raise a blister on the skin to lance for bleeding. A small incision was made in the patient and a piece of lint placed in the cup and ignited; the open end of the cup was placed over the incision or wound creating a vacuum which drew the desired amount of blood out. Bleeding was an ancient method of treating patients that was still in use during the Civil War, but the practice became increasingly unpopular as the war progressed.

Images Courtesy Wilson’s Creek National Battlefield; WICR 30588 & 30589

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Fleams

From: civilwarvirtualmuseum.org

These are examples of lancets and scarificator used to puncture veins to promote bleeding; once the desired amount of blood was drawn, the incision was closed with a suture of wire or silk.

Images Courtesy Wilson’s Creek National Battlefield; WICR 30572, 30575, & 30601

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Civil War Brass Bleeder

From: joshuasattic.com

This is a Spring-loaded bleeder from the Civil War period. It was probably made in Germany and imported here. It comes in s custom-fitted wooden box lined with pattered cotton. Full 3 1/4" long. One can slide rear panel off to see spring mechanism inside. Used for draining the sick or toxic "humours" from the ill patient's vascular system.

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Cupping and Bloodletting

From: worldturndupsidedown.blogspot.com
   

This painful procedure was performed during the Civil War on Sarah Morgan, a wealthy refugee from Baton Rouge after a wagon accident left her unable to walk. She described the experience in her journal, which has recently been published as “The Civil War Diary of a Southern Woman,” as follows:

“I was interrupted yesterday morning by Mrs Badger who wished to apply a few dry cups to my back, to which I quietly submitted, and was unable to move afterwards with[out] pain, as a reward for my patience.”

When the doctor visited her later, she wrote of the pain she experienced, the large amount of blood lost and the reactions of her sister and friends during another cupping procedure. "two dozen shining, cutting teeth were buried in my flesh....Then came the great cups over the cuts that I thought loosened the roots of my teeth with their tremendous suction power, and which I dare say pulled my hair in at least a foot."

By the end of the Civil War, cupping was no longer such an accepted practice in the medical community.  However, it was recently brought to my attention that cupping has become somewhat fashionable recently. Celebrities are touting the health benefits of cupping, and are happily displaying the marks left from these treatments.

It appears that the celebrities don’t have quite the same experience with cupping as poor Sarah Morgan.  However, I strongly suspect that the health “benefits” gained are the same in both cases!

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Cupping

By Lori Eggleston

Cupping is an ancient practice which was very popular during the period of “Heroic Medicine” prior to the Civil War.  Though cupping was beginning to wane in popularity at the start of the war, it was still practiced.

Cupping involves heating small cups, usually made of glass, and then placing them on the skin.  As the cup cools, a vacuum is created inside and the skin is drawn up inside the cup to form a raised blister.  In dry cupping, the cup would be left on the skin for several minutes.  This was thought to promote better blood flow to the area where the cups were applied.  In wet cupping, small cuts would be made in the skin so that the cups would also draw out blood from the area.  Bleeding was thought to reduce the “bad humors” in the body.

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Gross Medicine: Maggots, Leeches and Dirt

Hundreds Of Years Ago, Maggots, Leeches, And Dirt Were “Medicine Cabinet” Staples. Now Old Is New Again: Ready To Try Them?

By Maia Weinstock and Mark Bregman | October 19 , 1991

You're lying in the emergency room, in agonizing pain from an open gash on your leg. You crashed your bike weeks ago, but the wound has gotten worse — black, festering, and foul-smelling. Now you have acute gangrene — "flesh-eating" microscopic bacteria are feeding on your live tissue. What would it take to destroy the bacteria causing your leg to rot?

Well, how do maggots sound? That's your doctor's recommendation: unleash dozens of tiny worm-like fly larvae to feast on your leg. Is this a putrid nightmare? Have you become the star of yet another sequel — Halloween: When the Bugs Bite ???

It may curdle your blood, but science is re-examining a host of "folk" remedies to heal all kinds of wounds and diseases. They include maggots, leeches (a type of segmented worm), and even geophagy or dirt-eating.

Alternative folk cures were standard medical fare for centuries. But late-19th-century advances like the sepsis theory — keeping wounds and instruments free from germs promotes healing — and 20th-century drugs called antibiotics, helped banish folk remedies from modern hospitals.

Now, recent studies suggest some old remedies may do the trick as well as, or better than, some techniques that replaced them. "We no longer think of antibiotics as the cure-all for every infection," says Dr. Ronald Sherman, at the University of California at Irvine.

"Almost by chance we're relearning that nature's medicines — often called 'gross' — are sometimes the best," adds Michele Root-Bernstein, author of Honey, Mud, Maggots and Other Medical Marvels (Houghton Mifflin, 1997). Maggot and leech therapies are a growing trend, says Root Bernstein, though you probably won't find them in your local doctor's office. "Doctors are likely to turn to maggots and leeches only when nothing else works," she says.

Today, as in the past, maggots are used to eat dead tissue, thereby cleaning open wounds. During the Civil War and again in World War I, battlefield physicians saw that soldiers' wounds infested with maggots tended to heal better than non-infested wounds. Soon maggot therapy was born.

On the other hand, leeches were put to the test in a practice called phlebotomy, or bloodletting, a remedy once as popular as today's aspirin. A leech's bite was only one tactic used to drain human blood — knives, sharp stones, teeth, and thorns also proved popular. Though they didn't know why at the time, doctors found bloodletting reduced severe fever. A doctor might use leeches to drain ounces or pints of blood — in extreme cases, up to 1/5 of a person's total blood supply! Today, leeches are making a comeback in reconstructive surgery when, for example, surgeons reattach a severed finger.

Maggot therapy
Today, more than 200 hospitals in the U.S. and Europe have prescribed maggots to treat patients with infections from injuries like pressure ulcers ("bed sores"), leg and foot ulcers, stab wounds, and post-surgical wounds that won't heal. In fact, about 5,000 laboratory grown and disinfected (microorganism-free) maggots are delivered to hospitals across the U.S. every week!

"It's faster than any non-surgical method for wound-healing and not as likely to injure healthy tissue," says Dr. Sherman. He grows the larvae in his Irvine laboratory and ships batches to hospitals around the world. The flies that lay maggot eggs are force-fed on Gainers Fuel 100, a body-building supplement. Sherman puts up to 20,000 maggot eggs in a single vial, and after hatching, feeds them sterilized meat. The larvae are then placed in special bandages which hold the maggots in after they are applied to a human wound.

Here's an example of when and how maggot therapy works: Open, untreated wounds can become infected and gangrenous if left untreated. Gangrene is the death of human cells or tissues caused by a blockage of blood supply to a wound. If gangrenous tissue isn't removed, the affected limb eventually begins to rot. And if bloodless tissue should become infected by poisonous bacteria such as clostridium, results can be fatal.

Maggots are immature blowflies (a type of fly) in their second or larval stage of life. Young blowfly maggots are implanted directly onto a wound, where they eat dead flesh, clean out dead skin, and kill harmful bacteria that need injured tissue to survive. Once maggots reach their fill of dead and dying flesh, they're removed from the wound and new maggots are applied. Blood can then flow throughout the tissue, promoting the growth of new flesh.

Are patients totally grossed out by maggot therapy? "I've never had anyone freak out — not even those who are initially extremely reluctant," says Dr. Jane Petro, a plastic surgeon at Westchester County Medical Center in Valhalla, New York. Maybe someone should conduct a study on how her patients got such strong stomachs!

Leeches: out on a limb
Maggots may not be the only healing creepy critters to have earned a foul rap. For 2,500 years, doctors have used blood-sucking leeches for bloodletting. A leech can gorge itself with up to five times its body weight in blood!
In 1994, a woman's scalp was ripped off when her hair was yanked into moving machinery. Doctors performing micro-surgery at the University of Southern California reattached the scalp, but one area swelled with congested blood. They applied leeches, one at a time for eight days, to suck up stagnant blood. Eventually new capillaries, or tiny blood vessels, formed in the scalp wound, leading to healing circulation.

Is something repulsive going on? All leeches have two suckers — one on each end of its body — and the mouth end has hundreds of teeth. When applied to an injury or reattached limb, leeches dig their teeth right into the flesh and start sucking. Surprisingly, the bite doesn't seem to hurt. That's because leech saliva contains a natural anesthetic, or pain-killer.

Leech saliva is also full of other important curative chemicals. One is called hirudin, which keeps blood from clotting. Scientists have devised a method to genetically engineer hirudin, which they hope to prescribe as an alternative treatment for unclogging blood vessels during heart surgery.

Another leech benefit is an agent that prevents bacteria from infecting the wound area. And a third is a vasodilator, which causes human blood vessels to open. "Leeches are like a mini-drugstore, because of the 'cocktail' of chemicals within their systems," says Anna Baldwin at the Biopharm Leech Center in Charleston, South Carolina. The potent leech cocktail seems to promote the circulation of blood critical to healing a wound. By the way, when a leech has finished sucking your blood, it simply falls off. How comforting!

Will such creepy folk remedies become part of the future's mainstream medicine? Would you let a doctor apply slimy maggots or leeches to your body? If you love gross-outs, your prayers have been answered.

From: scholastic.com

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Civil War Bloodletting

By Glenna R. Schroeder-Lein

A patient suffering from an infectious illness characterized by a high fever, a rapid pulse, and delirium was considered to have an inflammation caused by congestion of the blood vessels and excited tissues. In the terminology of the time this was called a "sthenic" disease. The category included such illnesses as typhoid fever and pneumonia.

Doctors believed that the way to reduce the inflammation was by depleting the fluids. This could be done through bloodletting by cutting a vein or an artery or, less drastically, by using leeches to suck a smaller amount of blood. Bleeding was practiced infrequently by the time of the Civil War. Only four instances were recorded in "The Medical and Surgical History of the War of the Rebellion".

Depletion could also be achieved by the use of "counter-irritants". These substances and procedures were supposed to provide a sort of distraction for the body by drawing blood to the surface of the skin and thus relieving the inflammation. Cupping consisted of heating a glass or metal cup and placing it on the skin--for example, on the chest or back of a pneumonia patient. As the glass or metal cooled, it pulled the patient's skin into the cup, creating a painful irritation. Blistering could be achieved by mustard plasters, poultices, or specific substances applied to the part to be irritated.

Although counter-irritants did not cure any illnesses, they continued to be used into the twentieth century.

From: "The Encyclopedia of Civil War Medicine"

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Bloodletting (Venesection) During the Civil War

By Dr. Michael Echols

After reviewing an inventory list of medical supplies from a N.Y. military hospital at the end of the War, the presence of scarificators in the inventory lead to this investigation of evidence in the military literature of bloodletting being in use during the War.   From examination of the literature gathered from the Medical and Surgical History citations, venesection was indeed practiced during the Civil War, but was rapidly being abandoned as the War years progressed and knowledge of medicine and bleeding wounds increased.

In eighteenth- and nineteenth-century America, many symptoms of illness were believed to be caused by an excess of blood: the removal of some was therefore thought to alleviate the condition. There were two main methods of bloodletting: using leeches and venesection (i.e. cutting open a vein).  Bloodletting is achieved by fleams, scarificators, cupping glasses, leeches, and assorted instruments.

Venesection (or phlebotomy) was the technique of lancing open a vein to remove blood, which could be drained into a bowl. It could also be removed by suction using a bloodletting cup in which was burned a small amount of alcohol to create a vacuum.   Leeches are annelid worms that inhabit fresh water. They are injurious to animals and people from whom they suck blood. They attach themselves by means of their strong mouth adapted to sucking. The medicinal leech, Hirudo medicinalis, was employed on "bleeding" patients. It is still used for some medical purposes and is a source of the anticoagulant, hirudin.

If you search for 'bloodletting' in the Medical and Surgical History of the War of the Rebellion not that much shows up.  However if you search for 'venesection', then many citations pro and con as well as actual cases are found.

There is abundant evidence reported of the earlier use of bloodletting and bleeding in the History, but only two cases of actual "bloodletting".  The problem is with the term: bloodletting.  The term used by surgeons at the time was 'venesection', not the older term 'bloodletting'.  Most of the information is in defense or rebuke of the process, not the actually use nor which instruments were used unless reference was made to a specific procedure like cupping or leeches.

Examples in the defense of bloodletting or venesection is found thorough out the various medical reports, much of which is from pre-War literature.  Of note is the adamant advice from the Confederate medical leaders that bloodletting should be avoided for various treatments.

The bottom-line is bloodletting or venesection was practiced through out the Civil War, because when the War started, bleeding was an accepted practice in the medical community.  As the war progressed, evidence based treatment was leaning against the use of bleeding for various medical or surgical problems as reported in the Medical and Surgical History.

Edited from the medical text book Handbook of Surgical Operations, 1863, (in this collection)  written during the Civil War by Stephen Smith, M.D.:

BLOODLETTING: The abstraction of blood is divided into general and local bleeding.

General Bleeding.—In general bleeding, blood may be drawn from the veins, when the operation is called venesection; or from the arteries, when it is known as arteriotomy.

Lancets differ as to their points; some are very blunt, others are very acute- the more obtuse are generally used when the vessel is superficial, and the more acute when it is deeply seated.

Venesection.—Blood may be taken from any of the superficial veins, but those of the neck, the bend of the arm, and at the ankle, are generally selected. The patient may be seated or recumbent, but in general the position should be chosen which most enlarges the vessels. The operation should commence by stopping the flow of blood to the heart by a ligature applied around the part on the proximal side of the point selected for the operation, sufficiently firm to close the veins and still leave the arteries unobstructed. The veins now become prominent unless the person is very fleshy, when the position of the vein must be determined by its corded feel. The operation is performed by placing the thumb of the left hand firmly on the vein (Fig. 40), a little to the distal side, to prevent the vessel from rolling aside on the attempt to puncture it. The lancet, held-between the thumb and index finger of the right hand, the blade at an obtuse angle with the hand, is plunged into the vein obliquely to its transverse diameter, and the hand being fixed, the point of the lancet is elevated so as to cut its way out.

The success of the operation is determined by the flow; if this should be slight, it may be due to too small an orifice, which should then be enlarged; or to a mass of protruding fat, which may be pushed aside. If an increased flow is required the patient should be directed to grasp repeatedly the staff, or the operator may rub the limb from the wrist towards the elbow.

When the proper amount of blood is drawn the band should be removed, and a small compress being placed over the wound, a figure-of-eight bandage is applied;. to prevent air entering the circulation in bleeding from the jugular, pressure on the wound should be made before the compress is removed.

Venesection is generally performed either on the external jugular, the median basilic or cephalic, or the internal saphena.

External Jugular.—A compress is placed over the vein in the supra-clavicular fossa, and firmly retained by a bandage passed over it and under the opposite axilla; the index finger of the left hand is placed upon the vein above, and the incision is made upwards and outwards across the platysma myoides.

Median Basilic and Cephalic.—The cephalic vein may be selected on account of its isolation. The basilic is the largest, but the brachial artery passing directly under it is in danger of being wounded. The position of the artery must first be determined. A band is then passed firmly around the arm, above the elbow, and with his band the patient grasps a staff. The operator, standing in front of the patient, grasps the arm with the left hand, placing the thumb on the distended vein, and the fingers on the back of the elbow, and holding the lancet in the right, opens the vessel.

Internal Saphena.—The foot is first placed in a vessel of warm water to distend the veins; a band is then passed around the leg, just above the malleoli; the thumb being placed on the vein it is opened just above the inner ankle, with an oblique incision.

Arteriotomy.—The temporal artery is that on which this operation is practised. It may be opened just over the zygoma, in front of the tragus, before its division into the anterior .and posterior branches, but the anterior branch is generally selected. The position of the artery is determined by its pulsations; the skin being made tense a straight incision is made with a scalpel, involving a part of the caliber of the vessel; when a sufficient amount of blood has been withdrawn the artery should be completely divided, and compression made on either side of the incision with small graduated compresses, firmly retained with a bandage.

Local Bleeding.—The local abstraction of blood is effected by leeching, cupping, scarification, and punctures.

Leeching.—Leeches should not be applied to parts liable to infiltration of blood, and discoloration, as the eyelids, scrotum, prepuce, or where a wound would disfigure, as their bites sometimes leave scars, nor over the track of a superficial vein. They are best applied by placing them in a small glass vessel, and inverting it over the inflamed part; blood, or sweetened milk, is often put on the skin. A single leech can take about an ounce of blood. When removed, the parts may be fomented to increase the flow; if it is desired to stop the blood the bites may be sprinkled with flour, starch, or other absorbent material; if the flow of blood continues astringents are used, of which the best is the persulphate of iron.

Cupping.—Cupping requires a scarificator and cupping-glass. The scarificator is an instrument containing eight or twelve blades, moved by a single spring, and so arranged as to be readily graduated as to the depth which they shall penetrate. They cover but the small space of an inch and a half or two inches square, and make eight, twelve, or more parallel cuts. The cupping-glass .may be simple tin or glass, of the proper size and shape, and applied by exhausting  air within by burning a few drops of alcohol; or it may have an exhausting pump attached to the top ; or, finally, it may have an india-rubber top, which requires only to be squeezed to produce a vacuum. The latter cups have but lately come into use, and are preferable to any other.

Scarification.—In making scarifications, the lancet, scalpel, or bistoury should be used, and the cuts should be made only partially or entirely through the skin, as may be necessary to promote the local abstraction of blood. The incisions should generally be made the entire length of the inflamed part, and within an inch of each other. The flow of blood may be greatly increased by warm fomentations.

Puncturing.—Punctures are made with a straight sharp-pointed bistoury, or a common lancet. The instrument is thrust into the inflamed tissues, to a depth varying from an eighth of an inch to an inch, carefully avoiding vessels and nerves. They should' be repeated until the entire surface is relieved of tension. Warm fomentations will increase the depleting effect.

IMAGE: Cupping & lancet instruments shown in the c.1867 Tiemann catalogue

FROM: medicalantiques.com

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