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By Root 1115 0

and, in the blink of an eye, slips in the three-quarter-inch needle. Steve doesn’t flinch. (I do.) He’s had this procedure done at least fifty times in the past dozen years; he’s used to steeling himself against discomfort and potential bad news. That he’s had to learn this skill, I find heartbreaking. In this context I appreciate Rosemary’s gentleness and competency. Unlike some phlebotomists, she always uses a “butterfly,” a needle stabilized against the skin with tapered “wings” and connected to a narrow, eight-inch tube. At the end of this tubing is a barrel into which consecutive vials are inserted. The vacuum in each vial sucks Steve’s burgundy-black blood up through the thin hose. He loves butterflies. Without one, each vial has to be jammed directly into the base of the needle, which tends to rip up the vein. Butterflies are expensive, so not all labs use them.

Every piece of equipment Rosemary employs has evolved from basic bloodletting tools. The pressurized vials, which look like test tubes with color-coded caps, are a counterpart to bleeding bowls, large clay or pewter basins placed below the incision site to catch the blood. These were often graduated like measuring cups so the phlebotomist could tally the amount removed before discarding it. The modern syringe has a mixed heritage: Its housing is descended from the small glass cups used for suctioning blood from tiny cuts made in the skin. “Cupping” has a history almost as long as bloodletting. In practice these cups, heated over a flame, were applied to different parts of the body; a partial vacuum held them in place. Doctors used cupping for localized pain or if a patient was too young or weak to be bled properly from a vein. The syringe needle actually has the most ancient origins, reaching all the way back to the earliest human’s use of a thorn or animal tooth to break the skin. Jumping forward to the early eighteenth century, the preferred implement for piercing a vein was the new spring lancet, as compact as nail clippers, with a trigger-activated blade. One Baltimore bloodletter so adored his spring lancet that he was driven to poetry. “I love thee, bloodstain’d, faithful friend!” one stanza began.

The most cringe-inducing tool of the bloodletter was the leech, although nothing in Rosemary’s work space is remotely related, thank God. Like cupping, leeches had been used since antiquity as an auxiliary to venesection. Placed on the skin, these bloodsucking creatures, close kin to earthworms, fed on a patient until sated. After about an hour, they’d drop off. A doctor would typically employ five to ten at a time, although to be covered with fifty wasn’t unheard of. Leeches were handy for hard-to-reach spots, such as up the anus, down the throat, or inside the vagina. Tiny thread leashes kept the leeches from getting lost. The leech of choice was the European Hirudo medicinalis, exported worldwide from Sweden and Germany. In 1833 alone France imported 41.5 million of the suckers. A standard part of medical practice, leeches were kept close by in water-filled clay or glass jars.

A woman self-medicating with leeches, as depicted in a seventeenth-century woodcut

One would think that the huge gains made in understanding human biology from the Renaissance forward would’ve curtailed the popularity of bloodletting. But no. In fact, the practice reached its height in the eighteenth and nineteenth centuries. The Western world’s most powerful people, receiving what was considered the very best of care, were needlessly bled, cupped, and leeched. Retired president George Washington’s death in December 1799 was hastened by excessive bloodletting, for example, historians conclude. The president, sixty-seven and suffering from a severe throat inflammation, was tended by three top physicians who could have saved their patient’s life had they had access to two things not yet invented: antibiotics and steroids. Instead, they bled Washington four times within a twelve-hour period, a total of 2.5 quarts. He died that day. It sounds like manslaughter to me, but the doctors