Even though it was recognized that bleeding was a delicate operation that could be fatal if not done properly, it was, from the medieval period on, often left in the hands of the barber-surgeons, charlatans, and women healers. In the early Middle Ages the barber-surgeons flourished as their services grew in demand. Barber-surgeons had additional opportunities to practice medicine after priests were instructed to abandon the practice of medicine and concentrate on their religious duties. Clerics were cautioned repeatedly by Pope Innocent II through the Council at Rheims in 1131, the Lateran Council in 1139, and five subsequent councils, not to devote time to duties related to the body if they must neglect matters related to the soul.[30]
By 1210, the barber-surgeons in England had gathered together and formed a Guild of Barber-Surgeons whose members were divided into Surgeons of the Long Robe and Lay-Barbers or Surgeons of the Short Robe. The latter were gradually forbidden by law to do any surgery except bloodletting, wound surgery, cupping, leeching, shaving, extraction of teeth, and giving enemas.[31] The major operations were in the hands of specialists, often hereditary in certain families, who, if they were members of the Guild, would have been Surgeons of the Long Robe.
Figure 4.—Bleeding bowl with gradations to measure the amount of blood. Made by John Foster of London after 1740. (Held by the Division of Cultural History, Greenwood Collection, Smithsonian Institution; SI photo 61166-C.)
To distinguish his profession from that of a surgeon, the barber-surgeon placed a striped pole or a signboard outside his door, from which was suspended a basin for receiving the blood (Figure [4]). Cervantes used this type of bowl as the “Helmet of Mambrino” in Don Quixote.[32] Special bowls to catch the blood from a vein were beginning to come into fashion in the fourteenth century. They were shaped from clay or thin brass and later were made of pewter or handsomely decorated pottery. Some pewter bowls were graduated from 2 to 20 ounces by a series of lines incised around the inside to indicate the number of ounces of fluid when filled to that level. Ceramic bleeding bowls, which often doubled as shaving bowls, usually had a semicircular indentation on one side to facilitate slipping the bowl under the chin. Bowls to be used only for bleeding usually had a handle on one side. Italian families had a tradition of passing special glass bleeding vessels from generation to generation. The great variety in style, color, and size of bleeding and shaving bowls is demonstrated by the beautiful collection of over 500 pieces of Dr. A. Lawrence Abel of London and by the collection of the Wellcome Historical Museum, which has been cataloged in John Crellin’s Medical Ceramics.[33] These collections illustrate the stylistic differences between countries and periods.
The barber-surgeons’ pole represented the stick gripped by the patient’s hand to promote bleeding from his arm. The white stripe on the pole corresponded to the tourniquet applied above the vein to be opened in the arm or leg. Red or blue stripes appeared on early barber poles, but later poles contained both colors.[34]
The dangers posed by untutored and unskilled bleeders were noted periodically. In antiquity Galen complained about non-professional bleeders, and in the Middle Ages, Lanfranc (1315), an outstanding surgeon, lamented the tendency of surgeons of his time to abandon bloodletting to barbers and women.[35] Barber-surgeons continued to let blood through the seventeenth century. In the eighteenth and nineteenth centuries, the better educated surgeon, and sometimes even the physician, took charge of bleeding.
Bloodletting and the Scientific Revolution
The discovery of the blood’s circulation did not result in immediate changes in the methods or forms of bloodletting. William Harvey, who published his discovery of circulation in 1628, recognized the value of investigating the implications of his theory. Harvey could not explain the causes and uses of the circulation but he believed that it did not rule out the practice of bloodletting. He claimed that