Sanguinem, incisa vena, mitti, novum non est, sed nullum paene morbum esse in quo non mittatur novum est (II. x).
The operation continued just as frequent all through the Roman period, and the writings on venesection are very voluminous. Galen has three treatises on the subject. The operation was performed in exactly the same way as at the present day, and the lancet was apparently the same as that figured in modern instrument catalogues, viz. sharp-pointed, double-edged, and straight. A consideration of all the various operations to which the phlebotome was put bears this out. The following passage from Hippocrates shows that there were various sizes of the phlebotome:
Τοῖς γε μαχαιρίοις ὀξέσι δεῖ χρῆσθαι καὶ πλάτεσι, οὐκ ἐπὶ πάντων ὁμοίως παραγγέλλομεν, κτλ. (i. 60).
‘We do not recommend that the lancets narrow and broad should be used indiscriminately in all cases, for there are certain parts of the body which have a swift current of blood which it is not easy to stop. Such are varices and certain other veins. Therefore, it is necessary in these to make narrow openings, for otherwise it is not possible to stop the flow. Yet it is sometimes necessary to let blood from them. But in places not dangerous, and about which the blood is not thin, we use the lancets broader (πλατυτέροις χρῆσθαι τοῖς μαχαιρίοις), for thus and not otherwise will the blood flow.’
The phlebotome appears to have been a convenient instrument for all sorts of operations besides phlebotomy, especially for the opening of abscesses and the puncture of cavities containing fluid, and for fine dissecting work. Paulus Aegineta mentions its application for the excision of fistula lachrymalis (VI. xxii), the removal of warts (VI. lxxxvii), slitting the prepuce in phimosis (VI. lv), incising the tunica vaginalis in excision of hydrocele sac (VI. lxii), opening abscesses (VI. xxvii), dissection of sebaceous cysts (VI. xiv). Galen (xiv. 787) mentions its use in dissecting open an imperforate vagina. Celsus has no special word for phlebotome. He always refers to it by the general term scalpellus. Theodorus Priscianus, whose Latin takes curious forms, gives us a transliteration of the Greek term:
Convenit interea prae omnibus etiam his flebotomum adhibere, convenit etiam eos ventris purgatione iuvari (Euporiston, xxi. 66).
Hippocrates in the famous passage on the surgical treatment of empyema (ii. 258) says:
‘Incise the skin between the ribs with a bellied scalpel, then let a phlebotome (ὀξυβελεῖ) which has been wound round with a rag, leaving the breadth of the thumb nail at the point, be pushed in.’
Ὀξυβελής literally means sharp-pointed. The term occurs in the Iliad, e. g. applied to an arrow (iv. 126), but Galen in his Lexicon expressly states that Hippocrates by it means the phlebotome. In his treatment of empyema Paulus Aegineta uses not the phlebotome but a sharp curved bistoury; however, in opening the abdomen for ascites it is the phlebotome he recommends:
‘We take a curved bistoury or a phlebotome and, having with the point of the instrument dissected the skin that lies over the peritoneum, we divide the peritoneum a little higher up than the first incision, and insert a tube of bronze.’