All these various applications of the phlebotome are consistent with the supposition that the phlebotome was the same as that figured in the catalogues of the present day. Heister says:
Spectant huc primo loco ea quae Tab. 1 sub litt. A & B ([Pl. VII, figs. 6, 7]) exhibentur, scalpellum nempe minus et maius; vulgus lancettas eadem nominant. Serviunt eadem, praesertim minora, venis incidendis, quare phlebotoma Graecis vocantur; sed et abscessibus aperiendis, imprimis maiora; ideoque Gallis etiam lancettes a l’absces appellari consueverunt.
A bronze blade of this shape is shown in [Pl. VII, fig. 3]. It was found near Rome.
The identity in shape of the abscess knife and the phlebotome holds good to-day. The best example of the phlebotome is in the Cologne Museum. It was found in the Luxemburgerstrasse along with the other contents of a surgeon’s case. It is all of steel, with a square handle and blade of myrtle leaf shape ([Pl. VII, fig. 2]). There is in the Naples Museum an instrument which is of this shape, and Vulpes (Tav. VI, fig. 1) has described it as a lancet for bleeding. The instrument, however, is formed of a blade of silver set in a handle of bronze, so that it can scarcely be regarded as a cutting instrument (see [Pl. XIX, fig. 2]). I look upon it as an unguent spatula. There is, however, an instrument of bronze of phlebotome shape in the Naples Museum. It was found in the house of the physician in the Strada del Consulare of Pompeii, and it was described by Vulpes as an instrument for removing the eschar formed by a cautery, as it was found lying alongside a small trident-shaped cautery. It is doubtful whether the eschar formed by a cautery was removed at all, and it is still more doubtful whether Vulpes is justified in postulating a special instrument for doing so, and as this instrument is of phlebotome shape it is more likely to have been a phlebotome than anything else. It is of bronze, 8 cm. long and 9 mm. in the broadest part of the blade. The handle is neatly decorated with raised ring ornamentation.
The following account of the discovery of a phlebotome in excavating some graves along the line of the old Watling Street Road, in the neighbourhood of Wroxeter, is given by C. Roach Smith in the Gentleman’s Magazine (1862, pt. ii. p. 677):
‘Several sepulchral interments have been met with of a character similar to those usually found in Roman cemeteries. In some of them objects of particular interest were found, with urns and other earthen vessels; as, for instance, the fragments of a circular mirror in the bright, shining, mixed metal commonly known as ‘speculum’ metal; and what appears to be a surgeon’s lancet, contrived in a very ingenious manner. The point for penetrating the flesh is of steel, not unlike that in use at the present day. It is surmounted by a guard to hinder it from cutting too deeply, and above this is a handle, which is bow-shaped, and of bronze.’
J. Corbet Anderson, in The Roman City at Wroxeter, p. 92, says it was embedded in the remains of a case in which it had been carried, and he gives an illustration of it ([Pl. VII, fig. 5]). A similar object is classified as a surgical instrument in the Louvre, but both these articles are I believe detached mirror handles. The passage quoted from Hippocrates shows that the ordinary phlebotome was not guarded in this way. A phlebotome of the principle of the fleam is figured by Albucasis and the method of using it in dividing the frontal vein by striking it with a comb is described. There is also a similar instrument in the Naples Museum, from Pompeii, which is classed as a veterinary instrument ([Pl. VIII, fig. 3]). It is probable, however, that such an instrument was used by Roman physicians, as the offices of surgeon and veterinarian were often held by the same individual in Roman times. It is not unlikely that the method is referred to by Antyllus in the passage beginning—ποτὲ μὲν καταπείροντες ποτὲ δὲ ἀναπείροντες φλεβοτοῦμεν (Oribasius, Collect. VII. x).
This passage describing the technique of phlebotomy has given rise to great and voluminous discussion (see Daremberg’s Oribas. vol. ii. p. 776) from the fact that Antyllus goes on to state that we operate καταπείροντες—cutting inwards—in cases where the vessels are deep, and ἀναπείροντες—cutting outwards—where the vessels are superficial, and the advice has seemed to most commentators to be the reverse of what one would expect. The explanation seems to me to be simple. Superficial vessels are those which could be seen standing out on applying the fillet, and were to be divided by the method in vogue at the present day by transfixing the vessel through its middle and bringing the lancet outwards. The reason of this is that the danger of injuring important structures lying deep to the vein was well understood by the ancients. Thus Galen warns against wounding the nerve in phlebotomy of the median, the tendon of the biceps in phlebotomy of the scapulo-cephalic, the artery in dividing the basilic, and so on. But in opening deep-lying veins the method of transfixing was inapplicable, and the bone was cut boldly down upon till the issue of blood showed that the vein was opened. The deep vessels which were divided were those about the scalp, and as they had no important relations they were divided by cutting through everything overlying the bone, often with razor-shaped knives. Thus Paulus Aegineta (VI. vii) says: ‘When many deep vessels send a copious defluxion to the eyes we have recourse to the operation called Periscyphismus.’ This consisted in making a transverse incision down to the bone over the vertex from one temple to the other.
The ‘Katias.’
Κατιάς -ιάδος (ἡ) (Soranus, II. xviii); καθιάς (Paul, VI. lxxiv); κατιάδιον (τό) (Aetius, II. iii. 2); κατειάδιον (τό) (Aretaeus, Cur. Morb. Diut. i. 2).