measured. When enough blood was removed, the bleeding would be
stopped by a bandage or compress applied to the incision.

[Illustration: FIGURE 5.--18th-19th century lancets and lancet cases. The
cases are made of mother-of-pearl, silver, shagreen, and tortoise shell.
(NMHT 308730.10. SI photo 76-9116.)]

Teaching a medical student how to bleed has had a long tradition. Before
approaching a patient, the student practiced opening a vein quickly and
accurately on plants, especially the fruits and stems.[51] The mark of a
good venesector was his ability not to let even a drop of blood be seen
after the bleeding basin was removed.[52]

It required some degree of skill to strike a vein properly. The most
common vein tapped was in the elbow, although veins in the foot were also
popular. The arm was first rubbed and the patient given a stick to grasp.
Then a tourniquet would be applied above the elbow (or, if the blood was
to be taken from the foot, above the ankle), in order to enlarge the veins
and promote a continuous flow of blood. Holding the handle between the
thumb and the first finger, the operator then jabbed the lancet into the
vein. Sometimes, especially if the vein was not close to the surface of
the skin, the instrument was given an extra impetus by striking it with a
small mallet or the fingers to insure puncturing the vein.[53] The
incisions were made diagonally or parallel to the veins in order to
minimize the danger of cutting the vein in two.[54]

For superficial veins, the vein was sometimes transfixed, that is, the
blade would be inserted underneath the vessel so that the vessel could not
move or slip out of reach. The transfixing procedure ensured that the vein
would remain semi-divided so that blood would continuously pass out of it,
and that injury to other structures would be avoided. Deep-lying veins of
the scalp, for example, could not be transfixed. They were divided by
cutting through everything overlying them since there were no important
structures to injure.[55]

The consequences of puncturing certain veins incorrectly were discussed by
many early writers including Galen, Celsus, Antyllus, and Paul of
Aegina.[56] Injury to a nearby nerve, muscle, or artery resulted in
convulsions, excessive bleeding, or paralysis.

Bloodletting was at its most fashionable in the eighteenth and early
nineteenth centuries. In this period it was considered an art to hold the
lancet properly and to support