Fashion, capricious everywhere, is especially so in surgery and medicine. Smoking we are now taught to regard as a pernicious practice, to be abhorred as James the First abhorred it. Yet Dr. Archer, and Dr. Everard in his "Panacea, or a Universal Medicine, being a discovery of the wonderful virtues of Tobacco" (1659), warmly defended the habit, and for long it was held by the highest authorities to be an efficacious preservative against disease. What would schoolboys now say to being flogged for not smoking? Yet Thomas Hearne, in his diary (1720-21) writes—"Jan. 21, I have been told that in the last great plague in London none that kept tobacconists' shops had the plague. It is certain that smoking was looked upon as a most excellent preservative. In so much, that even children were obliged to smoak. And I remember that I heard formerly Tom Rogers, who was yeoman beadle, say, that when he was that year, when the plague raged, a school-boy at Eton, all the boys of that school were obliged to smoak in the school every morning, and that he was never whipped so much in his life as he was one morning for not smoaking."Blood-letting, so long a popular remedy with physicians, has, like tobacco-smoking for medicinal purposes, fallen into disuse and contempt. From Hippocrates to Paracelsus, who, with characteristic daring, raised some objections to the practice of venesection, doctors were in the habit of drawing disease from the body as vintners extract claret from a cask, in a ruddy stream. In the feudal ages bleeding was in high favour. Most of the abbeys had a "flebotomaria" or "bleeding-house," in which the sacred inmates underwent bleedings (or "minutions" as they were termed) at stated periods of the year, to the strains of psalmody. The brethren of the order of St. Victor underwent five munitions annually—in September, before Advent, before Lent, after Easter, and at Pentecost.

There is a good general view of the superstitions and customs connected with venesection, in "The Salerne Schoole," a poem of which mention continually occurs in the writings of our old physicians. The poem commences with the following stanza:—

Wadd mentions an old surgical writer who divides his chapter on bleeding under such heads as the following:—1. What is to limit bleeding? 2. Qualities of an able phlebotomist; 3. Of the choice of instruments; 4. Of the band and bolster; 5. Of porringers; 6. Circumstances to be considered at the bleeding of a Prince.

Simon Harward's "Phlebotomy, or Treatise of Letting of Bloud; fitly serving, as well for an advertisement and remembrance to all well-minded chirurgians, as well also to give a caveat generally to all men to beware of the manifold dangers which may ensue upon rash and unadvised letting of bloud," published in the year 1601, contains much interesting matter on the subject of which it treats. But a yet more amusing work is one that Nicholas Gyer wrote and published in 1592, under the following title:—

"The English Phlebotomy; or, Method and Way of Healing by Letting of Bloud."

On the title-page is a motto taken from the book of Proverbs—"The horse-leach hath two daughters, which crye, 'give, give.'"

The work affords some valuable insight into the social status of the profession in the sixteenth century.

In his dedicatory letter to Master Reginald Scot, Esquire, the author says that phlebotomy "is greatly abused by vagabund horse-leaches and travailing tinkers, who find work almost in every village through whom it comes (having in truth neither knowledge, nor witte, nor honesty), the sober practitioner and cunning chirurgian liveth basely, is despised, and accounted a very abject amongst the vulgar sort." Of the medical skill of Sir Thomas Eliot, and Drs. Bulleyn, Turner, PeniÉ, and Coldwel, the author speaks in terms of warm eulogy; but as for the tinkers aforementioned, he would regard them as murderers, and "truss them up at Tyborne."

Gyer, who indulges in continual reference to the "Schola Salerni," makes the following contribution to the printed metrical literature on Venesection:—

"Certaine very old English verses, concerning the veines and letting of bloud, taken out of a very auncient paper book of Phisicke notes:—

To bleed on May-day is still the custom with ignorant people in a few remote districts. The system of vernal minutions probably arose from that tendency in most men to repeat an act (simply because they have done it once) until it has become a habit, and then superstitiously to persevere in the habit, simply because it is a habit. How many aged people read certain antiquated journals, as they wear exploded garments, for no other reason than that they read the same sort of literature, and wore the same sort of habiliments, when young. To miss for once the performance of a periodically recurring duty, and so to break a series of achievements, would worry many persons, as the intermitted post caused Dr. Johnson discomfort till he had returned and touched it. As early as the sixteenth century, we have Gyer combating the folly of people having recourse to periodic venesections. "There cometh to my minde," he says, "a common opinion among the ignorant people, which do certainly beleeve that, if any person be let bloud one yere, he must be let bloud every yere, or else he is (I cannot tell, nor they neither) in how great danger. Which fonde opinion of theirs, whereof soever the same sprong first, it is no more like to be true, than if I should say: when a man hath received a great wound by chaunce in any part of his body, whereby he loseth much bloud; yet after it is healed, he must needs have the like wounde againe there the next yeare, to avoid as much bloud, or els he is in daunger of great sickness, yea, and also in hazard to lose his life."

The practitioners of phlebotomy, and the fees paid for the operation, have differed widely. In the middle of the last century a woman used the lancet with great benefit to her own pocket, if not to her patients, in Marshland, in the county of Norfolk. What her charge was is unknown, probably, however, only a few pence. A distinguished personage of the same period (Lord Radnor) had a great fondness for letting the blood (at the point of an amicable lancet—not a hostile sword) of his friends. But his Lordship, far from accepting a fee, was willing to remunerate those who had the courage to submit to his surgical care. Lord Chesterfield, wanting an additional vote for a coming division in the House of Peers, called on Lord Radnor, and, after a little introductory conversation, complained of a distressing headache.

"You ought to lose blood then," said Lord Radnor.

"Gad—do you indeed think so? Then, my dear lord, do add to the service of your advice by performing the operation. I know you are a most skilful surgeon."

Delighted at the compliment, Lord Radnor in a trice pulled out his lancet-case, and opened a vein in his friend's arm.

"By-the-by," asked the patient, as his arm was being adroitly bound up, "do you go down to the House to-day?"

"I had not intended going," answered the noble operator, "not being sufficiently informed on the question which is to be debated; but you, that have considered it, which side will you vote on?"

In reply, Lord Chesterfield unfolded his view of the case; and Lord Radnor was so delighted with the reasoning of the man (who held his surgical powers in such high estimation), that he forthwith promised to support the wily earl's side in the division.

"I have shed my blood for the good of my country," said Lord Chesterfield that evening to a party of friends, who, on hearing the story, were convulsed with laughter.

Steele tells of a phlebotomist who advertised, for the good of mankind, to bleed at "threepence per head." Trade competition has, however, induced practitioners to perform the operation even without "the threepence." In the Stamford Mercury for March 28, 1716, the following announcement was made:—"Whereas the majority of apothecaries in Boston have agreed to pull down the price of bleeding to sixpence, let these certifie that Mr Clarke, apothecary, will bleed anybody at his shop gratis."

The readers of Smollett may remember in one of his novels the story of a gentleman, who, falling down in his club in an apoplectic fit, was immediately made the subject of a bet between two friendly bystanders. The odds were given and accepted against the sick man's recovery, and the wager was duly registered, when a suggestion was made by a more humane spectator that a surgeon ought to be sent for. "Stay," exclaimed the good fellow interested in having a fatal result to the attack, "if he is let blood, or interfered with in any way, the bet doesn't hold good." This humorous anecdote may be found related as an actual occurrence in Horace Walpole's works. It was doubtless one of the "good stories" current in society, and was so completely public property, that the novelist deemed himself entitled to use it as he liked. In certain recent books of "ana" the incident is fixed on Sheridan and the Prince Regent, who are represented as the parties to the bet.

Elsewhere mention has been made of a thousand pounds ordered to be paid Sir Edmund King for promptly bleeding Charles the Second. A nobler fee was given by a French lady to a surgeon, who used his lancet so clumsily that he cut an artery instead of a vein, in consequence of which the lady died. On her death-bed she, with charming humanity and irony, made a will, bequeathing the operator a life annuity of eight hundred livres, on condition "that he never again bled anybody so long as he lived." In the Journal EncylopÉdique of Jan. 15, 1773, a somewhat similar story is told of a Polish princess, who lost her life in the same way. In her will, made in extremis, there was the following clause:—"Convinced of the injury that my unfortunate accident will occasion to the unhappy surgeon who is the cause of my death, I bequeath to him a life annuity of two hundred ducats, secured by my estate, and forgive his mistake from my heart: I wish this may indemnify him for the discredit which my sorrowful catastrophe will bring upon him."

A famous French MarÉchal reproved the clumsiness of a phlebotomist in a less gratifying manner. Drawing himself away from the bungling operator, just as the incision was about to be made, he displayed an unwillingness to put himself further in the power of a practitioner, who, in affixing the fillet, had given him a blow with the elbow in the face.

"My Lord," said the surgeon, "it seems that you are afraid of the bleeding."

"No," returned the MarÉchal, "not of the bleeding—but the bleeder."

Monsieur, brother of Louis XIV., had an insuperable aversion to the operation, however dexterous might be the operator. At Marly, while at table with the King, he was visited with such ominous symptoms, that Fochon, the first physician of the court, said—"You are threatened with apoplexy, and you cannot be too soon blooded."

But the advice was not acted on, though the King entreated that it might be complied with.

"You will find," said Louis, "what your obstinacy will cost you. We shall be awoke some of these nights to be told that you are dead."

The royal prediction, though not fulfilled to the letter, soon proved substantially true. After a gay supper at St. Cloud, Monsieur, just as he was about to retire to bed, quitted the world. He was asking M. de Ventadour for a glass of liqueur sent him by the Duke of Savoy, when he dropped down dead. Anyhow Monsieur went out of this life thinking of something nice. The Marquis of Hertford, with all his deliberation, could not do more.

The excess to which the practice of venesection was carried in the last century is almost beyond belief. The Mercure de France (April, 1728, and December, 1729) gives the particulars of the illness of a woman named Gignault. She was aged 24 years, was the wife of an hussar, and resided at St. Sauge, a town of the Nivernois. Under the direction of Monsieur Theveneau, Seigneur de Palmery, M.D., of St. Sauge, she was bled three thousand nine hundred and four times in nine months (i. e. from the 6th of September, 1726, to the 3rd of June, 1727). By the 15th of July, in the same year, the bleedings numbered four thousand five hundred and fifty-five. From the 6th of September, 1726, to the 1st of December, 1729, the blood-lettings amounted to twenty-six thousand two hundred and thirty. Did this really occur? Or was the editor of the Mercure de France the original Baron Munchausen?

Such an account as the above ranges us on the side of the German physician, who petitioned that the use of the lancet might be made penal. Garth's epigram runs:—

It would, however, be difficult to imagine a quicker method to destroy human life than that pursued by Monsieur Theveneau. A second adviser could hardly have accelerated his movements, or increased his determination not to leave his reduced patient a chance of recovery.

"A rascal," exclaimed a stout, asthmatic old gentleman, to a well-dressed stranger on Holborn Hill—"a rascal has stolen my hat. I tried to overtake him—and I'm—so—out of breath—I can't stir another inch." The stranger eyed the old gentleman, who was panting and gasping for hard life, and then pleasantly observing, "Then I'm hanged, old boy, if I don't have your wig," scampered off, leaving his victim bald as a baby. M. Theveneau was the two thieves in one. He first brought his victim to a state of helplessness, and then "carried out his little system." It would be difficult to assign a proper punishment to such a stupid destroyer of human life. Formerly, in the duchy of Wurtemberg, the public executioner, after having sent out of the world a certain number of his fellow-creatures, was dignified with the degree of doctor of physic. It would not be otherwise than well to confer on such murderous physicians as M. Theveneau the honorary rank of hangman extraordinary.

The incomes that have been realized by blood-letting alone are not less than those which, in the present day, are realized by the administration of chloroform. An eminent phlebotomist, not very many years since, made a thousand per annum by the lancet.

About blood-letting—by the lancet, leeches, and cupping (or boxing, as it was called in Elizabeth's days, and much later)—the curious can obtain many interesting particulars in our old friend Bulleyn's works.

To open a vein has for several generations been looked on as beneath the dignity of the leading professors of medicine or surgery. In some cases phlebotomy was practised as a sort of specialty by surgeons of recognised character: but generally, at the close of the last century, it was left, as a branch of practice, in the hands of the apothecary. The occasions on which physicians have of late years used the lancet are so few, that it is almost a contribution to medical gossip to bring up a new instance. One of the more recent cases of a notability being let blood by a physician, was when Sir Lucas Pepys, on Oct. 2, 1806, bled the Princess of Wales. On that day, as her Royal Highness was proceeding to Norbury Park, to visit Mr. Locke, in a barouche drawn by four horses, the carriage was upset at Leatherhead. Of the two ladies who accompanied the Princess, one (Lady Sheffield) escaped without a bruise, but the other (Miss Cholmondley) was thrown to the ground and killed on the spot. The injuries sustained by the Princess were very slight, but Sir Lucas Pepys, who luckily happened to be in the neighbourhood at the time of the accident, bled her on his own responsibility, and with his own hand.