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Fleam

A fleam is a historical handheld surgical instrument designed for bloodletting, typically featuring a metal blade or multiple blades attached to a handle made of materials such as horn, wood, or metal, used to incise veins and release blood as a medical treatment.^[1]^[2] Originating in antiquity, with evidence of bloodletting practices dating back to ancient Egypt around 1550 BC, the fleam emerged as a specialized tool by the medieval period, particularly in Europe and Scandinavia, where it was employed to balance bodily humors according to prevailing medical theories.^[3]^[1] Archaeological finds from sites like medieval Oslo (AD 1240–1500) reveal fleams with looped terminals, rectangular cross-sections, and U-shaped blades, indicating their use by practitioners including barber-surgeons in both urban residential and professional settings.^[1] The instrument's application extended to both human and veterinary medicine, with variations including single or multiple folding blades for precise incisions on arms, necks, or animal limbs, often swung to strike a vein while blood was collected in a bowl; sessions could remove from milliliters to several cups of blood to treat ailments ranging from fevers to mental disorders.^[4]^[1]^[3] By the 16th to 19th centuries, refinements such as thumb-operated lancets and spring-loaded mechanisms improved its efficiency, though bloodletting—and thus the fleam's prominence—waned in the late 1800s as scientific studies demonstrated its risks, including fatalities, leading to its obsolescence in favor of modern phlebotomy techniques for conditions like hemochromatosis.^[4]^[3]^[1]

Etymology and Terminology

Origins of the Name

The term "fleam," referring to a lancet-like instrument used in bloodletting, derives from the Greek phlebotomos, a compound word meaning "vein-cutter" or "one who opens a vein," formed from phlebos (blood vessel or vein) and tomos (a cutting or incision).^[5] This etymological root reflects the instrument's primary function in phlebotomy, the ancient practice of therapeutic blood removal. The Greek term entered Latin as phlebotomus, serving as the basis for subsequent adaptations in Romance and Germanic languages.^[6] The earliest recorded use of "fleam" in English appears in late Old English texts around 1000 AD, where it entered via Old French flieme (Modern French flamme), from Medieval Latin fletoma and Late Latin flebotomus.^[5] This transition occurred during a period when medical terminology was being vernacularized in early medieval England, drawing on Latin ecclesiastical and scholarly texts that preserved classical knowledge. By the late Old English era, "fleam" specifically denoted the surgical tool for venesection, distinguishing it from broader terms for bloodletting procedures.^[5] The term's wider adoption across European languages was significantly shaped by medieval translations of Greek medical texts, including those by Galen (c. 129–216 AD), whose treatises on humoral imbalances and phlebotomy—such as De venae sectione adversus Erasistratum—emphasized precise vein incision for health restoration.^[7] These works, first rendered into Arabic by scholars like Hunayn ibn Ishaq in the 9th century and later into Latin during the 12th-century Toledo School of Translators, introduced standardized phlebotomy vocabulary into Western medicine, influencing Middle English variants of "fleam."^[8] Galen's authoritative discussions on the instrument's application helped embed the term in professional lexicon, bridging ancient Greek concepts with emerging European medical traditions.^[9]

Alternative Names

The fleam, a handheld surgical instrument used for bloodletting, has been known by several synonyms in English historical texts, including phleam and phlebotome, with the latter term deriving from the Greek phlebos (vein) and tomē (incision).^[10] In veterinary contexts, particularly among farriers, the variant phleme was employed to describe a lancet-like tool for animal venesection, as documented in historical medical texts.^[10] Regional linguistic adaptations include the German Fliete, a 17th- and 18th-century term for a right-angled blade variant used in Germany, Holland, and Vienna, and the French flamette (or flamme), referring to a similar design prevalent in the same era across French-speaking regions.^[11] These names reflect adaptations in medical terminology tied to local practices and etymological roots in Latin and Greek influences.^[12]

Physical Description

Design Features

The fleam is a handheld, lancet-like surgical instrument designed primarily for incising veins during bloodletting procedures, featuring a broad blade positioned at a right angle to the handle for stability and precision when struck.^[13] The blade typically adopts a U-shaped form for controlled penetration while minimizing tissue damage beyond the intended vein.^[1] This configuration allows the tool to be placed directly over accessible veins, facilitating a quick incision upon impact.^[14] In terms of dimensions, fleams generally measure 3 to 5 inches (80-130 mm) in overall length, with blade lengths typically ranging from 0.5 to 1 inch (12-25 mm) to accommodate varying incision depths and vein sizes.^[10] A protective bolster or shield encases the base of the blade, providing a firm striking surface and preventing accidental slippage during use, which enhances user safety and control.^[15] Many designs incorporate multiple folding blades of graduated sizes within the same handle, enabling selection based on the procedure's requirements without needing multiple tools.^[13] The handle is ergonomically shaped to fit comfortably in the palm, often with a flattened or shielded profile that distributes force evenly when the instrument is struck with a specialized fleam stick, a wooden or leather mallet-like tool.^[16] This design prioritizes one-handed operation and rapid deployment, reflecting the fleam's evolution as a practical tool for both human and veterinary applications in pre-modern medicine.^[1]

Components and Materials

The fleam consists of several key components designed for precise incision during bloodletting. The blade, typically double-edged and beveled for clean cuts into veins, forms the primary cutting element and is set at a right angle to the shank for effective penetration.^[10] Early single blades were straight and pointed, while later designs incorporated multiple fold-out blades—up to five in veterinary models—to allow for incisions of varying depths without repeated applications.^[10] The shank serves as the connecting element between the blade and handle, providing structural support and often featuring a hinged mechanism for folding the blade into a protective position.^[10] Handles offer a secure grip, frequently shaped as shields or cases to encase the blade when not in use, and bolsters—metal guards or reinforcements at the handle-blade junction—prevent slippage and protect the user's hand during operation.^[10] Historically, fleam materials evolved with advancements in metallurgy and availability. Pre-1000 AD examples, such as a Roman fleam from Pompeii, featured bronze blades measuring about 8 cm in length and 9 mm in width, reflecting early alloy use for durability.^[10] Medieval fleams often used iron for blades.^[1] By the 17th century, steel became the standard for blades due to its superior sharpness and strength, as seen in European hand-forged models from Switzerland and Tyrol.^[10] Shanks and bolsters were commonly crafted from brass, an alloy of copper and zinc, for corrosion resistance, while handles utilized organic materials like horn for lightweight protection in 19th-century designs, such as those with three steel blades folding into a horn shield (National Museum of History and Technology, NMHT 254866).^[10] Bone and wood appeared in handles for affordability, with bone used in some 19th-century veterinary fleams and wood in protective cases, though ivory was rarer, limited to handle tips in specialized instruments like certain bloodletting knives from 1844.^[10] The shift to multi-bladed fleams in the 18th and 19th centuries, often with brass or horn components, facilitated quicker procedures in both human and veterinary contexts, marking a transition from simple lancet-like tools to more versatile instruments.^[10]

Historical Development

Early Origins

The practice of bloodletting, foundational to the development of the fleam as a specialized instrument, traces its earliest precursors to the Bronze Age in ancient Egypt around 1500 BC, where rudimentary tools such as sharpened flint or bronze blades were employed to open veins and restore bodily balance. The Ebers Papyrus, dating to circa 1550 BC, documents extensive vascular and therapeutic procedures, including methods suggestive of bloodletting to alleviate ailments attributed to fluid imbalances.^[17] These early Egyptian techniques influenced subsequent Mediterranean practices, with artifacts from burials indicating the use of lancet-like devices for venesection.^[18] In ancient Greece, bloodletting gained theoretical grounding through the humoral theory articulated in Hippocratic texts from the 5th century BC, which posited that health required equilibrium among four bodily humors—blood, phlegm, yellow bile, and black bile—and prescribed phlebotomy to remove excess blood. Hippocrates and his followers advocated lancets or scalpels for precise incisions, marking an evolution from cruder tools to more refined metal instruments suited for targeted vein access.^[19] This Greek framework, emphasizing observation and humoral balance, directly informed Roman adaptations, where bloodletting became a staple of medical routine.^[20] Roman medicine integrated and refined these practices, introducing phlebotomes—early handheld venipuncture devices resembling the fleam—for both human and veterinary use, as described in texts like Celsus's De Medicina (1st century AD), which details bronze knives for incising veins. Surviving artifacts, such as a bronze phlebotome from Pompeii (approximately 8 cm long), illustrate the instrument's design with a fixed blade for efficient blood release, facilitating the spread of the technique across the Roman Empire and into Europe.^[10] By the early medieval period, this Roman legacy reached Anglo-Saxon England, where the term "fleam"—derived from the Latin phlebotomus or flebotome, meaning "vein cutter"—first appears in manuscripts around 1000 AD, documenting its application in therapeutic bloodletting.^[10] The fleam's role expanded in monastic medicine during the early Middle Ages, where bloodletting was a routine treatment in European religious communities to maintain humoral balance and treat fevers or imbalances, often guided by translated Arabic texts. Al-Zahrawi (936–1013 AD), in his seminal 10th-century encyclopedia Kitab al-Tasrif, devoted a volume to surgery that illustrated over 200 instruments, including specialized knives and lancets for phlebotomy, emphasizing precise techniques to minimize patient distress and infection.^[21] These descriptions, bridging classical and medieval practices, influenced early European surgical traditions by standardizing bloodletting tools and procedures in monastic infirmaries.^[18] Archaeological evidence from medieval sites further illuminates the fleam's use; for instance, excavations in Oslo (AD 1240–1500) have uncovered fleams with looped terminals, rectangular cross-sections, and U-shaped blades, suggesting employment by barber-surgeons in both urban residential and professional contexts across Scandinavia and Europe.^[1]

Evolution in Europe

The evolution of the fleam in Europe began to accelerate during the Renaissance, building on earlier medieval designs, with significant innovations emerging in the 17th century. In Germany, the introduction of the Fliete marked a key advancement, featuring blades set at right angles to the handle, which facilitated more precise incisions into veins. This design represented an early form of the modern fleam and was widely adopted across continental Europe for its ergonomic improvements over straight-bladed predecessors.^[10] By the 18th century, French instrument makers refined the fleam further through the development of flamettes, incorporating advanced steel forging techniques that enhanced blade durability and sharpness. These innovations drew on broader advancements in metallurgy, allowing for thinner, more resilient edges suitable for repeated use in surgical settings. The flamette thus exemplified the era's emphasis on precision craftsmanship in medical tools, with production centered in Parisian workshops.^[10] The 19th century saw the fleam's industrialization, particularly in Britain and Ireland, where mass production techniques enabled widespread availability. Centers like Sheffield in Britain became hubs for manufacturing, with firms such as Joseph Rodgers & Sons producing multi-bladed fleams using cast steel processes that standardized quality and reduced costs. In Ireland, the instrument's cultural significance was underscored by its depiction as two golden fleams in the coat of arms of the Royal College of Surgeons in Ireland, established in 1784 and formally granted arms in 1907, symbolizing the surgical heritage of the institution. Fleam production peaked between approximately 1800 and 1850, aligning with the height of bloodletting practices before scientific scrutiny began to diminish its use.^[22]^[8]

Medical and Veterinary Applications

Use in Human Medicine

In human medicine, the fleam served as a tool for bloodletting, a practice rooted in Galenic humoral theory, which posited that illness arose from imbalances in the four humors—blood, phlegm, yellow bile, and black bile—and that removing excess blood could restore equilibrium, particularly to treat fevers, inflammation, and various systemic disorders.^[20] Physicians employed fleams to incise superficial veins, believing this purged "corrupt" blood and alleviated symptoms associated with humoral excess.^[8] This approach dominated Western medicine from antiquity through the early modern period, with fleams facilitating controlled venesection as a staple intervention.^[11] Preferred venesection sites for fleam use included the veins of the forearm, such as the cephalic and median antecubital, the basilic vein at the elbow, and occasionally the jugular in the neck, selected based on the targeted humor or affected body region.^[10] However, fleams were less commonly employed in human practice compared to lancets or spring-loaded devices, largely due to their broader veterinary associations and the preference for more precise instruments in delicate human procedures.^[13] Historically, fleams featured prominently in epidemic responses, such as during the 14th-century Black Death, where bloodletting with such instruments was recommended to counteract plague-induced humoral corruption, though outcomes were often fatal due to excessive depletion.^[23] In the 17th century, eminent physicians like William Harvey, despite his groundbreaking work on blood circulation, continued advocating bloodletting, integrating the practice into his clinical routine even as it faced growing scrutiny.^[20] These applications highlight the fleam's entrenched, albeit diminishing, place in human medicine before the rise of evidence-based alternatives in the 19th century.^[1]

Use in Veterinary Practice

The fleam found its primary application in veterinary medicine for performing bloodletting on livestock and working animals, particularly horses, cattle, and dogs, to address conditions such as founder (also known as laminitis) and colic, which were believed to result from imbalances in bodily humors. In horses, the dominant species treated, fleams were used to incise the jugular vein in the neck, often struck with a wooden bloodstick to ensure a swift cut, as this site allowed for substantial blood removal to alleviate perceived excesses of blood or inflammation. For cattle, the saphenous vein along the hind leg served as a preferred access point, accommodating the instrument's blade size for effective venesection in larger vessels. Dogs, though less frequently documented, underwent similar procedures for analogous ailments, with techniques detailed for domestic species in late 19th-century veterinary guides.^[13]^[24]^[25] This practice was integral to farriery and animal husbandry during the 18th and 19th centuries, where farriers and specialized healers known as cowleeches routinely incorporated bloodletting into routine care to prevent or treat overwork-related disorders in draft animals. Veterinary texts from the era, such as those in Polish literature emphasizing farm animal management, described the fleam as an essential tool, with instructions for positioning the blade over the vein and securing it via hammer strike to minimize animal distress. British army veterinarian George Fleming, in his 1895 writings, provided detailed protocols for bloodletting across species, underscoring its persistence in professional practice well into the late 19th century, including recommendations for equine laminitis that echoed earlier mid-century advice.^[26]^[27]^[25] Although fleams were occasionally adapted for human use, a controversy arose over their suitability, as most designs featured broader blades optimized for the thicker veins of larger animals, rendering them less precise for smaller human vessels and prompting veterinary specialists to reserve them exclusively for animal treatments. This distinction highlighted the instrument's evolution toward specialized veterinary roles, separating it from finer human phlebotomy tools like lancets.^[28]

Procedure and Techniques

Bloodletting Process

The bloodletting process using a fleam began with careful preparation to ensure safety and precision. In human medicine, the practitioner identified superficial veins, such as the cephalic or basilic in the arm, often applying a tourniquet above the site to distend the vein and rubbing the skin to promote visibility.^[11] For veterinary applications, particularly in large animals like horses or cattle, the jugular vein in the neck was commonly selected based on the condition and season, with the animal restrained using a cord loop tightened above the incision to immobilize the area and swell the vein.^[27] The incision followed immediately after vein localization. The triangular or beveled blade of the fleam was positioned directly over the vein at a right angle to the skin, and a controlled cut was made by striking the fleam's handle with a wooden stick to drive the blade into the vessel without excessive depth.^[11]^[27] This technique allowed for a precise opening, typically shallow to avoid damaging surrounding tissues, and the blade was withdrawn promptly once the vein was punctured. Blood extraction ensued as the incision permitted free flow into a collection basin, with the practitioner monitoring the volume and the patient's response to prevent over-bleeding. In human procedures, amounts generally ranged from 7 ounces to about 1.5 pounds (roughly 200-700 milliliters), adjusted based on the individual's condition until signs of relief or syncope appeared.^[11] Veterinary extractions were larger, such as 5-10 pounds (2.3-4.5 liters) for horses or 6-12 pounds for cattle, collected until the desired quantity was reached, often enhanced by manual pressure on the vein.^[27] Post-procedure care focused on hemostasis and recovery. Manual pressure was applied via compress or bandage to promote clotting, or in veterinary cases, the incision was secured with thread or horsehair to stem the flow, allowing natural coagulation to seal the wound.^[11]^[27] The entire process typically lasted until sufficient blood was removed, emphasizing close observation to mitigate risks like faintness.

Associated Tools

In historical bloodletting procedures involving fleams, a fleam stick—typically a short wooden mallet or bloodstick measuring about 35-38 cm in length and 2 cm in diameter—was employed to strike the fleam's blade, driving it into the vein for the incision. This tool was particularly common in veterinary phlebotomy, such as on horses' jugular veins, where manual force was needed to ensure precise penetration without excessive trauma.^[11]^[13] To staunch bleeding after the fleam incision, closure aids such as pins were used to approximate wound edges, often secured with figure-eight loops of horse tail hair or silk thread, especially in veterinary applications on larger animals. These methods allowed for controlled hemostasis while minimizing infection risk in field settings. Bandages or compresses were subsequently applied to maintain pressure and promote clotting.^[27]^[11] Optional attachments enhanced the fleam's utility in some designs; for instance, forceps or silver pincers facilitated vein manipulation or instrument handling during the procedure. Certain fleam models incorporated inset thumb lancets—small, double-edged blades shielded by horn or tortoise shell—for supplementary precision cuts, serving as a compact alternative for minor venesections.^[11]^[16] In more advanced setups, tourniquets made of braided leather or cord were applied proximal to the incision site to distend the vein and regulate blood flow, while cups—often glass or horn vessels—collected the extracted blood, transitioning from simple basins to specialized exhausters in 19th-century practices.^[11]^[16]

Variations and Types

Blade Configurations

Fleams were primarily characterized by their blade configurations, which varied in number, shape, and orientation to suit different incision depths and applications in bloodletting. The most fundamental distinction lies between single-bladed and multi-bladed designs, with the former emphasizing precision and the latter enabling broader or repeated cuts. These configurations evolved from ancient prototypes to more standardized forms by the early modern period, reflecting advancements in surgical needs for both human and animal procedures.^[11] Single-bladed fleams served as the standard for precise, shallow incisions, allowing practitioners to target specific veins with minimal tissue disruption. This configuration, often featuring a pointed, double-edged steel blade mounted at a right angle to a handle or shield, was most common before 1700 and drew from Roman phlebotomes that resembled simple scalpels. For instance, early examples included bronze blades, approximately 8 cm long and 9 mm wide, designed for superficial venesection in human medicine. Such blades facilitated controlled cuts in accessible areas like the elbow or foot, prioritizing accuracy over force.^[11]^[13] In contrast, multi-bladed fleams, typically incorporating 2 to 4 steel blades housed in a brass or horn shield, were engineered for deeper or multiple incisions, particularly in veterinary contexts where thicker hides required greater penetration. These became prevalent in the 19th century, with blades of varying sizes—often foldable for portability—enabling simultaneous or sequential cuts to expedite blood flow from larger vessels like the jugular vein in horses or cattle. A representative example is an 18th-century Danish fleam with five blades in a brass shield, measuring 89 mm long and 30 mm wide, which allowed for adjustable incision depths during animal bloodletting. This setup reduced the need for repeated applications, enhancing efficiency in farm or battlefield settings.^[13]^[11] Blade shapes further diversified fleam functionality, with triangular forms optimized for piercing veins and clover-leaf designs intended for broader surface cuts. Triangular blades, common in thumb-lancet variants, provided a sharp apex for clean entry into vascular sites, while clover-leaf shapes—featuring rounded, multi-lobed edges—spread the incision over a wider area to promote faster bleeding without excessive depth. Right-angle variants, emerging in 17th-century Germany, positioned the blade perpendicular to the handle for improved leverage and stability during use, as seen in hand-forged iron examples from the period. These shapes were selected based on the target's anatomy, with narrower profiles for human limbs and wider ones for animal necks.^[13]^[11]^[29] A notable point of contention surrounds adaptations of fleam designs for human versus animal use, particularly those incorporating thumb-lancet elements. While single-bladed fleams with small, clover-leaf thumb-lancets were occasionally employed in human phlebotomy for quick vein access, larger multi-bladed versions were predominantly veterinary, requiring tools like bloodsticks for added force against animal skin. Historians debate the extent of crossover, as smaller human-oriented blades risked inefficacy on livestock, and veterinary models could cause undue trauma in patients; evidence suggests limited inclusion of thumb-lancet features suitable for both, highlighting a deliberate divergence in design priorities.^[13]^[11]^[29]

Manufacturing Differences

In ancient times, fleams were hand-forged from bronze, as evidenced by a Roman example discovered in Pompeii, measuring 8 cm in length and 9 mm in width, used for both human and veterinary bloodletting.^[10] This early craftsmanship involved simple forging techniques to create double-edged blades suitable for venesection. By the 16th century, production shifted to steel in Sheffield, England, where the city's emerging cutlery trade leveraged water-powered grinding wheels and early steelmaking methods to produce more durable instruments.^[30] Sheffield's steel fleams featured pointed edges at right angles to the handle, marking a transition from brittle bronze to resilient cast steel for sharper, longer-lasting blades.^[10] Regional variations emerged in the 18th and 19th centuries, with Scottish makers like J. Sanderson of Dunse producing horn-handled fleams, often with brass shields enclosing multiple folding blades for veterinary use.^[31] These Scottish examples, less common than English counterparts, emphasized sturdy horn grips for practical farm applications. In France, ivory-handled versions were crafted, such as those by makers like A. Druesne of Lille around 1880, incorporating elegant materials for pocket veterinary sets that included fleams alongside other tools.^[32] French production favored compact, foldout designs over bulkier spring lancets, reflecting preferences for portability in both human and animal medicine.^[10] The 19th century brought industrialization to fleam manufacturing, particularly in Sheffield, where stamped steel processes enabled mass production of affordable veterinary tools like those from Harmer & Co., featuring engravings such as "Cast Steel Fleams/Sheffield."^[10] This shift, driven by surgical supply companies and patents like Joseph Gordon's 1857 spring lancet design, standardized blades and reduced costs, making fleams accessible for widespread veterinary practice on livestock.^[10] By mid-century, vulcanized rubber elements were integrated for durability, further streamlining production.^[10] Quality in fleams was often denoted by engraved bolsters or hallmarks, such as crowns and stars on British examples or maker stamps like "Rodgers/Sheffield," indicating origin and superior craftsmanship from reputable forges.^[10] These markers, including patent notations on French pieces (e.g., "Breveté S.G.D. Gouv."), assured users of reliable steel quality and regional authenticity.^[10]

Decline and Legacy

Reasons for Obsolescence

The obsolescence of the fleam in medical and veterinary practice stemmed primarily from a profound scientific shift in the 19th century, as the longstanding humoral theory—which posited that diseases arose from imbalances in bodily fluids and justified bloodletting to restore equilibrium—was increasingly rejected in favor of evidence-based understandings of pathology.^[33] This transformation accelerated with Louis Pasteur's development of germ theory in the 1860s, which demonstrated that specific microorganisms caused diseases rather than humoral imbalances, thereby undermining the rationale for routine blood removal.^[8] Pasteur's experiments on fermentation and infection, which influenced later scientists like Robert Koch, shifted medical focus toward microbial agents and targeted interventions, rendering bloodletting obsolete as a broad therapeutic approach.^[34] Pivotal clinical studies further eroded confidence in bloodletting's efficacy, providing empirical evidence of its limited benefits and potential harms. In 1835, French physician Pierre-Charles-Alexandre Louis published analyses of bloodletting in inflammatory conditions like pneumonia, concluding through numerical comparisons of treated and untreated cases that it offered no overall reduction in mortality and could even increase risks when performed early in disease onset.^[35] Similarly, Pierre-Fidèle Bretonneau, in his observations on fevers such as diphtheria during the early 19th century, determined that bloodletting provided no benefit and often coincided with patient death, advocating restraint in its use for such conditions.^[36] In veterinary medicine, bloodletting faced increasing scrutiny by the mid-19th century, though uses such as for equine laminitis persisted amid declining support for broader applications.^[27] The emergence of safer, more precise alternatives hastened the fleam's decline, as innovations allowed for controlled vascular access without the risks of open incisions. The hypodermic needle, independently developed in the 1850s by Scottish physician Alexander Wood and French surgeon Charles Gabriel Pravaz, enabled subcutaneous injections and later venipuncture for both medication delivery and blood sampling, minimizing infection and tissue damage compared to lancet-based methods.^[37] These tools facilitated modern phlebotomy techniques by the late 19th century, shifting practices toward sterile, vein-specific procedures that avoided the fleam's crude lancing.^[38] By the late 19th century, accumulating evidence of inefficacy led to its increasing curtailment in medical institutions across Europe and North America, reflecting broader professionalization of medicine.^[8]^[39] Despite this shift, bloodletting persisted in some medical literature into the 20th century, such as recommendations for pneumonia in 1942 textbooks, before full abandonment.^[39]

Cultural and Collectible Significance

The fleam holds symbolic importance in medical heraldry, notably featured as two lancets on the coat of arms of the Royal College of Surgeons in Ireland, which has been in use since the institution's founding in 1784 and officially granted in 1907.^[22] This emblem appears on the college's flag, representing the historical surgical practices central to its identity.^[40] Antique fleams are highly sought after by collectors of medical history artifacts, often fetching significant prices at auctions due to their craftsmanship and historical context. For instance, multi-bladed examples from the 19th century have sold for between $125 and $290 at specialized medical antique sales.^[41]^[42] Prominent museums preserve these instruments for educational purposes; the Smithsonian Institution's National Museum of American History houses several fleams, including 19th-century brass models used for bloodletting, accessible through its online collections.^[43]^[44] While the fleam itself has not seen direct revival, modern hirudotherapy—using medicinal leeches for bloodletting—has experienced limited resurgence in microsurgery to alleviate venous congestion in procedures like digit reattachments, as supported by clinical reviews.^[45] Veterinary applications of bloodletting with fleams largely phased out by the early 1900s, supplanted by advances in animal health practices, though some advocacy persisted into the late 19th century.^[25] In contemporary education, fleams feature in digital archives for virtual study and 3D-printed reproductions as historically inspired models, aiding in the teaching of medical history without functional use.^[46]

References

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Among our collection of yesteryear's medical oddities, the Maple Ridge Museum displays a fleam, otherwise known as a bloodletting knife.
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The cure is to hold a red-hot iron close to the sore until the sore is hot and then vent (MS C avent) it with a fleme (i.e. 'lancet') in seven places. Then ...
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[26]
The Long, Respected History of Bloodletting - Duke Today
Feb 18, 2000 · Dating back to at least fifth century B.C. and in practice across many cultures, bloodletting served as a foundation stone of Western medicine.Missing: Fliete German
[27]
Fleam - Straits Cultural Center
The triangular-shaped blades were designed to be placed over the vein (most commonly the jugular or saphenous) and struck with a fleam stick. Once the desired ...Missing: leaf | Show results with:leaf<|control11|><|separator|>
[28]
Bloodletting - AVMA Journals
In 1895, George Fleming, a British army veterinarian, still favored bloodletting. Fleming described in great detail the tech- nique for each domestic animal, ...
[29]
One History, One Medicine | Royal College of Physicians of Edinburgh
Fleam. Bloodletting fleam (1800s). Bloodletting has been used for millennia to treat both humans and domestic animals. Ancient physicians believed that blood ...
[30]
Historical Surgical Treatments in Polish Veterinary Medicine - PMC
Aug 24, 2020 · To conduct bloodletting, the veterinarian should “track down the vein”, place a bloodletting fleam (Figure 2) on the vein and hit the blade with ...
[31]
Interesting Artifacts - Harmony Museum
These multi-bladed medical instruments are known as a fleams or phlebetomes, from the Greek words “Phlebos,” for blood vessel and “tome” meaning to cut.Missing: phlebotome | Show results with:phlebotome
[32]
[PDF] A Short History of the Fleam - BOW, BLADES & BATTLES
For venesection, an instrument known as a fleam or phlebotome was used. While sharp thorns and sharpened stones were among the earliest implements used to let ...
[33]
Steel City: an Archaeology of Sheffield's Industrial Past
The first positive record of steelmaking in Sheffield is in 1692. The steel making industry grew slowly. Only two steel furnaces are shown on a 1737 Prospect ...
[34]
[PDF] Donations to and Purchases for the Museum, 1 April 1980-31 March ...
Scottish judge's robes worn by Lord Anderson, late 19th century. Coins ... 89 Set of fleams marked 'Sanderson, Dunse'. By R FINLAY, Edinburgh. 90 Part ...
[35]
Lot 22 - A Fine Pocket Set of Veterinary Instruments, - Flints Auctions
May 26, 2022 · French, c.1880, by A Druesne, Lille, in gilt embossed leather case, instuments in steel with ivory handles, including hoof knives, fleam, ...
[36]
The Decline of Humoral Theory - Wisconsin 101
Louis Pasteur and Robert Koch's experiments in pathology demonstrated the existence of foreign bodies and their role disease, called in to question humoral ...
[37]
Louis Pasteur | Science History Institute
His research, which showed that microorganisms cause both fermentation and disease, supported the germ theory of disease at a time when its validity was still ...
[38]
Pierre-Charles-Alexandre Louis and the evaluation of bloodletting
In the light of these findings, Louis concluded that there were useful effects of bloodletting, but only for specific indications.
[39]
[PDF] Pierre Bretonneau and the history of diphtheria in ... - eScholarship
Bretonneau believed that blood-letting was not of beni fit in cases of ... Throat of Bretonneau, a disease which, though not of recent origin, has not ...
[40]
The Hypodermic Syringe - The Polyphony
Jun 6, 2020 · The hypodermic syringe was developed in 1853 by Alexander Wood or Charles Gabriel Pravaz, and named in 1858 by Dr. Charles Hunter.
[41]
The Bloody History of Medical Needles - Phlebotomy USA
Sep 12, 2025 · In 1853, Alexander Wood and Charles Pravaz each developed hollow needles on their own. Each doctor's needle was fine enough to pierce the skin ...The Middle Ages · The Renaissance · 19th Century
[42]
The demise of bloodletting - PubMed
The effectiveness of bloodletting for treating diseases such as pneumonia was convincingly challenged in the mid-nineteenth century, but medical conservatism ...
[43]
Royal College of Surgeons in Ireland - CRW Flags
May 18, 2009 · I have seen the flag flying from the RCSI in St. Stephen's Green, Dublin. It is a banner of their arms, granted in 1907: Argent, on a Saltire ...Missing: fleam | Show results with:fleam
[44]
https://americanhistory.si.edu/collections/object/nmah_1432836
[45]
-- Antique Price Guide
Antique Medical Instrument Fleam Blood Letting 7 Blade & original Shagreen case Completed $290.8. Antique FLEAM Blood Letting MEDICAL Tool Brass 3BLADE With ...
[46]
Fleam | National Museum of American History
Fleam ; Location: Currently not on view ; Object Name: FleamfleambloodlettingOther Terms: Fleam; Bloodletting Instruments ; See more items in: Medicine and Science ...
[47]
Fleam | National Museum of American History - Smithsonian Institution
Description: Fleam used for bloodletting. Location: Currently not on view. See more items in: Medicine and Science: Medicine. Exhibition:.
[48]
A Comprehensive Review of Medicinal Leeches in Plastic and ... - NIH
Dec 26, 2019 · ... hirudotherapy, indications in plastic surgery, implementation (leech ... Prophylactic use of levofloxacin during medicinal leech therapy. Int ...
[49]
https://cults3d.com/en/3d-model/various/historically-inspired-fleam-bloodletting-knife-set