Bloodletting as a therapy dates back to antiquity. For centuries it was not the decision to bleed but the decision of how much blood to remove that engaged the physician or surgeon. Phlebotomy was still routinely practiced in the nineteenth century.

In the early twentieth century, in his famous text Principles and Practice of Medicine, Sir William Osler (1849-1919), a renowned physician at the time, advised the use of bloodletting in the treatment of stroke in patients with hypertension.

An ingenious tool - the scarificator - added a degree of sophistication to the technique.

Several scarificators can be found among the extensive artefact collection held by the RACP History of Medicine Library.

The most common model was the basic brass octagonal English scarificator pictured above. It was manufactured by London based cutlers and surgical instrument makers Savigny & Co.

The operator had a choice of three interchangeable cutter blades of steel and depth adjustor.

By placing the instrument on the patient's skin, possibly with blood drawn to the surface by prior cupping, the physician then released the trigger switch, which allowed the bleeds to swing around and make a series of cuts.

"The patient was about seventy years of age, of a spare habit, and debilitated constitution. He was affected with vertigo, and pain in the head, confusion of mind, faltering in speech, and strabismus in a very great degree. As the blood flowed, all the symptoms gradually abated..."

--John Cooke, A Treatise on Nervous Diseases, 1820

Contained in its own velvet-lined box, this would have been the perfect tool for the sophisticated nineteenth century physician. These instruments were often used in association with cupping.

This surgeon's case, also held in the Library, contains not only a brass scarificator but also several 'drawing glasses' and a cautery lamp.

The plaque on the lid shows us that this once belonged to Dr. I Barnett, an army surgeon in the Crimean War who served at the battles of Balaclava and Inkerman in 1854.

One can only speculate that the contents of this little box may have also seen action at these battlefields. Edward Ford (1902-1986), Curator of the Library from 1958 to 1986, donated this item to the College collection.