Can you identify this instrument? Inside the brass box (4×4×3 cm) there are two axles, each holding a rack of six thin sharp steel plates. At the base are two parallel rows of six narrow slits. The trigger-shaped handle on the top is a cocking device that tensions strong springs attached to each axle. Pressing the button on the side produces an audible click but no visible action.These instruments date from the 1600s and appear in our earliest medical catalogue, that of S Maw and Sons of 1866, and as late as the Aesculap catalogue of 1973 in their vaccination section. Figure 1. An instrument thought to date from mid 19th Century engraved ‘H&H Hilliard Edinburgh' Figure 2. Inside the instrument Those thin plates on the two shafts are sharp rounded blades. The shiny metal pieces under the axles are strong springs, cocked by the trigger. When pressed, the button at the side releases these springs to make the opposing rows of blades spring out through the slits, far too quickly to see. Their arcs are up to 15 mm long, adjustable to between 3 and 8 mm deep. This design was a great advance on its predecessors as it eliminated the recoil of a single axle. Answer—The instrument is a scarificator, originally to puncture the skin for bloodletting. The associated ‘cupping' involves a partially evacuated glass bottle quickly placed over the wound. The cup's low pressure promoted bleeding. Typically, a skilled bloodletter (one slick enough never to spill a drop) took 8 to 16 fluid ounces of blood from virtually anywhere on the skin surface. Bleeding's heyday as a panacea was the early 19th Century. Perhaps an American aptly named Physick who, at 90 ounces at one go,1 may hold the record! Whichever bloodletting atlas was at hand prescribed the site for the patient's condition. Even the temples! The patient's approaching unconsciousness was a common end-point of the procedure. Figure 3. The business end Springs and gears need greasing. This and its general complexity obviated sterilization. However, (hygiene conscious?) makers sold blade-cleaning mats of suede leather or other soft material.2 Bloodletting slowly became outmoded in the 19th Century as evidence to its dangers grew.2 An early trial, described in Alexander Hamilton's MD thesis, occurred in the Peninsula wars in 1809.3 Hamilton and two British Army surgeon colleagues each cared for similar batches of over 100 casualties each. The non-bleeders, Hamilton and Anderson, lost 4 and 2 patients compared with 35 deaths under their regularly bleeding third colleague. Later, in 1873, Dr Shann cautioned not to lightly dismiss such a well-established practice as bleeding in his case report of an oesophageal puncture.4 By 1900 therapeutic bleeding virtually stopped, except for conditions like haemochromatosis. However cupping remains alive and well among alternative practitioners, but thankfully, deliberate bleeding seems restricted to a few token drops. More recently, the scarificator sold solely as a vaccination instrument. This is the purpose of the Aesculap example. But what vaccine requires such drastic application?

Can you identify this instrument? Inside the brass box (4×4×3 cm) there are two axles, each holding a rack of six thin sharp steel plates. At the base are two parallel rows of six narrow slits. The trigger-shaped handle on the top is a cocking device that tensions strong springs attached to each axle. Pressing the button on the side produces an audible click but no visible action.These instruments date from the 1600s and appear in our earliest medical catalogue, that of S Maw and Sons of 1866, and as late as the Aesculap catalogue of 1973 in their vaccination section. Figure 1. An instrument thought to date from mid 19th Century engraved ‘H&H Hilliard Edinburgh' Figure 2. Inside the instrument Those thin plates on the two shafts are sharp rounded blades. The shiny metal pieces under the axles are strong springs, cocked by the trigger. When pressed, the button at the side releases these springs to make the opposing rows of blades spring out through the slits, far too quickly to see. Their arcs are up to 15 mm long, adjustable to between 3 and 8 mm deep. This design was a great advance on its predecessors as it eliminated the recoil of a single axle. Answer—The instrument is a scarificator, originally to puncture the skin for bloodletting. The associated ‘cupping' involves a partially evacuated glass bottle quickly placed over the wound. The cup's low pressure promoted bleeding. Typically, a skilled bloodletter (one slick enough never to spill a drop) took 8 to 16 fluid ounces of blood from virtually anywhere on the skin surface. Bleeding's heyday as a panacea was the early 19th Century. Perhaps an American aptly named Physick who, at 90 ounces at one go,1 may hold the record! Whichever bloodletting atlas was at hand prescribed the site for the patient's condition. Even the temples! The patient's approaching unconsciousness was a common end-point of the procedure. Figure 3. The business end Springs and gears need greasing. This and its general complexity obviated sterilization. However, (hygiene conscious?) makers sold blade-cleaning mats of suede leather or other soft material.2 Bloodletting slowly became outmoded in the 19th Century as evidence to its dangers grew.2 An early trial, described in Alexander Hamilton's MD thesis, occurred in the Peninsula wars in 1809.3 Hamilton and two British Army surgeon colleagues each cared for similar batches of over 100 casualties each. The non-bleeders, Hamilton and Anderson, lost 4 and 2 patients compared with 35 deaths under their regularly bleeding third colleague. Later, in 1873, Dr Shann cautioned not to lightly dismiss such a well-established practice as bleeding in his case report of an oesophageal puncture.4 By 1900 therapeutic bleeding virtually stopped, except for conditions like haemochromatosis. However cupping remains alive and well among alternative practitioners, but thankfully, deliberate bleeding seems restricted to a few token drops. More recently, the scarificator sold solely as a vaccination instrument. This is the purpose of the Aesculap example. But what vaccine requires such drastic application?