The taking of blood (1950)

h it's very kind of you to help Mr Watkins as I think I said I must get this article on The Taking of Blood Out by by Monday and frankly well it's a subject about which I know absolutely nothing yes I see well I think perhaps the best thing I can do is to show you a film strip on the historical side of blood liting and then see if our pathologist Dr Johnson can come up and have a chat with you on present day practice well yes that would be grand did you say Johnson yeah I think I know him de CH with glasses and mustach yes that's right hello hello Johnson it's Watkins here I've got a with Mr car with me looking for information on blood leting and photomy incidently he thinks he knows you yes yes that's right that's him well I'm going to show him a film strip now and I wondered if you could come up in a few minutes and put him right on current practice you will oh splendid thanks so much he remembers you quite well he's coming up soon meanwhile let's start off in the historical end Splendid you know writing this article was rather getting me down I shall be ready in a moment would you mind turning the lights off sure now this film strip covers bloodletting and photomy or Venus section from very early times it's been um practiced in one form or another for centuries and has only ceased being used as a sort of universal Panacea within the memory of the older living Physicians it's still used by primitive people and its underlying principle was to open a vein or scar if y the skin deeply near an affected part for both purposes primitive man used Thorns flints or fleam sometimes made from a shark's tooth on a wooden handle like this one the first refinement in Venus section was probably a bronze flee of very similar appearance certainly the Romans were using flees consisting of a double-edged tooth shaped blade of bronze attached to a handle in the first two centuries ad examples were found at Pompeii together with a bronze cupping vessel like this and a number of other instruments also of Bron various modifications of the flee were used during the centuries but the shape of the blade changed very little as you can see from this 17th century example a double-edged scalpel or lanet was apparently developing concurrently with the fleet because kton described the L set in 1494 lanets reached their final form in the 17th century they were usually carried in the surgeon's waist coat pocket in sets of 2 to six in flat Leather silver or shag green cases this particular set as a matter of fact was actually used by Baron dimsdale to vaccinate Katherine the Great in 1768 indicating another useful an very interesting but um Tri unhygienic wasn't it yes sepsis was pretty common however when the practice of bloodletting reached its Zenith in the 17th and 18th centuries they became more mechanically minded and the scarifier was introduced as you see it consists of a metal box with from six to 16 trigger operated blades which produce incisions to a required depth it was used for cutting the skin not the veins you know this example belonged to Lord lster himself H what a Savage looking weapon I'm glad it's out of date yes it is a bit fearsome isn't it as a matter of fact I've got another 19th century instrument here if you'd like to have a look at it I should indeed well there it is there are two scars and a spirit lamp it's made of silver and it belonged to a Dr Atkinson of Brighton how does it work oh that's quite simple you just set the trigger like that and then you place it into position press the button and they are the blades come down so quickly you can hardly see them actually they look like this very unpleasant well if that's how you feel I have an even more horrific specimen here which you like great scottw Contraption is it's called a foty bow The Cutting Edge being shot straight into the vein like an arrow it was used in morar and grease but but perhaps not unnaturally it doesn't seem to have become very popular well I must say I'm glad I I didn't live in those days I that's all right all through this long period special vessels were used for receiving the blood draw come in hope I'm not too early not a bit my dear fell sit down a minute we very nearly finished now where was I there is primitive race is used rough Earth andwar collecting BS and coconut shells for the blood but hand BS of beaten metal or glazed Earth andwar roughly similar in shape to this 18th century example appear to have been used by the barber surgeons of the Middle Ages cter bows like this came into use in the 17th century while in Italy rare Venetian glass vessels were sometimes used and became family alomes the next step in evolution was obviously to combine the scarif fire and the receiving vessel no doubt there were many attempts which have not survived but one ingenious instrument has come down to us in this so-called artificial leech of 1850 in which the left hand cylinder houses the trigger operated blades and the right hand one a syringe type piston for sucking out the blood this was followed in 1854 by the first or glass syinge invented by Ferguson the instrument maker and used by Dr Wood of edra it embodied the first Hollow hypodermic needle wood syinge of course is the direct ancestor of our modern syringes and as it rarely finishes the historical side I'm going to hand you over to Dr Johnson well I certainly do what I can Splendid would you mind turning on the lights yeah certainly well thank you very much Mr Watkins that's been most helpful not a bit how are you Doctor nice to see you again can you really spare the time to give me a present day picture of uh FL what you call it foty yes of course I can I'll try and give you a thumbnail sketch of the whole setup I think I can't do better than take you in imagination over to my path lab to begin with and then down to the Consulting room oh that'll be grand it should give me all the information I want Well you ended up historically on wood syringe it was rather primitive but it worked and by 1896 All Glass syringes were being made in some numbers these of course are entirely modern in 196 the composite mesal and glass type was evolved it was an advance on contemporary glass syringes and is still widely used a later modification was a syringe in which the metal parts were made of alloy to avoid damage during heat sterilization syringes remain probably the most commonly used tool for the taking of blood they are easy to hold the quantity of blood withdrawn can be measured and they can of course be used for injections as well yes they they certainly look less vicious than that old crossbow thing true enough now we come to the vaman needle which as you see consists of a short rubber tube attached to a needle they are easy to clean and store but as they are rather tricky to hold they are seldom used except in Laboratories and Clinics handling large numbers of Ven Panos a more modern development is this vacuum tube or venor which is easy to handle has its own needle and UR a sterile blood sample after use you simply file off the needle carrying part and there's your sample ready to be sent off wherever you like there's another apparatus working on the same vacuum principle this bottle Arrangement it's used for obtaining larger quantities of blood as you would from blood ders or polymics the bulb is for extracting the air that's all quite clear but what is all this bloodletting mostly wanted for nowadays oh for a great variety of pathological examinations for instance serological tests for which we need plotted blood the man over there by the way is doing a vaman here you see serum and cloth in ordinary lab test tubes and here in some of those venil tubes you saw earlier other serum tests include the vdal for the anic group of infections the Paul banel for glandular fever and of course most of the chemical tests however if you want to examine whole blood I.E unclotted blood an anticoagulant is necessary in the tube sodium oxalate is the Communist nowadays for example when doing blood diura tests when it comes to cell counts hemoglobin estimations and blood sedimentation rates we use a mixture of potassium and ammonium oxalate called wintrobe to prevent clotting or a substance called Heparin the advantage of Heparin is that it does not distort the cells or break up blood parasites in the sample in the laboratory we have for example small windroe tubes with the anticoagulant already in into which the blood has to be put immediately after taking if you are using venal tubes the appropriate anticoagulant is already in the tube itself so that you don't have to transfer the blood into another Container for instance this is a win venue this contains Heparin this sodium fluoride and this sodium oxalate rather convenient when you're busy bacterial culture is another thing we need blood for it's rather a tricky business to catch the particular organisms you're looking for in the comparatively small quantity of blood being drawn at any one time so you may need to take several samples here is a blood culture in glucose broth from a pyrexial case taken with a syringe here is another culture in a special type of venue also contain in glucose bro well now you have filled me up with facts but you've still not have word yet on how you take blood steady on I'm coming to that now in the Consulting room is an expectant mother who has come for her routine recess test first comes the choice of the vein in this case and in general the most obvious and the easiest is what of the basilic veines although sometimes one has to look elsewhere then of course you've got to obstruct the Venus return a blood pressure cuff is useful here with this inflated and the patient in a good light with the arm fully extended the vein is easily palpated even even if deep or it may be made to Stand Out by milking the forearm towards the ton or by making a fist or gently tapping over the vein the skin is now prepared with iodine or methylated spirit and taking note of the direction of the vein the left hand grips the forearm 3 or 4 in below the selected point of entry the thumb exerts firm traction on the skin thereby steadying the vein the needle bevel uppermost must first obtain a purchase in the skin it is then thrust firmly into the vein to digress for a moment the technique with a vaman needle is exactly similar but it needs practice digressing still further I should add that ven puncture with this venal device is extremely simple the glass sheath is filed off revealing a sterile needle the technique is virtually the same as in the case of the syringe but a simple manipulation of the instrument causes the vacuum to suck the blood into the tube but to return to our original patient after an adequate quantity of blood has been taken the t is released the needle is withdrawn and the puncture sealed by firm pressure with a swab after use you have to use cold water for washing otherwise the blood clots especially at the juncture between metal and glass next the syringes are dipped first in alcohol then in ether or in acetone alone both to dry them and to remove any residual stickiness after this they are sterilized to do this efficiently is a bit of a job this paper published by the medical research Council during the war Drew attention to some of the dangers of inadequate sterilization it is the usual thing to boil syringes in water but if you are going to use them afterwards for injection as opposed to withdrawal of blood you may find yourself passing on all sorts of unpleasant things like cellulitis abses gas Gang Green or even infectious hepatitis unless you boil them for a long time another method which is considered reasonably safe though it does not destroy spores or viruses is the use of 75% methylated Spirits for 10 minutes in a laboratory like this where we use a lot of syringes we dry sterilize them the syringes are assembled in stoer test tubes and the needles are similarly treated the test tubes are placed in metal baskets in the dry sterilizer they are sterilized for 1 hour at 160° Centigrade a method which is 100% efficient of course all these precautions are unnecessary with the vual tube because the thing is only used once and is sterile from the word go yes that vacuum Arrangement does seem to have its advantages tell me how does it actually work that's easy the venor is ingenious enough but perfectly simple it consists of a vacuum tube body the vacuum of which is maintained by a rubber bung through the bung passes a glass tube in which is sealed a sterile needle enclosed in a glass sheath as the rubber is elastic and the needle carrying tube passes through it at an angle the inner end of the tube is held tightly against its seating on the interior of the rubber bun by bending the body of the tube in relation to the needle carrying section the inner end of the tube leaves it seating and breaks the vacuum when the pressure on the body is removed the end of the needle carrying tube returns to its seating and stays there of course if in the meantime the glass covering of the needle has been filed off and the needle itself inserted in the vein the blood obviously flows into the tube when the body of the venor is allowed to resume its original position the end of the tube is again sealed and the needle may be withdrawn very neat and that I think car is about the best picture I can give you and I do hope it's been a help well it certainly has doctor and I'm very very grateful to you as a matter of fact I feel like it almost go straight off now and commit a successful ven puncture to myself what about letting me have a tab at you first he Mr Watkins no sir you go home and practice in a hot water bottle and then I don't mind watching you have a crack at the doctor here