SECT. XLI.—ON CUPPING.
We must not have recourse to cupping at the commencement of complaints, nor when the body is in a plethoric state, but when the general system has been evacuated, and when there is no defluxion any longer to the part, and especially when there is a necessity of removing, dislodging, and determining something outwardly. Dry cupping then dissipates flatulence, stops defluxions to the stomach, attracts blood to a part, and stops it again, when determined to a part, if applied to the opposite parts; and it also occasions a translation from the deep-seated parts to the surface, and on the whole produces a metastasis of the fluids, and an evacuation of the spirits. But cupping with scarifications facilitates the evacuation of the offending causes, which it manifestly brings from the deep-seated parts; for it produces the discharge not only of blood but of the other humours, and especially if applied with much heat. And if we wish to make the abstraction from parts that are fleshy, we must first scarify and then apply the cupping instrument; but if the part is not fleshy, we must first have recourse to dry cupping, and when the parts becomes swelled up, we scarify and apply the cupping instrument again. If we wish to make but a small evacuation we must be satisfied with one incision, but if we wish much we must make several. And if we apprehend that the contained blood is of a thinner consistence we will make superficial scarifications, but if of a thicker, deep-seated. When we wish to evacuate coagulated blood, occasioned by a blow, we must be regulated as to the depth of the incisions by the thickness of the skin above. Some have devised an instrument for this purpose, by joining three equal lancets together, so that by one application it may produce three incisions, but we consider it inconvenient, and use a simple lancet. Others have used cupping instruments of glass, in order that the quantity of blood which is evacuated may be seen; but those made of copper have a more powerful attraction, as being able to endure a stronger fire, whereas those of glass are apt to break. But such as draw out the blood by sucking with the mouth through horns, evacuate less, but do not dry, like those applied with fire. If necessary, when we are about to apply the cupping instrument, having placed the limb in an erect posture, we fasten it to the side; for if we apply the lamp above when lying, the wick falling upon the skin with the flame burns in a painful manner, whereas there is no necessity for this. Sometimes the size of the instrument is proportioned to the part on which it is applied; and on that account there is a great variety of cupping instruments with regard to smallness and greatness of size. For the same reason, those which are made with longer necks and broader bellies are possessed of a stronger power of attraction. We must avoid applying the cupping instrument near the breasts, for sometimes they fall into it, and swelling greatly, render the removal difficult, and in that case sponges out of hot water are to be applied round the cupping instrument, which make it relax. But if even with this it do not fall off we must perforate it.
Commentary. On this mode of abstracting blood, and of altering its determination, the records of ancient surgery are so full of information that our only difficulty lies in selection.
It appears that the father of medicine and his successors practised cupping. (De Articulis, 49, and de Medico, 6.)
Celsus mentions two kinds of cupping instruments, the one being made of horn, and the other of copper. Those of copper were open at one end and shut at the other. Those of horn had a larger opening at one end and a smaller at the other. A piece of cloth was set on fire and thrown into the copper one, and its mouth was then fitted to the body and pressed on until it fastened. In applying the one made of horn, the air was exhausted by sucking at the smaller end, which was then covered up with wax, and in this state it would fasten to the part. He remarks that when the part to which the instrument is applied had been previously scarified, blood is discharged, but otherwise nothing but spirits. He states that the principal use of the cupping instrument is to remove any local affection when the general constitution is sound. Upon the whole, he considers it to be a safer but less efficacious remedy than venesection. Cupping, he adds, is to be had recourse to in chronic diseases, in order to remove any corrupted matter which may be seated in a part; and in acute, when the strength will not allow of venesection. (ii, 11.)
According to Galen, cupping is useful after evacuation, but does not answer when there is plethora. In inflammation of the brain and its membranes, therefore, he forbids cupping at the commencement, and also in inflammation of other parts, until the defluxion is stopped and the general system has been evacuated; and states that the object of cupping in such diseases is to move and determine the inflammatory particles outwards. In general, he advises us not to apply the instrument to the part affected, but to the adjacent part, with the view of producing revulsion, de hirud. revuls. cucurb., &c. He likewise gives an interesting account of leeches. He recommends their tails to be clipped off when it is wished to abstract much blood by means of a few leeches. (Ibid.)
Oribasius is the ancient author who discusses this subject at the greatest length, and to him Paulus is principally indebted. He mentions that cupping instruments are made of glass, horn, or copper. Those of silver, he says, are to be rejected; those of copper are in most general use; those of glass answer best when we wish to see the quantity of blood that flows into the instrument; and those of horn are to be applied to the head because copper ones are difficult to remove; and besides, timid persons are afraid of the flame in such cases. Those which are made deep attract more strongly than such as are shallow; instruments of the latter description are to be applied to the head. Before using them he recommends us to warm the part with fomentations and cataplasms. Upon the authority of Herodotus he enumerates the beneficial effects which may be derived from cupping; such as evacuating the matters fixed in the part, diminishing inflammation, recalling the appetite, strengthening the stomach, determining to the surface, provoking menstruation, and so forth. (Med. Coll. vii.)
Aëtius gives a similar but less copious account of this subject. (iii.)
Actuarius forbids us to apply cupping instruments until after general evacuation, when, he says, they will be useful by producing revulsion of the noxious humours. He also approves of cupping for strengthening the stomach when it has lost its tone, and to discuss flatulence in the bowels. (Meth. Med. iii, 4.)
Albucasis gives a most circumstantial and interesting account of the methods of cupping every part of the body. He particularly recommends cupping the nape of the neck in affections of the brain and eyes. He gives a full account of dry cupping. He recommends it to be applied when the disease is seated in places which do not bear cupping with scarifications, such as the region of the liver and spleen, the kidneys, the bowels, and the joints affected with gout. In applying the instrument he directs us either to create a flame in it, or to fill it with hot water. He gives drawings of various instruments for cupping. (Chirurg. ii, 98.) He also treats fully of leeching, which, however, he recommends only in cases in which the cupping instrument cannot be applied. When the bleeding continues longer than is desired, he directs a piece of cloth soaked in cold water to be applied to the place, or if that does not prove effectual, styptics, such as galls, beans without their skins, and the like. When the leeches will not take, the place is to be smeared with fresh blood. When it is desired to make them drop off, powdered aloes, salts, or ashes are to be sprinkled upon them. (ii. 99.)
Haly Abbas gives an ample enumeration of the cases in which cupping is applicable. He recommends it particularly in such cases as do not admit of general bleeding, for ophthalmies, cynanche, and in an especial manner for amenorrhœa, when it is applied to the breasts.
The other Arabians, although some of them treat fully of this subject, especially Avicenna and Rhases, yet give little additional information. Rhases speaks of applying a glass or a cupping instrument to draw off the blood after leeching. He gives a full account of the different kinds of leeches. Before applying them, some, he says, smear the part with blood and some with milk. When they are too long of falling off he directs us to sprinkle salt upon their mouths. He recommends them to be kept in a vessel containing water herbs. (Cont. xxviii.) When it is wished to abstract more blood after the leeches have fallen off, Albucasis directs us to foment the part with hot water, to rub it, and apply a cupping instrument to it. When, on the contrary, it is wished to stop the discharge, Avicenna recommends us to apply galls, lime, or other astringents, to the part. For this purpose Albucasis likewise directs us to apply a mass of beans deprived of their skins.