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.
SECT. XLII.—ON BURNING THE ARMPIT.
In dislocation at the joint of the shoulder, it sometimes happens that the head of the arm falls out over and over again, either from the prevalence of too much humidity, or because the way is paved to it by its frequent occurrence. In this case then we have recourse to burning. Wherefore, the patient being laid on his back, or on the sound side, the skin at the inner part of the armpit, where the dislocation mostly takes place, is to be stretched between two fingers of the left hand, or with hooks, and burnt with heated cauteries, of a slender and oblong shape, until the cautery, being pushed through to the other side, occasion the formation of two eschars at one application. And if the distance between them is considerable, having passed the head of a specillum through them, we make another eschar in the middle by burning down until the cautery reach the specillum. And Hippocrates wishes two other eschars to be formed on each side of the middle one at the same distance as they, so as to form a quadrangular figure. We must not burn deeper than the skin, because nerves, glands, and other substances, which may give rise to inflammation and disturbance, lie below. The treatment may be conducted by means of leeks applied with pounded salts, and the rest of the treatment of eschars. Afterwards we may use the hand cautiously.
Commentary. Hippocrates (as stated by our author) recommends this operation for preventing the recurrence of dislocation at the shoulder-joint: it is minutely described by him. (De Artic. xi.) Albucasis describes the operation, but it will be readily understood from our author’s account of it. (Chirurg. i. 27.) It is described in like manner by Haly Abbas. (Pract. ix. 73.)