A great variety of bodily parts were cupped, just about any part that had sufficient surface area to hold a small cup in place. Knox, for example, gave directions for cupping on the temple, back of the head, behind the ears, throat, back of the neck, extremities, shin, chest, side, abdomen, back and loins, back of the thighs, perineum, sacrum, and on buboes.[125] In reply to those who wondered if cupping hurt, Knox asserted that “those who calculate the pain incurred in cupping by comparison with a cut finger are very much deceived.” The scarificator itself produced little pain, he claimed, but he admitted that the pressure of the rims of the glasses could cause a degree of discomfort.[126]
Nineteenth Century Attempts to Improve Cupping Technology
The story of nineteenth-century attempts to improve cupping technology is an interesting one, in that a great deal of effort was expended on comparatively short-lived results. For those who were adept at cupping, the cups, torch, and standard scarificator were quite adequate. Innovations were thus aimed at making the operation more available to the less practiced. The new gadgets could not rival the traditional instruments in the hands of an experienced cupper, and, moreover, they were usually much more expensive.
Most of the attempts at innovation centered in eliminating the need for an alcohol lamp or torch to exhaust the cups. As far back as Hero of Alexandria,[127] we find directions for the construction of “a cupping-glass which shall attract without the aid of fire.” Hero’s device combined mouth suction with a system of valves. Another famous inventor of assorted devices, Santorio Santorii (1561-1636), described a cup that contained a syringe in the early seventeenth century.[128] From the 1780s on, cups with brass syringes began to appear in compendia of instruments. A cup with brass fixings would be screwed onto a brass pump, placed on the skin, and the air within removed by a few strokes of the piston.[129] This sounded better in theory than it worked in practice. Expert cuppers agreed that they thoroughly disliked using the syringe. Mapleson (1813) offered three strong objections to the instrument. First, exhaustion could easily be carried too far, so as to obstruct the flow of blood. Second, the operation become tedious and fatiguing to the bloodletter because of the repeated screwing and unscrewing of syringe and glasses. Third, the valves were liable to malfunction.[130] Twenty-three years later Knox continued to disapprove of the syringe for the very same reasons. Of all the new inventions for cupping, he declared in 1836, “the worst is the syringe, as it makes that a most complicated and bungling operation that which, with common care and attention is one of the most simple in surgery.”[131]
Despite rejection by experienced cuppers, manufacturing of an air-tight syringe continued to challenge inventors throughout the nineteenth century. Some attempted to substitute stopcocks for valves, and some to place long flexible tubes between pump and glasses so that the pumping motions would not be communicated to the patient. Pumps were gradually improved, and, although rarely recommended by experts, were sold in great numbers as part of fancy and expensive cupping sets. These sets, with prices as high as fifteen dollars, consisted of a mahogany or leather box with brass latches, lined in plush, and containing compartments for scarificators, a brass pump, and an assortment of glasses provided with metal attachments. Some of the most elegant of the cupping sets were those made by Maison Charrière of Paris. Today the luxury of these cupping sets seems rather incongruous with the bloody purposes for which the instruments were used. Yet, the beauty of the instruments and their containers must have added to the esteem of the physician or surgeon in the mind of the patient.
Syringes were not only useful in cupping but also were employed in a wide variety of medical and surgical operations. Creating an all-purpose syringe that would extract or inject liquids into any part of the body was yet another inventor’s dream. Two of the earliest English surgical patents were awarded to two such syringes. John Read (1760-1847), surgical instrument maker for the British Army and the East India Company, patented a pump in 1820 for use in “extracting poison from the stomach, administering clysters, introducing tabacco fumes into the bowels, transfusion of blood, draining off the urine, injecting the bladder, female injection, anatomical injection, administration of food and medicine, cupping, drawing the breasts ... &c.”[132] John Weiss, inventor of the improved scarificator, invented his own patent syringe in 1825, which he claimed to be superior to all previous syringes because it employed stopcocks in place of valves, which were subject to leakage and clogging. Cupping was only one of many operations that could be performed with its aid. The Truax Surgical Pump is an example of a late nineteenth-century all-purpose patent pump outfit that included cups among its numerous optional attachments.[133] (Figure [14].)
Those who went a step further in their efforts to improve cupping procedure attempted to combine cup, lancet, and exhausting apparatus all in one instrument. Bayfield described and rejected several such devices in 1823, including perhaps the earliest, that of the Frenchman, Demours. Demours’ instrument, first introduced in 1819, consisted of a cupping glass with two protruding tubes, one containing a lancet, and the other an exhausting syringe. The lancet, surrounded by leather to keep air out of the cup, could be supplemented by a cross with four additional blades, if more than one puncture was desired.[134] In 1819, Thomas Machell, a member of the Royal College of Surgeons in London, described a similar apparatus in which the glass cup was separated from the tin body of the apparatus by a flexible tube. The facility and precision of the instrument, claimed Machell, “are incalculably surpassed by the power of its application to any part whatever of the surface, under any circumstances indicating its propriety, and by any person untrained to the manual dexterity of a professed cupper.”[135]
Professional cuppers who took pride in their skill naturally avoided such novelties. Bayfield found the complex instruments objectionable because even “the most trifling degree of injury is generally sufficient to render the whole apparatus useless.”[136]
The Smithsonian collection contains two patent models of American wet cupping devices. The first is an ingenious cupping set patented by a Philadelphia navy surgeon, Robert J. Dodd, in 1844. It consisted of a metal syringe provided with a plate of lancets that screwed on to a glass tube with a protuberance for collecting blood. The most interesting feature of the apparatus was the provision made for cupping internal parts of the body such as the vagina, throat, or rectum. One could attach to the pump either a curved or a straight tapering glass tube, seven to eight inches long, and corresponding flexible metal lancet rod. The pump could also be adapted for extracting milk from the breasts of women by attaching a metal cap with a hole just large enough to accommodate the nipple.[137] The second patent model is that of W. D. Hooper of Liberty, Virginia, who invented in 1867 an apparatus combining cup, pump, and scarificator. The novel part of the instrument was the tubular blades that were injected into the flesh and then left in place while the blood was being removed, “by which means the punctures are kept from being closed prematurely, as frequently happens with the ordinary device.”[138]
It is unlikely that any of these ingenious devices were marketed in quantity. For those skilled in the art of cupping, the torch, cups, and scarificator were more effective. For those not experienced in the art, the new devices were simply too expensive, inconvenient to carry about, and fragile. While doubtless some surgeons bought fancy equipment in order to impress their patients, other surgeons, and the professional cuppers, realized that expensive and unfamiliar gadgets could inspire more dread than awe, especially among rural patients. The cupper Monson Hills advised his readers: