Part 5 (1/2)
In America, there were five patents on scarificators, of which the Smithsonian possesses three patent models. The most significant American patent was that of George Tiemann in 1846. Tiemann's scarificator had a flattened base and an ebony handle, which contained a coiled spring. The blades were moved by a rack and pinion mechanism, and triggered by a k.n.o.b at the end of the handle. The advantages claimed by the inventor were ease in handling, ease in cleaning, and the diagonal cut of the blades that allowed the blood to flow more freely and the wounds to heal more readily.
Tiemann & Co. was still selling their patent scarificator as late as 1889 for a price of $7.00.[150] The Smithsonian possesses a marketed version in addition to the patent model.
The two other patent scarificators in the Smithsonian collection were both invented by Frederick M. Leypoldt of Philadelphia. The first, patented in 1847, was similar in external appearance to the common scarificator. The novelty consisted of a new arrangement of the c.o.c.king lever and cantilever spring that allowed use of a lighter and cheaper casing. Although the patent model was made of bra.s.s, Leypoldt claimed that with his improvements in the internal mechanism, the case could, with safety, be made of tin.[151]
Leypoldt's second patent, issued in 1851, was for a scarificator with a greatly simplified inner mechanism allowing for a substantially smaller and lighter case. The c.o.c.king lever was placed horizontally in the casing and engaged the blade rods through a rack and pinion mechanism. According to Leypoldt, this scarificator was more convenient, more portable, cheaper, safer, and more reliable than the common scarificator.[152]
Leypoldt probably marketed his scarificators, there being in the Smithsonian collection other bloodletting instruments with his name, but he did not form a major surgical supply company as did George Tiemann.
[Ill.u.s.tration: FIGURE 16.--Advertis.e.m.e.nt for phlebotomy and cupping instruments. Note the rubber cups. (From George Tiemann & Co., _American Armamentarium Chirurgic.u.m_, New York, 1889. SI photo 76-13542.)]
After 1860, interest in inventing new scarificators declined as wet cupping decreased in popularity. The improved cups and scarificators, while they had achieved a limited success, had still failed to supplant the common octagonal scarificator and the plain gla.s.s cup. As interest in wet cupping declined, medical attention s.h.i.+fted to the therapeutic virtues of dry cupping. Dry cupping offered even greater opportunities for inventors, who sought means to bring the effects of the vacuum to more areas of the body for greater lengths of time.
_Dry Cupping_
Dry cupping, in its simplest form, was said to act as a ”revulsive” or ”derivant.” By the nineteenth century these once hotly debated terms had become nearly interchangeable in discussions of cupping. In cupping for revulsive purposes, one cupped on a distant part to relieve excess of blood in the affected part. In applying cupping as a ”derivant,” one cupped closer to the affected part. In either case, the source of pain was presumed to be somewhere below the skin, and the pain was relieved by bringing blood away from the affected part to the surface of the body.
Thus, one nineteenth-century cupper concluded, revulsion was only derivation at a distant point.[153]
If dry cupping was applied for ten minutes or longer so that the capillaries burst, the action of the cups was said to be that of a counter-irritant. According to ancient medical theory, the counter-irritant was a means of relieving an affected part by deliberately setting up a secondary inflammation or a running sore in another part.
Counter-irritations were traditionally produced in a number of ways, among them, blisters, cautery, setons, moxa, and dry cupping.[154]
One of the most popular counter-irritation devices commonly a.s.sociated with cupping instruments in catalogs of surgical goods, was Baunscheidt's _Lebenswecker_, sold by most American surgical supply houses in the second half of the nineteenth century. The _Lebenswecker_, or ”Awakener of Life,”
was the mainstay of the mystical medical system known as _Baunscheidtismus_, after the founder of the device, Carl Baunscheidt of Prussia (1809-1860).[155] The system apparently gained much notoriety in Germany, England, and America, for Baunscheidt's book went through ten German editions and several British and American editions. At least two Americans patented improvements on the _Lebenswecker_.[156] The device was made of ebony, about 250 mm long, and contained a coiled spring attached to a handle. At the other end of the spring was a place about 20 mm in diameter, with about thirty projecting needles. By pus.h.i.+ng upon the handle, one sent the needles into the skin. The ability of the instrument to create blisters was enhanced by the application of Baunscheidt's special oil to the irritation (Figure 17).
[Ill.u.s.tration: FIGURE 17.--Venus and Adonis with marks showing where Baunscheidt's _Lebenswecker_ should be applied. (From Carl Baunscheidt, _Baunscheidtismus, by the Inventor of the New Curing Method_, Bonn, 1859(?). Photo courtesy of NLM.)]
Dry cupping stimulated much theoretical debate in the nineteenth century as well as a number of physiological experiments.[157] Although physicians generally agreed that dry cupping had curative value if employed properly, they disagreed widely on when to employ the remedy, and on the manner in which the remedy operated. Did application of cups affect only the surface vessels, or could cupping affect the entire nervous system, and through the nerves, the action of the secretory organs? Were the effects of dry cupping of only a temporary nature, or were they permanent? An interesting series of investigations in Europe and America sought to ascertain the value of dry cupping in checking the absorption of poison. An American, Dr. Casper Wistar Pennock, replying to investigations performed by Martin Barry, an Edinburgh physician residing in Paris, carried out an impressive series of physiological experiments in 1827, in which he administered strychnine and a.r.s.enic under the skin of dogs and rabbits and then cupped over the wounds. He concluded that while dry cupping prevented almost certain death from the poisons, once the cups were removed, death would ensue, unless the poisons were surgically removed.[158]
Interest in dry cupping led to attempts to apply the therapeutic effects of the operation to larger areas of the body than could be accommodated by a cup. In France, Victor-Theodore Junod (1809-1881) adapted cupping to entire limbs. Shortly after receiving his degree in medicine in 1833, Junod presented at the Academy of Sciences his apparatus, known thereafter as Junod's boot. Junod believed that actual extraction of blood was a dangerous remedy and that the benefits of bleeding might as easily be obtained by his ”derivative method,” which withdrew blood from the general circulation but allowed it to be returned at will. Junod's boot and Junod's arm, which sold for as much as $25.00 apiece,[159] were constructed of metal and secured against the limb by a silk, and later a rubber, cap. To the boot was attached a flexible tube, stopc.o.c.k, pump, and if desired, a manometer for measuring the vacuum produced. In chronic illnesses, Junod recommended that the boot be applied for an hour. So much blood was withdrawn from the circulation by use of the apparatus that the patient might easily faint. To explain how his boot worked, Junod invented a theory that he called ”hemospasia,” meaning the drawing of blood.[160]
This was typical of a number of attempts to introduce sophisticated terminology into discussions of traditional remedies. Junod's arm and boot were widely available through American surgical supply companies. As late as 1915, Heinrich Stern, previously mentioned as a latter-day proponent of bloodletting, had no doubt that application of the boot to the foot would relieve congested states of the abdominal viscera.[161] (Figure 18.)
Americans patented a number of modifications of the arm and boot, and in addition they patented a number of whole body devices called ”depurators.”
Junod had introduced such a device along with his boot--a metal casing in which a patient would be placed leaving only his face showing. The air inside would then be exhausted by means of a gigantic syringe. In America such ”depurators” may have been regarded more as quackery than as a legitimate extension of cupping, for despite the fact that Americans patented some twenty of these devices, surgical supply houses did not sell them and little was written about them.
In the last decade of the nineteenth century, Dr. August Bier, professor at the University of Bonn, developed another sophisticated theory supporting the use of blood-suction devices, known as the theory of hyperemia, meaning ”excess of blood.” According to the doctrine, lesions are always accompanied in nature by hyperemia, ”the most widespread of auto-curative agents.”[162] If we, therefore, wish to imitate nature, we create an artificial hyperemia. Bier recommended several means of increasing the blood supply of an affected part, including hot-air baths, suction devices such as Junod's boot, and dry cupping. Several American surgical suppliers sold Bier's Hyperemic Cups in the early twentieth century. These were gla.s.s cups, of a great variety of shapes and sizes including some with curved rims, each fitted with a rubber tube and bulb for exhausting the air. A major function of these cups was to collect wound secretions from boils or furuncles.[163]
[Ill.u.s.tration: FIGURE 18.--Junod's boot applied to a baby in the cradle.
(From Victor Theodore Junod, _A Theoretical and Practical Treatise on Maemespasia_. London, 1879. Photo courtesy of NLM.)]
_Breast Cupping_
Related to cupping by its technology is the practice of drawing milk from the b.r.e.a.s.t.s by means of breast pumps. Mothers with underdeveloped or inflamed b.r.e.a.s.t.s posed a frequent problem for the nineteenth-century physician, who treated them with either large doses of tartar emetic, a strong purgative, or with cupping.[164] Breast pumps were small gla.s.s cups with fluted edges made to accommodate the nipple. While some surgeons, as the American Samuel Gross, recommended using a bottle with a long neck in which the air had been rarified by means of hot water,[165] most breast pumps were exhausted by mechanical means. For reasons of modesty, the pumps were usually designed so that the woman could draw her b.r.e.a.s.t.s herself. Perhaps the simplest design of a breast pump was a gla.s.s cup having a long spout extending in such a way that the woman could perform suction herself. Such all-gla.s.s cups were ill.u.s.trated in the eighteenth century.[166] A few, reputedly made centuries earlier, are found in the Wellcome Historical Medical Museum. Early in the nineteenth century, breast pumps, just as gla.s.s cups for bleeding, were attached to bra.s.s syringes, and were often included among the variety of cups in cupping sets provided with syringes. Read's and Weiss's patent syringe as well as Thomas Mach.e.l.l's cupping device were adapted for breast pumping. With the invention of vulcanized rubber, the breast pump was frequently attached to a large rubber bulb. A gla.s.s protuberance was often added to pumps exhausted by syringes or rubber bulbs, in order to collect the milk so that it could be fed to the infant. In the 1920s some breast pumps were attached to electric motors.[167] Breast pumps have continued to be employed up to the present day. Of all instruments employing the principle of the cupping device, breast pumps were the most frequently patented.