or
of the Baptist Mission, who sent the horn, noted that he had often seen
Africans sitting in the market place with such horns on their backs or
their heads. Scarifications were made with a handmade razor.[94]

[Illustration: FIGURE 8.--Scarification without cupping in Egypt in the
16th century. To obtain sufficient blood, 20 to 40 gashes were made in the
legs and the patient was made to stand in a basin of warm water. (From
Prosper Alpinus, _Medicina Aegyptorum_, Leyden, 1719. Photo courtesy of
NLM.)]

In addition to horn cups, the ancients employed bronze cups in which a
vacuum was obtained by inserting a piece of burning flax or linen into the
cup before its application to the skin. Most Greek and Roman cups were
made of metal.[95] Although Galen already preferred glass cups to metal
cups for the simple reason that one could see how much blood was being
evacuated, metal cups were used until modern times. Their main virtue was
that they did not break and thus could be easily transported. For this
reason, metal cups were especially useful to military surgeons. Brass and
pewter cups were common in the eighteenth century, and tin cups were sold
in the late nineteenth century.

Since the latter part of antiquity, cups have been made of glass. The
Smithsonian possesses two Persian opaque glass cups dating from the
twelfth century, called "spouted glasses" because of the spout protruding
from the side of the cup by which the cupper exhausted the air with his
mouth. Similar spouted glasses were illustrated by Prosper Alpinus
(sixteenth century), so designed that the blood would collect in a
reservoir instead of being sucked into the cupper's mouth. Like the horn
cups illustrated by Alpinus, the glass cups were provided with a small
valve made of animal skin. It appears that the sixteenth-century Egyptians
were not familiar with the use of fire for exhausting cups. (Figure 9.)

Cupping and leeching were less frequently practiced in the medieval
period, although general bloodletting retained its popularity.[96] When
the eastern practice of public steam baths was reintroduced into the West
in the late sixteenth and early seventeenth centuries, cupping tended to
be left in the hands of bath attendants (Bagnio men) and ignored by
regular surgeons. Some surgeons, such as Pierre Dionis, who gave a course
of surgery in Paris in the early eighteenth century, saw little value in
the operation. He felt that the ancients had gre