protruded from the oblique end. The wick was dipped in alcohol,
ignited, and inserted briefly into the cup. The torch was more convenient
than the older teapot lamp because it was easier to insert into the cup,
and was small enough to hold in the hand at the same time as one held the
scarificator.[107]

The introduction of the scarificator represented the major change in the
art of cupping between antiquity and the nineteenth century. Unlike later
attempts at improving cupping technology, the scarificator was almost
universally adopted. Previous to its invention, the cupper, following
ancient practice, severed the capillaries by making a series of parallel
incisions with a lancet, fleam, or other surgical knife.[108] This was a
messy, time consuming, and painful procedure. Ambroise Pare (1510?-1590)
was the first to employ the word "scarificator" and the first to
illustrate a special instrument for scarification in his compendium of
surgical instruments.[109] However, a precursor to the scarificator had
been suggested by Paulus of Aegina (625-690), who described an instrument
constructed of three lancets joined together so that in one application
three incisions could be made in the skin. The instrument, recommended for
the removal of coagulated blood in the wake of a blow, was considered
difficult to use and was not generally adopted.[110] Pare's scarificator
had a circular case and eighteen blades attached to three rods projecting
from the bottom. A pin projecting from the side may have served to lift
the blades and a button on the top to release them although Pare did not
describe the spring mechanism.[111] Pare did not recommend the instrument
for cupping, but rather for the treatment of gangrene. Several sixteenth-
and seventeenth-century surgical texts made reference to Pare's
instrument, among them Jacques Delechamps (1569) and Hellkiah Crooke
(1631).[112]

It is not known who made the first square scarificator and adapted it to
cupping. The instrument was not found in Dionis (1708), but it did appear
in Heister (1719) and in Garengeot (1725). Thus it appears that the
scarificator was invented between 1708 and 1719. Garengeot disliked
cupping in general and he had little good to say of the new mechanical
scarificator. "A nasty instrument," he called it, "good only for
show."[113] The German surgeon, Lorenz Heister, was more appreciative of
the innovation. After describing the older method of making sixteen to
tw