s took a renewed interest in cupping in the early
nineteenth century. Cupping was no longer regarded as merely a useful
substitute for bloodletting. Recent physiological research seemed to prove
to the advocates of cupping that the effects of slow withdrawal of blood
from the capillaries produced a different effect on the constitution than
the quick withdrawal of blood from a vein. Thus, Knox was convinced by the
results of this research that, while phlebotomy was indicated in cases of
high fever, "particular phlegmasiae" specifically required the
intervention of cupping.[122]

The procedure that the experts followed in wet cupping was as follows.
First, the cups were immersed in hot water. Bayfield recommended that one
glass be used for every four ounces of blood required. Thus, to abstract
18 to 20 ounces, as was common in cupping on the back or abdomen, four or
five glasses were needed. The spot chosen for placement of the cups should
be free of bone, but also not overly fatty. Cupping over the belly of a
muscle was especially recommended. After the spot was fomented with hot
water, the torch was dipped in alcohol, lit, and inserted into the cup for
about two seconds. Once the torch was removed, the cup was allowed to sink
of its own weight into the skin. During the minute that the skin was
allowed to tumefy under the cup, the scarificator was warmed in the palm
of the hand in preparation for the most difficult part of the operation.
It required great skill to manage torch, scarificator, and cups in such a
way as to lift the cup, scarify, and recup before the tumefaction had
subsided. Monson Hills (1834) described the manipulations involved thus:

The torch is held in and across the palm of the right hand, by the
little and ring finger, leaving the thumb, the fore and middle
fingers free to hold the scarificator, which may be done by the thumb
and fore finger only; the glass is then grasped by the thumb, fore
and middle fingers of the left hand, leaving the little and ring
fingers free; the edge of the glass is then detached from the skin by
the middle finger of the right hand; the scarificator being set, care
must be taken not to press upon the button with the thumb too
quickly; directly the glass comes off, we apply the scarificator,
spring it through the integuments, and then placing it between the
free little and ring fingers of the left hand, we apply the tor