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           My object in calling attention to the ancient and well-known therapeutic method of dry-cupping is with a view to urge a more frequent practice of it. It may appear to many to be hardly necessary to do so, since, as a remedial measure, under suitable circumstances, the employment of derivatives of various kinds is enjoined by the best systematic and clinical teachers. I am, however, so convinced that a more extended use of this means is called for and justifiable, that I believe it may be well to review in this place some of the advantages derivable from it. I propose to discuss, first, the objects sought to be attained by dry-cupping, and the theory of its action; and, secondly, to indicate the class of cases in which its employment is warranted; lastly, I shall make a few practical remarks upon the operation itself.

          I have already spoken of this measure as classed amongst derivatives. By this term is to be understood a different action from that produced by a counter-irritant strictly so called. According to Pereira, derivation is a form, or, as he terms it, case of counter-irritation, and he thus distinguishes between revulsion and derivation — in the first the artificial or secondary disease is produced in a part remote from the seat of the primary affection; in the latter the artificial disease is set up in the neighborhood of the primary malady.

          I think a distinction should be made between a purely derivative and a counter-irritant action, and I lay stress upon this just now, because it seems to me that we may employ the practice of dry- cupping in both of these ways, and this I hope to show presently.

          The results we obtain by dry cupping sets vary accordingly as we produce a purely derivative effect, or a counter-irritant one in addition. The object then of this practice is to withdraw from an engorged viscous or part some of the excess of blood contained in it. Under ordinary circumstances this withdrawal is more or less temporary; and if it be secured to a sufficient extent, an opportunity of recovery is afforded to subdjacent or adjacent parts. The organs are relieved, and thus set at rest. By this means we check the flow of blood in the larger arteries, and engorge the cutaneous small vessels and capillaries. It is needless here to do more than recall the well-ascertained anatomical facts regarding the vascular connections between the cutaneous, subcutaneous, and visceral systems. These facts, which were unknown twenty years ago, have assisted greatly in converting for us into therapeutic science what was formerly but empirical art. Cupping acts as a kind of temporary ligature on the vessels of the part to which the glass is applied, including even the capillaries, and it is in this way that it tends to prevent the absorption of poisons locally applied.

          Professor George Johnson holds the view that dry-cupping acts similarly to hot fomentation. The object is first to draw the blood through the arteries into the capillaries; then to allow it quickly to return by the veins; and not to keep it stagnating in the capillaries, which will happen if the glasses be retained long on the spot. Thus the ligature theory of Graves cannot hold if the operation be performed so as to permit a continuous onward flow of blood through the capillaries to the veins. It is, however, easy to see that the effect alluded to by Graves is attainable by modifying the operative procedure, and it was to this point I before referred when I stated that I believed it possible to employ dry-cupping both as a pure derivative, and a strict counter- irritant.

          The sole object of dry-cupping is not to irritate the skin, but to draw blood rapidly from the arteries. According to this practice, then, the effect is simply derivative; to produce the ligature-action of Graves the process must be so conducted as to prove counter-irritant, whether this effect be desired or not. The difference is practically accomplished by removing the cups as soon as the integument is fully raised within; they must not be left on longer if a simple derivant effect is sought. To produce a counter-irritant action , the massage the cups may be retained for ten minutes or more when the ligature action is set up, or, in other words, stagnation of blood current occurs, and ultimate rupture of capillaries, leading to ecchymosis or even larger extravasation if the process be pushed far enough.