Bad Blood

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These two objects were among fourteen bronze cupping vessels excavated from the site of Pompeii, the Roman town just inland of the Bay of Naples, which fell to the mercy of Mount Vesuvius in 79AD. Cupping vessels were just one type of the many surgical and medicinal devices found across the Roman city, which included speculums, forceps, hooks and probes. These two cupping vessels were found in a building known as ‘the House of the Surgeon’, after the concentration of medical instruments found there, as pictured below.

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Medical instruments from the House of the Surgeon,

The practice of cupping regained fame during the 2016 Rio Olympic games, when athletes appeared with strange patterns of red, circular bruises covering their backs, provoking baffled commentary and discussion from spectators. The earliest evidence of cupping can be found in the Eber’s Papyrus from Egypt, dated at 1,500BC, and the practice also forms a major part of ancient Chinese medicine.

There are two different practices associated with these cupping vessels. The first, known as ‘dry cupping’, does not draw blood, and the other, ‘wet cupping’, involves scarification of the skin, designed to draw out unwanted substances in the blood. Bloodletting was, or is, the process of allowing blood to flow in order to rebalance the liquids in the body. There were two different ways of bloodletting. The first was through venesection or arteriotomy (cutting the veins or arteries), and the latter was a more localised methods, breaking the skin through scarification, and then using leeches or cupping. In the first century AD (the same time as Pompeii), the Roman physician Aulus Cornelius Celsus suggests that cupping therapy was preferred over bloodletting from veins, and was used in a wide variety of cases. Galen records pain relief, flatulence, menstrual problems, fever and hemorrage as conditions for which cupping was a useful procedure.

stele of jason - cupping vessel

A Roman physician examines a patient with swollen abdomen and wasted limbs. On the right is a cupping vessel. Funerary Monument, 2nd Century AD

But how did this work in practice? The skin was scraped with small knives, and then the cupping vessel, like those pictured above, were placed mouth-down on the skin. Pressure had to be created within the vessel in order to create a vacuum which would draw up unwanted blood. There were two ways in which a vacuum could be made. The first, and older, was to use a vessel with a whole in the top and to extract air by suction. The whole would then be blocked with wax, eggshell, or just a finger. The other method, which applies to our objects, is to heat the vessels before application, allowing the cooling air to form a vacuum. While most vessels that have been found are made of copper alloy (such as bronze), vessels made of glass were also used. The rings on the top of the two vessels shown above would have probably been used to suspend the vessels during heating, and to assist with removal at the end.

To understand the purpose of such bloodletting, we must forward in time to Galen of Pergamon and his theory of the humours:

Galen was a Greek physician born in Pergamon, Asia Minor in the first century AD. Having studied in Alexandria, he made for Rome and became one of the most influential physicians from the ancient world. Galen’s ideas built on those found within the Hippocratic corpus from the 5th/4th century BC, which held that the human body was composed of four basic liquids, known as humours. These were blood, phlegm, black bile, and yellow bile. The health of an individual was determined by the balance of these four humours, which, if disrupted, caused illness. These humours all held opposing characteristics: yellow bile is hot and dry; blood is hot and damp; phlegm is cold and damp; and black bile is cold and dry. These ideas, through the writings of Galen, continued to be commonly accepted until the end of the 18th century. However, Galen was born more nearly one hundred years after the eruption of Mount Vesuvius, and in a different part of the world from Pompeii, so we must understand these ideas as part of the evolving conception of the human body which were held at this time.

Bloodletting was practiced, therefore, to release blood from the body, and restore balance. Bloodletting was thought to divert blood from one part of the body to another, an idea that had serious consequences for medical practice. The doctor’s task was to rebalance, so if a patient was bleeding to death through one wound, the obvious solution was to open another, and the bleeding from the first would stop.

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Votive table depicting cupping and bleeding instruments from Temple of Asclepius at Athens. In centre is represented a folding case containing scalpels of various forms. On either side are cupping vessels.

From the late archaic Greece to the Roman empire, cupping vessels are the most abundant material remains of Greco-Roman surgical instruments, emphasising their extensive use by medical practioners for a vast array of ailments. These vessels are also commonly depicted on funerary and votive monuments, used as a symbol of the medical arts to mark a location or profession.

In his fourteenth Satire, Juvenal criticises bad parents and exclaims  ‘Despite your age, you’ve done worse,/Your forehead, empty of brains, in need of a cupping glass.” (14.58). The latin word he uses to describe the cupping vessel (cucurbita) is ventosa, meaning ‘windy’ or ‘swift’, but here perhaps more suitably describing the sucking sound of the vacuum created underneath a bronze vessel!