.GrteUsTof the Wet-Cup in 
Place of the Leech in Cer- 
tain Acute Diseases of 
the Ear. 
BY 
GOKIIAM BACON' M.D. 
SEP HINTED FROM 
Neto ¥otfc JJtaeUfcal 
for January 7, 1888. Reprinted from the New York Medical Journal 
for January 7, 1888. 
ON THE USE OF 
THE WET-CUP IN PLACE OF THE LEECH 
IN CERTAIN ACUTE DISEASES OF THE EAR. 
By GORHAM BACON, M. D. 
Otologists in this country, as well as in Europe, are 
generally agreed as to the great value of leeching in cases 
of acute inflammation of the auditory canal, middle ear, or 
mastoid process, attended with intense pain when there are 
great hyperaemia and infiltration of the parts, and engorge- 
ment of the vessels in the periosteum and mucous mem- 
brane. In such cases the pain is almost always alleviated 
and frequently removed by the local abstractioniof blood, 
and in many instances, I believe, the further progress of the 
disease is arrested. 
According to Roosa, " an attack of diffuse inflammation 
of the external auditory canal in an adult may often be cut 
short by the use of leeches," and, in speaking of acute ca- 
tarrh of the middle ear, he says : " The application of from 
one to six leeches, according to the severity of the disease 
and the age of the patient, will usually be sufficient to quiet 
the most severe pain in the ear, and to check the intensest 
form of catarrhal inflammation, I have seen almost magi- 
cal effects from their use," 2 
ON THE USE OF THE WET-CUP 
Schwartze says: " In cases of actual middle-ear catarrh 
where the pain is severe, if leeches are applied in the hyper- 
aemic stage dose to the tragus, they will relieve not only 
the pain and tension in the ear, but will gradually cut short 
the inflammatory process." Leeches are also of benefit in 
the first stage of inflammation of the mastoid cells. 
Hartmann also says: " Bloodletting is often employed 
with very favorable results in acute inflammation of the 
different parts of the organ of hearing, or in acute exacer- 
bations of chronic inflammation, accompanied by great hy- 
peremia and violent pain." 
Wilde and v. Troeltsch have shown that the blood-sup- 
ply of the tympanum is influenced by the local abstraction 
of blood when the point for the operation is selected close 
to the tragus, in front of the pinna. This is due to the 
fact that the veins from the membrana tympani run along 
the anterior superior wall of the external meatus in its lin- 
ing membrane, and empty into the anterior facial vein, just 
in front of the tragus. Politzer says that " bleeding in this 
locality will also effect a depletion of the venous network 
situated in the cavity of the maxillary joint and its neigh- 
borhood, the importance of which Zukerkandl was the first 
to point out, the supply of blood in the vessels of the tym- 
panic cavity, which are in communication with these ves- 
sels, being thus lessened." There is also an anastomosis 
between the vessels of the mastoid cells and the vessels of 
the integument covering the mastoid process, so that local 
bleeding at this latter point will produce a temporary deple- 
tion, not only of the vessels from the mastoid, but also of 
those from the tympanum anastomosing with them. 
During the past eighteen months I have been using a 
wet-cup to produce local bleeding, instead of the leech, with 
most satisfactory results. For this purpose I have had made 
a scarificator (Fig. 1) in which six lance-shaped needles are IN PLACE OF THE LEECH. 
3 
concealed. The instrument is very similar to one shown 
by Dr. David Webster at the last meeting of the Medical 
Fig. 1. 
Society of the State of New York, which he uses, together 
with cocaine and galvanism, for producing anaesthesia about 
the eye, except that I have substituted different needles. 
The depth of the punctures can be regulated by screwing 
or unscrewing the end or cap of the scarificator. When 
this is determined, the spring is pulled back, the instru- 
ment is applied to the parts, and the tissues are scarified. 
A cupping-glass (Fig. 2), similar to those manufactured by 
Fig. 2. 
the Davidson Rubber Company, except that the glass is 
made smaller and adaptable to the parts about the ear, is 
then immersed in hot water for a few moments, in order to 
promote the bleeding as much as possible, and applied close 
to the tragus, or below the lobule, or over the mastoid 
process. The glass itself holds three drachms. If neces- 
sary, three cups can be applied at once in front of the 
tragus, just below the lobule and over the mastoid. 4 
OX THE USE OF THE WET-CUP 
Heurteloup's artificial leech is recommended by Politzer 
" in cases in which a rapid depletion is required and the 
quantity of blood to be withdrawn is to be exactly con- 
trolled." The objection to its use is that the cutting in- 
strument causes considerable pain and the cupping-glass is 
so large that its application behind the ear is attended with 
much difficulty on account of the irregular surface of the 
mastoid process. On the other hand, the punctures made 
with the instrument which I use cause but little pain, and 
the cupping-glass is applied without difficulty and held in 
position by the patient, thus in every way being much sim- 
pler than the use of leeches. 
Bartholow, speaking of bloodletting by means of leeches 
and cupping, says : " The counter-irritant effects are much 
more pronounced from cups than from leeches," and accord- 
ing to Biddle " cups are generally preferable in internal in- 
flammations, from their more decided revulsive influence." 
I have been led to substitute the wet-cup for the leech 
for several reasons : 
1. Many patients, and especially children, have a great 
repugnance to having a leech applied to the ear, so that it 
is extremely difficult in such cases to use them. 
2. The bleeding from a leech-bite is frequently difficult 
to arrest, and in one case which came under my observation 
it was necessary to resort to the actual cautery to control 
the haemorrhage. 
3. A leech-bite occasionally gives rise to erysipelatous 
inflammation and ulceration, and not infrequently produces 
a circumscribed abscess, even in apparently healthy indi- 
viduals. 
4. Leeches are not always to be had, especially in the 
country, and are very frequently a troublesome remedy, be- 
sides being expensive. 
In a paper on " Sea-bathing as a Cause of Ear Disease," IN PLACE OF THE LEECH. 
5 
published in the "Medical News," January 29, 1887, I ad- 
vised the use of the cupping-glass in place of the leech 
where it is desirable to promote the abstraction of blood, 
because " the cupping-glass is always at hand, the quantity 
of blood abstracted can be entirely regulated, and it is much 
more agreeable to the patient." 
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