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 twenty small wounds in the skin with a knife, he announced that "The modern surgeons have, for Conveniency for themselves and Ease to the Patient, contrived a Scarificator ... which consists of 16 small Lancet-blades fixed in a cubical Brass Box, with a Steel Spring."[114] Heister noted that while Pare had used the scarificator only for incipient mortification, it was now "used with good success by our Cuppers in many other Diseases, as I myself have frequently seen and experienced."[115]