bloodletting, had no doubt that application of the boot to the foot would relieve congested states of the abdominal viscera.[161] (Figure 18.) Americans patented a number of modifications of the arm and boot, and in addition they patented a number of whole body devices called "depurators." Junod had introduced such a device along with his boot--a metal casing in which a patient would be placed leaving only his face showing. The air inside would then be exhausted by means of a gigantic syringe. In America such "depurators" may have been regarded more as quackery than as a legitimate extension of cupping, for despite the fact that Americans patented some twenty of these devices, surgical supply houses did not sell them and little was written about them. In the last decade of the nineteenth century, Dr. August Bier, professor at the University of Bonn, developed another sophisticated theory supporting the use of blood-suction devices, known as the theory of hyperemia, meaning "excess of blood." According to the doctrine, lesions are always accompanied in nature by hyperemia, "the most widespread of auto-curative agents."[162] If we, therefore, wish to imitate nature, we create an artificial hyperemia. Bier recommended several means of increasing the blood supply of an affected part, including hot-air baths, suction devices such as Junod's boot, and dry cupping. Several American surgical suppliers sold Bier's Hyperemic Cups in the early twentieth century. These were glass cups, of a great variety of shapes and sizes including some with curved rims, each fitted with a rubber tube and bulb for exhausting the air. A major function of these cups was to collect wound secretions from boils or furuncles.[163] [Illustration: FIGURE 18.--Junod's boot applied to a baby in the cradle. (From Victor Theodore Junod, _A Theoretical and Practical Treatise on Maemespasia_. London, 1879. Photo courtesy of NLM.)] _Breast Cupping_