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It is only necessary to say that the implements in question are of two kinds; one, the "carotid fork," is an adjustable instrument, which being held in the hand of the operator permits him to exert any degree of pressure upon both carotids for any desired length of time.
Two years ago I began a series of experiments on epileptics and maniacs, which involved the application of protracted pressure to the common carotid artery on both sides. In the course of these experiments the thought suggested itself that suppression of the carotids might prove a salutary means of reducing that form of cerebral congestion which is so prolific a source of headache and vertigo.
I know not how to describe it better than as a kind of tempest, which suddenly rose in my blood, and spread in a moment over every part of my body. My arteries began beating so violently that I not only felt their motion, but even heard it, particularly that of the carotids, attended by a loud noise in my ears, which was of three, or rather four, distinct kinds.
It passed through the veins of the legs and belly to the heart, which was beating like a thousand drums, and thence by the aorta and the carotids to the brain, whence it emerged by the fissures of the skull into the outer air. Through this it passed, I know not how, and found itself all at once in a new world.
The instrument used to effect this major injury was a blunt potato-peeling knife. Despite this terrible wound the patient lived to the sixth day. Hislop records a case of cut-throat in a man of seventy-four. He had a huge gaping wound of the neck, extending to within a half inch of the carotids on each side. The trachea was almost completely severed, the band left was not more than 1/4 inch wide.
Ellis mentions ligature of both carotids in four and a half days, as a treatment for a gunshot wound, with subsequent recovery. The patient was in profound collapse, but steadily reacted and was discharged cured on the forty-fifth day, with no perceptible pulse at the wrist and only a feeble beat in the pulmonary artery.
In hyperæmic headache cupping and blood-letting have been recommended; but as a rule both procedures are not only unnecessary but positively inadmissible, as exclusion of the superfluous amount of blood by compression upon the carotids, followed by a corresponding dilatation of the peripheral circulation by means of the foot-bath, will almost always be sufficient to cause a permanent cessation of the symptoms.
Indeed, pressure upon the carotids is an excellent method of differentiating the congestive form of headache from the nervous varieties of head pains.
The surgeon placed a hand on each side of it and pressed it slowly backwards and forwards. "Adherent at one place, gentlemen," he cried. "The growth involves the carotids and jugulars, and passes behind the ramus of the jaw, whither we must be prepared to follow it. It is impossible to say how deep our dissection may carry us. Carbolic tray. Thank you! Dressings of carbolic gauze, if you please!
She gave a quick side-glance at the instrument table as she passed, but the nurses turned her away from it. "What ails her?" asked the novice. "Cancer of the parotid. It's the devil of a case; extends right away back behind the carotids. There's hardly a man but Archer would dare to follow it. Ah, here he is himself!"
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