THE EFFECTS ON THE LARGE VEINS of the neck were well known to the ancients. The Assyrians were in the habit of tying the veins of the neck so as to cause insensibility while performing circumcision on adults. Serapion mentions the influence of pressure on the vessels of the neck for the relief of headache.

Dr Parry of Bath was the first to apply practically what he termed compression of the carotids for inducing sleep, and for the relief of attacks of hysteria and even epilepsy.1

In 1848, I published some cases which occurred in my own practice, showing the advantages of compression of the carotids for the removal of violent headache, epilepsy, hysteria, etc.2 Here are three cases in which it was used for other disorders.

Vagal compression to reduce vomiting

Mrs Y had been subject for some years to attacks of acute gastritis, during which the principal means employed to reduce the strong local pain, intense vomiting, nausea, and intolerance of most all ingesta, were local depletion by leeches, and later in the attack by vesication (with agents not containing cantharides).

Gradually the acute attacks subsided, leaving an irritable stomach, and the diet was obliged to be confined to animal food and stale unfermented bread. Nothing cold could be tolerated by the stomach. When from any neglect of these precautions the symptoms attained any degree of intensity, vomiting was induced mechanically, and the offending matter ejected.

I used vagal compression as a means of inducing tolerance and rest for a sufficient time to allow morphia to be absorbed. Half a grain of morphia was administered into the stomach, which was kept quiet from vomiting by occasional pressure on the vagus for about an hour. Although nausea still remained, at the end of this time the effect of the sedative became manifest; the vomiting had ceased, and finally the patient slept, and the attack was subdued. 

Some period later, on expressing my satisfaction at the improvement in her health and the increased range of foods that she was able to use with impunity, I found that she had been in the habit of applying vagal compression herself. Whenever any considerable irritation of the stomach was felt after eating, instead of waiting until the symptoms became severe, she immediately applied slight pressure on the vagus, thus arresting the symptoms at their début, and digestion was completed without further inconvenience. This novel mode of applying sedation to the stomach has been the means of allaying distressing symptoms, and the patient has consequently improved in strength under its influence.

Sea sickness

I have some expectation that vagal compression might be efficacious in cases of obstinate sea sickness, although I have not obtained, as yet, any decisive proof on the subject. I have applied it to myself (I must premise the statement that I am a complete martyr to sea sickness) the last time I passed from Ostend to London, at night, when in the berth. I found nausea commencing; pressure on the vagus produced sleep on two occasions, and I was enabled to escape the enemy by this indirect influence of vagal pressure.

Mania

In cases of mania, where the mind is trembling on the limits of unreason and reason, I have a strong conviction that the nervous shock caused by vagal pressure would, alone or in combination with other agencies, be productive of the most happy results.

Certainly, vagal compression is efficacious in cases where one pervading idea of an annoying nature occupies the mind, which cannot be dispelled, but is rather intensified by any attempt to dispel it. Under such conditions the influence of vagal compression is most heroic.

Even if sleep is not procured, if once we induce a sense of faintness by vagal pressure, it seems to act as a sponge passed over writing on a slate, either removing this one idea state, or bringing the intensified idea on a level with the others. I have repeatedly verified this effect on myself and other persons, by comparing the state of the before and after vagal compression.

1 Parry’s pathology. Passim, 1825.

2 Journal of Physiological Medicine, 1848.