IN CASES OF DISLOCATED BONES of difficult reduction vagal pressure presents several advantages possessed by no other means with which I am acquainted, as it is unattended with any kind of danger, and is always at hand in any emergency, however sudden. 

As illustration of this I may state the following case of very recent occurrence:

M.C. ______, a journeyman baker, a powerful and athletic man. In consequence of a fall down stairs the head of the humerus was dislocated beneath the clavicle. Dr G Julliard, whose patient he was, made an ineffectual attempt alone in the morning to reduce the fracture by placing his heel in the axilla. Some hours later Dr J. L. Prevost and myself accompanied Dr Julliard to give our assistance. While the man was lying on the bed some unavailing attempts at reduction were made, when Dr Julliard sent for chloroform. In the meantime I proposed to make another attempt with the assistance of compression of the vagus. After removing the pillows at the head, and arranging the patient more comfortably than before, I took my station at the head of the bed to apply compression on both sides, while Dr Julliard grasped the limb, and Dr Prevost performed counterextension.  At the end of two or three minutes, just as I felt the two carotids no longer beating beneath my fingers, a sudden click indicated the return of the bone into its socket. In this instance, although the chloroform had only to be procured from a chemist’s in the same house, the patient was bandaged and arranged comfortably before the messenger returned with the chloroform.

Vagal compression compared with chloroform

The administration of chloroform in the most skilful hands, and while surrounded with all the appliances of hospital practice, is still undeniably attended with a certain amount of danger, which is greatly increased when there is no medical man present to watch its effects. So much is this the case that as Dr Prevost pointed out to me, there were three fatal cases from chloroform within a few days’ interval in the different hospitals of Paris, where it was administered for the purpose of reducing dislocation of the head of the humerus.

On the other hand, compression of the vagus is perfectly free from any danger to life. I have used it in the most varied circumstances, and have never yet witnessed any instance whatever to inspire me with anxiety or doubt as to any fatal consequence. It is quite different with the ordinary anaesthetics, particularly chloroform, whose influence continues to accumulate in the various muscular organs, especially the heart, gradually destroying their irritability so insidiously that death may be imminent without our being aware of it.

Vagal compression for tooth extraction

I have lately tried vagal pressure in a case of tooth extraction. 

A molar tooth was extracted from an out-patient of the Hôpital Cantonal by one of the house-surgeons. While the patient was seated I was prepared at the back of the chair to apply pressure on both vagi. As soon as the key was gently applied round the tooth I began the pressure, and gave a sign for the operator to commence. The result was perfectly satisfactory.  According to the statement of the patient she had suffered no pain, and was most enthusiastic in her thanks to me. At the moment of extraction the patient cried out, which, however, occurs in many instances with chloroform, where, as in this case, the patients afterwards declare they have not felt any pain.

In summary, vagal compression use may be considered  in all cases of difficult reduction previous to the employment of any of the ordinary anaesthetics.  Also, in the case of tooth extraction, its employment produced, according to the patient, insensibility to pain, and it may probably be employed with advantage in many cases of the sort.