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.  Accordingly I made a protracted series of experiments with carotid compression upon those suffering from congestive headache, and I can only say that I have been so far pleased with the uniformly good results obtained, that I have felt it a duty to call the attention of the profession to a procedure which, for obvious reasons, possesses all the advantages of local depletion by leeching or cupping, without the manifest disadvantages of either of these methods.  The instruments which I have devised as substitutes for the primitive procedure of digital compression of the carotids have already been described in former communications.  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.  The other instrument, which I have designated as the “carotid truss,” for lack of a better name, is a circular spring provided with adjustable pads at each extremity.  The spring is placed about the neck of the patient, and by suitable appliances the pads at the extremities can be placed directly above the trunks of the two common carotid arteries.  By turning the screws to which the pads are attached the desired amount of pressure can be applied to the arteries, and the apparatus can be worn for any length of time by the patient.

With these instruments I have frequently succeeded in arresting the most obstinate form of congestive headache in an incredibly short time (on one occasion in about five minutes).  Where, however, the headache is of manifestly nervous origin and uncomplicated by any especial circulatory derangements, I have never been able to achieve notable results with this method.  Indeed, pressure upon the carotids is an excellent method of differentiating the congestive form of headache from the nervous varieties of head pains.

Of galvanism this much may be said, that it is one of the most valuable methods which we possess for treating the form of headache under consideration, for not only does it cause contraction of the smaller arteries, but it also exerts a soothing influence upon the plasma of the brain itself.

A powerful therapeutic agent, and one which has been more or less extensively employed in the treatment of various forms of head and spinal symptoms, is cold.