394 Scientific Intelligence, ^c. 



« 

 resources as we possess. I am not disposed to believe that any 

 material improvement can be made in the ordinary rules for the use 

 of evacuants or measures of depletion, but I have no doubt, that an 

 important advantage may be gained, by directing in a particular 

 manner, the mode of counter-irritation, and it is chiefly with the 

 view of recommending this attempt that 1 have premised the foregoing 

 remarks. Long experience has convinced me that the most efficacious 

 way of applying counter-irritation in diseases of the brain is a method 

 not often practised in other places, which has been for many years in 

 almost constant use at the Bristol Infirmary. An objection would 

 probably arise in the minds of those who have not witnessed the 

 application of this remedy, on account of its apparent severity. I 

 hope to convince the medical section, and through this opportunity, 

 to make more general than would otherwise be done, the persuasion 

 that the method of treatment to which I refer is by no means so 

 painful or severe a remedy as it might be supposed to be, and that it 

 greatly exceeds in efficacy any other means by which physicians have 

 attempted to relieve diseases of the brain on a similar principle. The 

 application I recommend is an issue produced either by means of a 

 soft caustic, or what is much better, by an incision over the scalp. 

 The incision is most frequently made in the direction of the sagittal 

 suture, from the summit of the forehead to the occiput. The scalp 

 is divided down to the pericranium. The incision, when that 

 method is used, or the aperture left by the slough, when caustic is 

 employed, is kept open by the insertion of one or two, or in some 

 instances three rows of peas. The discharge thus occasioned is con- 

 siderable, and it obviously takes place from vessels which communicate 

 very freely with the vessels of the encephalon. It would appear, a 

 priori, very probable, than an issue in this particular region, just 

 over the sagittal suture, would have a greater effiict on the state of 

 the brain, than in any other situation, and the result of very nume- 

 rous trials has abundantly established the fact. I can venture to 

 assert, that in all those cases of a cerebral disease in which counter- 

 irritation is at all an available remedy, an issue of the kind now 

 described is, next to bleeding, by far the most important of all the 

 means which have yet been, or are likely to be discovered. The 

 kinds of cerebral disease in which counter-irritation is beneficial, 

 include, according to my experience, all those complaints which are 

 accompanied by stupor or diminished sensibility, excluding all affec- 

 tions, attended by over-excitement, such as maniacal and hysterical 

 diseases. In the latter, I believe all such measures to be for the most 

 part highly injurious. 



A case has lately occurred in my practice at the Bristol Infirmary, 

 which strongly exemplifies the efficacy of the treatment which I have 

 recommended, and which I have fortunately an opportunity of bring- 

 ing before the Medieal Section in the most convincing way. A 

 youth aged about eighteen, came into the Infirmary labouring under 

 complete amaurosis, which had been coming on gradually for a week 

 or ten days before his admission. At that time it had become so 

 complete that vision was entirely lost, and the pupils were totally 

 insensible to light even when the rays of the sun were suffered to fall 

 immediately into the open eyes. At first he was freely and repeatedly 



