!08 SIXTH REPORT — 1836. 



perience has convinced me that the most efEcacious 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 all 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 em- 

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

 three rows of peas. The dischai'ge thus occasioned is considerable, 

 and it obviously takes place from vessels which communicate very freely 

 with the vessels of the encephalon. It would appear, i priori, very 

 probable that an issue in this particular region, just over the sagittal 

 suture, would have a greater effect on the state of the brain than in 

 any other situation, and the result of very numerous trials has abund- 

 antly 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 avail- 

 able 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 usual stupor or dimitriotical sen- 

 sibility, excluding all affections, attended by over-excitement, such as 

 maniacal and hysterical diseases. In the latter, I believe all such mea- 

 sures 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 bringing 

 before the Medical Section in the most convincing way. A youth 

 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 bled from the arm 

 and temporal artery, had leeches applied to the scalp, blisters to the 

 nape of the neck, and took calomel so as to render his gums sore. 

 Finding that no effect whatever was produced by these measures, I 

 gave uj) the expectation which I had at first entertained of his recovering 

 sight, but was resolved to give the remedies a complete trial. I ordered 



