Inflammation of Spinal Nerves.
The noteworthy diseases of the spinal nerves are the general conditions of neuritis, degeneration, etc., already de scribed; the painful affections included under the term neuralgia (vide infra); and the affection known as sciatica, now to be dealt with.
Sciatica.
This is to be regarded as a form of neuritis chiefly interstitial in character, the pathological changes being located in the nerve-sheath. In severe cases the nerve-fibrils are also affected. The lesion is usually localized at the sciatic notch and near the middle of the thigh, and the pathological alterations shown are those of simple neuritis, previously sketched.
The malady is most common in mid dle life, and is seen more frequently in men than in women. The remote or predisposing causes are general malnu trition; rheumatic, gouty, and uric-acid diatheses; digestive defects, syphilis, and anything which lowers general vital tone. The exciting causcs are exposure to cold, muscular overstrain, and direct injury, fIS from pressure or blows.
A careful examina lion of the pelvic viscera will frequently reveal the cause of a sciatica, prolapse of the utenly %%ftli no% t f-aon. prolapse of the roc taia„in inflamed oN ary or testicle, vati to,t'e, an inflamed or tender prostate, and It rinorrhoids are especially con di' ti% e to sciatica, \Odle fissure 111 .41 11.1re of the rectum, stricture of the impacted freces, and tumors in the IA IN le cavity are also causes. Press ure atom, the eourse of the nerve, con tinued for n long time, may produce an attml: of rciatica, as will, also, exposure to cold. F. Bishop (Virginia Med. ,eminionthly, July S. '9S).
Symptoms.—The characteristic symp ti ins of sciatic neuritis are pain and tendermss along the course of the sciatic nerve, with weakness and a sensation of stiffness in the muscles. The onset of the pain is usually gradual, it being at fir.st felt only on exertion, but, as it be comcs more severe, being constant. It is at times a dull ache; at others a sharp laminating or acute burning pain. For mication, tingling, and some degree of angesthesia are common. In later stages
there is some atrophy of the calf and other muscles supplied by the sciatic nerve, and in a few instances the disease extends to the lumbar plexus of nerves.
Trophic disorders, as cedematous swelling and herpes, are of not infre quent occurrence.
In about one-third of the cases of sci atica personally seen during the past eight ,years loss of the knee-jerk on the affected side noted. Raven (Brit. lied. Jour., Mar. 19, '92).
Attention called to the abolition of the tendo-Achillis reflex in sciatica, and its value indicated as a differential sign between true sciatica and hysterical pseudosciatica. J. Babinski (La Aled. .1od., Oct. 26, '98).
The disease endures for weeks, months, or even years, although eventual recovery is the rule. INIost cases last for months. The more acute and severe the initial symptoms, the longer the case will probably last. An obstinate form of neuralgia may persist after the other symptoms of sciatic neuritis are entirely gone. Secondary sciatic neuritis, from pressure of a tumor or a similar cause can, of course, be relieved only after re moval of the cause.
Treatment.—In the treatment of sci atica the first requisite is absolute and complete rest of the limb, all movements which give the least pain being scrupu lously avoided. Simply confining the patient to bed may answer in many cases, but in the aggravated forms placing the limb in splints is advised. Hot applica tions, as hot poultices, superheated air, etc., are grateful in relieving the pain, while occasionally ice is more useful. Counter-irritation by the actual cautery gives great relief sometimes. A strong galvanic current is always of service. The local hypodermic administration of drugs is preferable to the use of drugs by the mouth. Cold water injected into the muscles gives great relief. Acu puncture is frequently of great value. Where local remedies fail the internal adminis,tration of coal-tar products or morphine may be necessary.