The Continuous, Faradic, Static and High-frequency currents have all proved of some value in relieving severe lightning pains. Nitroglycerin and Amyl Nitrite are occasionally useful, but they need only be tried when the arterial pressure is high.
Crises.—When these are only moderately severe the agents useful for the relief of lightning pains should be tried, but severe attacks will require morphia hypodermically. Amyl inhalations sometimes relieve any form of visceral crisis when the tension is high. Gastric crisis demands rectal feeding, smart counter-irritation, or a hot poultice over the stomach, and small doses of s gr. Cocaine with Bismuth or 3-min. capsules of Creosote. Obstinate gastric crises have within the last 2 or 3 years been treated successfully by operative measures after the failure of all medicinal agents. The resection of the posterior nerve-roots from the seventh to the tenth on each side in order to interrupt the reflex nervous arc upon the integrity of which the symptoms depend has afforded relief, Laryngeal crisis may be first treated by Amyl inhalation or a whiff of Chloroform or the upper part of the larynx may be brushed over with a solution of Cocaine. Bladder and rectal crises yield to Morphine alone or with Belladonna in suppository form.
Joint Troubles.—Little can be expected from treatment once acute symptoms of Charcot's trophic change have manifested themselves, and these may appear with almost incredible swiftness ending in rapid disin tegration of all the arthritic tissues. Absolute rest to the affected articu
lation is necessary, and the application of carefully padded splints to minimise the dangers of dislocation. Sometimes incision and irrigation of the joint have done good when loose bodies and irregular masses of new bone have formed around the margins of the articular cavity.
Perforating Ulcers.—These are common in the foot about the head of the metatarsal bones of the great and little toes. The best treatment is rest, and the careful scraping away of any diseased bone, and the paring down of thickened skin and granulations. The writer has frequently seen complete healing follow the patient application of a weak continuous current, one pole being applied over the thigh and the other dropped into a warm salt-water foot-bath in which the affected limb is immersed for I hour at a time two or three times daily. As soon as the patient is able to move about pressure should be taken off the skin over the affected area by the use of a thick insole of spongio-piline perforated opposite the site of the lesion.
Hyperesthesia is much less common in various skin areas than the opposite condition; sometimes it shows itself by a girdle sensation. The best routine in such cases is to administer Antipyrine and to apply a weak continuous current to the spine. The actual cautery with a light touch and at a dull red heat has been successfully employed for the relief of spinal pain, but the dangers of sloughing must not be lost sight of.