LUMBAGO.
Rest in bed between blankets should be at once insisted upon: dry warmth when applied immediately may abort the attack. The best form for the application of heat is the india-rubber bag only partially filled with as hot water as can be borne and laid across the back. This is much better than hot poultices, which should be avoided. In the absence of the rubber bag or between the periods for its refilling a single layer of coarse brown paper being laid upon the seat of the pain, the part may be smoothed or firmly pressed with a hot smoothing-iron, such an appliance as is used in laundry-work answering well. This meets every requirement which can be achieved by the actual canter:, and does not produce severe smarting.
Acupuncture by driving several needles deeply into the affected muscles often gives speedy relief.
Aquapuncture may be tried, the muscles being deeply punctured by a stout hollow needle and a few drops of sterilised water inserted before withdrawing the needle after each stab. This method may be advan tageously comhined with Cocaine or Morphia injections if these sub stances are added to the water as in the'writer's plan of treating severe sciatica. Antipyrine, Amyl Nitrite, Carbolic Acid and other drugs may be employed in the same way, but their use is followed by severe pain.
llaig's manipulative treatment consists in making deep pressure with the thumbs on the lumbar muscles close to the spine, whilst with the upper part of the trunk the patient is made to perform acute flexion, rotatory and lateral movements, the lower part of the spinal column being kept immovable.
Of local anodyne applications there is no end; the most popular of these arc liniments or plasters which contain Belladonna, but they should be used with caution. The following application may be applied upon lint covered in with oiled silk, but its effects must be closely watched: Liniment. Belladonna 5ij.
Linimcnt. A coniti 5iss.
Liniment. Chloroformi ad 3vj. Misce.
The Chloroform of Belladonna (Squire) is a powerful anodyne.
For routine use the limp. Menthol is safer than that of belladonna. The variety spread upon perforated felt may be applied over a large surface or the ordinary rubber adhesive plaster may be applied so as to partially fix the spine. In very acute cases severe pain may be relieved by the spray of Ethyl Chloride or of Ether; cold applications are to be avoided.
Counter-irritation is more suitable for chronic or recurring cases when these do not yield to anodynes or to a thick layer of Antiphlogistine or of Cataplasma Kaolini (U.S.P.) covered in with mackintosh sheeting.
The Cautery, Blisters, Chili paste, Capsicum, Thermogene or Calorific Wool, Dry Cupping, Croton Oil Liniment, Tartar Emetic Strong Iodine, &c., have all been highly recommended in chronic cases. One of the best counter-irritating liniments is the Lin. Camph. Ammon. or the Lin. Tercb. Acetic.
In very chronic cases a flannel binder sprinkled with Sublimed Sulphur may be continuously worn around the loins, and the use of the various appliances for producing rapid vibration are often very beneficial.
In obstinate cases where the attack has originally followed sprains or injuries of the lumbar muscles it may be necessary under Chloroform tc forcibly flex and extend the spinal column with the pelvic and the thigh muscles in order to break down adhesions the result of the long-standing fibrositis.
Electrical treatment is of considerable value in lumbago. Occasionally speedy disappearance of all pain has been found to follow the early applica tion of a moderately strong continuous current. It is the best routine treatment in chronic or recurring cases when combined with massage and the judicious use of douches and hydropathic measures at resorts like Bath, Droitwich, Nantwich, Matlock and Ilarrogate. Static and high frequency currents and Faradism are also valuable, and X. ray and Radium emanations have been extolled.