SCIATICA.
Before commencing treatment there should be a minute investigation into every possible cause of local nerve irritation. There can he little hope of successful treatment till such affections as sacroiliac and hip joint or vertebral disease, and pelvic tumours of osseous or fibrous nature are excluded. Formerly sciatica was regarded as a true neuralgia of the nerve, and the agents supposed to alter or modify the nutrition of nerve tissue were employed. By all clinicians during recent years the view is accepted that the great majority of cases of sciatica should he regarded as examples of neuritis, and that the origin of the neuritis is a fibrositis, involving the sheath or the white fibrous tissue of the nerve trunk.
The treatment of neuritis and fibrositis has already been dealt with in the articles on Neuritis and Rheumatism, Chronic, and the treatment of sciatica must be based on the same lines. For convenience the various remedial agents may be here again enumerated as they apply to sciatica.
Rest in bed is essential in all cases. In the early stages of mild attacks, though the patient may be able to walk about without much suffering, he should be ordered to bed, as the action of the muscles tends to cause a considerable degree of pressure on the inflamed nerve, and a mild case is often converted into a very severe one by muscular exercise.
Acute pain and tenderness in the nerve are indications for the applica tion of a long splint or a series of sand-bags so applied around the limb as to prevent the muscles of the thigh or buttock being brought into action. A dry heat should be maintained by the application of warm wool to the limb, which should be kept in place by a many-tailed bandage. Sublimed Sulphur, sprinkled upon the wool before application to the limb, is often useful.
Internal remedies embrace a long list of the agents in use for the relief of pain; narcotics by the mouth must, however, be avoided in a diseased condition so liable to become chronic. When Morphia is im peratively demanded for the relief of agonising pain, it should be reserved for hypodermic use in the manner to be described later on.
Salicylates, or their derivatives, as enumerated in the article on Acute Rheumatism, afford the most satisfactory results; the best form for the administration of this class of drug is Aspirin, which may be given in cachets to the amount of 4o grs. daily. Bee stings have been resorted to on the rheumatic theory of the disease, and some excellent results have been reported by Burton. Iodides, in the later stages of the disease, are clearly indicated, but must be administered in full doses; 6o grs. daily of Sodium Iodide is not too large an amount, and this dosage may be tolerated when smaller quantities are badly borne.
Where there are reasons for regarding the sciatica as a pure neuralgia of the nerve, Quinine in 5 to DD gr. doses may be tried, and it may be combined with Gelsemium, and in gouty patients with Colchicum or Salicylates. The Salicylate of Quinine and Xaxaquin—the acetyl salicylate—are given in 5-gr. closes, and Saloquinine and its salicylate Rheumatin—in 15-gr. doses. Phosphorus, as in Sanatogen or as free phosphorus or as Glycerophosphates, is extolled in the neuralgia type of sciatica. Cod-Liver Oil is always useful, and Arsenic and Iron are indicated in all anaemic cases.
Local Treatment will consist in the application of heat by the various methods detailed under Rheumatism, Chronic, as by the electro-thermic bath of Dowsing, the hot-air, vapour, Turkish, or Russian baths. These latter mentioned, as well as hot-water baths, are contra-indicated in the acute stage of the disease, where the pain is always aggravated by the movements necessary in the application of these agents—hence the advantage of any appliance for the local use of dry heat without neces sitating the patient moving from his bed. The radiant heat bath can be readily employed, as the patient lies at complete rest in the horizontal position, and when the electricity necessary for its production is not available, a series of hot-water rubber bottles or of heated sand-bags, or the spirit-lamp arrangement employed in the treatment of Bright's Disease may be used.