As elsewhere described, a very hot smoothing-iron may be passed for several minutes along the course of the nerve, the skin being protected by a single layer of brown paper. This method of using dry heat for the relief of pain is not to be confused with the caustic or counter-irritant action which is obtainable from the actual cautery, which is also sometimes advocated. At a later period hot douches are indicated; these should be reserved for the chronic stage when the patient is able to leave his bed and avail himself of the advantage to be obtained from the various modifications of hydropathy as the Scotch, Aix massage douche, etc., carried out at Harrogate, Peebles, Bath, Matlock, Buxton. Brine bath treatment is of great value; this is procurable at Droitwich and at the more accessible Nantwich. At the latter resort the baths can be obtained, with excellent hotel accommodation, on the level of the patient's sleeping and living rooms—a desideratum when walking is very painful or im possible. At both of these resorts massage and electrical treatment can be obtained.
Massage, as in fibrositis,'is an agent of great value when skilfully and perseveringly employed. In the early stages of the disease it may greatly aggravate the malady, and even in chronic cases its rough or too thorough administration may convert a mild chronic into an acute sciatic neuritis.
Electricity has been employed in every conceivable form; the writer has obtained the best results from the daily use of the constant current. Luke speaks highly of the hydro-electric bath, whilst some authorities extol static electricity and the sinusoidal current.
Blistering relieves pain, and in some instances effects changes in the nerve or its sheath, which unmistakably hasten resolution and the absorption of fibroid thickening and nodosities.
As regards local remedies and anodyne applications, there is practically no end, and the methods by which these have been employed are also numerous. Thus Acupuncture, Aquapuncture, and Parenchymatous Injections of Narcotics or local anesthetics have been long employed. The writer's routine method of local treatment by Morphia combines all these methods, together with that of blistering, and affords, in his opinion, the best all-round plan of treating both acute and severe chronic cases.
It consists in the administration of a moderate dose of Morphia by a hypodermic syringe capable of holding about 2 drs. of liquid. The requisite amount of the narcotic (1- gr. to gr.) in solution is added to enough water or saline solution to fill the syringe. The course of the nerve being mapped out on the surface, a series of four to six small areas of the skin arc rendered anaesthetic by the application of strong Carbolic Acid; this is accomplished by applying the stopper of the bottle containing the acid to the skin for a few seconds, making four to six small, circular marks, over the course of the nerve, between the sacra sciatic notch and the calf of the leg. These insure sterilisation of the skin
and sufficient local anesthesia to prevent the needle punctures being felt, whilst afterwards they act as a series of small blisters. Into the centre of each spot the needle is thrust firmly at right angles to the surface and to a depth according to the leanness or fatness of the patient, sufficient to penetrate the nerve trunk. About 20 mins. are injected at each spot, and the nerve behind the head of the fibula may also receive a puncture.
In a sudden and severe attack of sciatic neuritis one such multiple injection, given early in the disease, may sometimes cause the disap pearance of all symptoms; but rarely will so striking a result be observed. The injections should not he repeated oftener than once in two days, and the danger of the opium habit being acquired should prevent more than half a dozen of such operations; but they may be continued for weeks by omitting the morphia, and using only Normal Saline solution. Next day, between the areas cauterised by the acid, three or four small, circular blisters, about the size of a penny-piece, may be applied, keeping in the course of the line of the nerve.
Alcohol (7o per cent.) has been injected into the trunk of the nerve in doses of r to 2 Prava2-syringefuls (16 to 32 mins.) by Schlosser, as in the treatment of neuralgia of the fifth nerve, but this has been followed by complete motor and sensory paralysis, which, however, passes off after the expiration of many months.
Lange's treatment is conducted on somewhat different lines to the writer's method; he injects from 2 to 3 oz. Normal Saline solution alone or containing per cent. Beta Eucaine, and Schlesinger injects 2 to 3 drs. normal saline cooled to zero Centigrade. These injections are only made into the tissue around the nerve at one spot, generally close to the notch. Cures reported after the use of various Vaccines are probably due to the physical effects of the fluid injections.
Cocaine, injected hypodermically or by the deep parenchymatous method, is a favourite local treatment, and the drug has been injected into the spinal canal after lumbar puncture. Ether has been also em ployed like strong alcohol, but its injection is not free from the danger of causing paralysis. Osmic Acid, in r per cent. solution, has been employed by injecting 5 to 15 mins. hypodermically or deeply into the nerve. The former method is probably a useless one, and if this drug be employed at all, it should be used by injecting it into the nerve substance. The writer has seen some most intractable cases yield to this treatment, but he injects half or one-third the full dose at two or three spots along the course of the nerve. Sometimes most severe pain and reaction follow the injections.