Salicylic Acid, Iodine and Cocaine Ionisations have been employed by the cataphoresis method, but these are useless in fat subjects owing to the depth of the nerve.
The X rays and Radium emanations have been employed with success in some cases. The X rays have " cured," according to Babinski, when everything else had failed. Mechanical vibration should always have a trial, but it is usually futile unless when combined with massage and other methods. Of local anodyne applications, those already mentioned as suitable for the treatment of chronic rheumatism may be tried, as Methyl Salicylate, Chloroform, Aconite and I3elladonna. Liniments are often useful. Pain may sometimes be rapidly relieved by Ether or Ethyl Chloride spray, applied over the course of the nerve. Camphor, Iodine, Menthol, Guaiacol, and Salicylic Acid may be advantageously applied in the liquid form, known as Oleogens. Mild and severe counter-irritants, short of producing vesication, are much employed, and the most popular of these is Chili or Capsicum paste. StrongTincture of Iodine applied along the course of the nerve seems to be beneficial in thin subjects.
Massage, electricity, mechanical vibration and douching or other forms of hydropathy should be reserved for the chronic stages of the affection, and the use of these agents is best carried out during the convalescing period at a suitable hydropathic institution, where treatment is scien tifically followed, and where the change of air, of scene, and of dietary will be further augmented by the administration of natural mineral waters, which promote the elimination of effete compounds. A change to a warm, equable climate, like that of Egypt, is most desirable in long standing cases before the patient is permitted to resume his usual occupa tion.
Surgical Treatment.—Where, notwithstanding the persevering use of the before-mentioned list of treatments, the pain and lameness persist, resort to surgical procedures is clearly indicated.
Acupuncture has already been incidentally mentioned; this consists in so-called " needling " of the nerve by piercing it in several places with a series of stout, sharp-pointed needles, introduced deeply at right angles to the surface; these may be left in situ for 15 to 3o minutes. As any benefits derivable from this painful operation may be easily obtained by using the hypodermic needle in the manner already described for the administration of morphia, cocaine, osmic acid, alcohol or normal serum, as a method of treatment per se it should be abandoned.
Nerve stretching has often proved valuable. This should be first tried (without dividing the skin) by forcibly flexing the hip beyond a right angle, the knee being afterwards gradually extended to a straight line with the thigh ; hut the operation, to be successful, should be performed under general anaesthesia. Failing relief by this method a free incision should be made over the course of the nerve, starting below the border of the gluteus maximus, the trunk of the sciatic shoul i be pulled out by the bent finger or a strong blunt hook, and a considerable degree of force applied steadily till the nerve is thoroughly loosened from its bed. Some surgeons supplement the stretching by the procedure known as " harrow ing," in which a series of superficial longitudinal incisions are made into the sheath to divide enlarged veins and any adhesions present, after which the limb is put up on a long splint and allowed to rest for several days before beginning passive movements.
Neurotomy (division of the nerve) or excision of a portion of the trunk is abandoned owing to the paralysis and contractures which are almost certain to follow.