SCIATICA. 



341 



cases it often lasts for months or years. Even after the disease has 

 disappeared, relapses very readily occur. 



TREATMENT. The causal indications can rarely be fulfilled. If 

 disease of the vertebrae be the cause of the sciatica, we may use moxa, 

 the hot iron, etc., to the back. Of the injurious influences that act on 

 the sciatic plexus in the pelvis, overfilling of the sigmoid flexure is 

 almost the only one that is accessible. Although rarely the sole cause 

 of sciatica, this is a frequent complication, hence the old habit of be- 

 ginning the treatment with a laxative is quite proper. If sciatica 

 remain after difficult delivery, and if we have reason to refer it to a 

 para or perimetritis, we may employ frequent abstractions of blood, 

 and use cataplasms for a long while. In rheumatic sciatica warm- 

 baths are useful, particularly the systematic treatment with baths at 

 Teplitz, Warmbrunn, Wiesbaden, or Wildbad. Among the antirheu- 

 matics administered, iodide of potassium in large doses appears to do 

 most good. I saw relief of the pain occur particularly in those cases 

 where the running from the nose, and the eruption caused by the 

 iodine, came on early. 



In recent cases, the indications from the disease are best answered 

 by the local abstraction of blood, and wet cups are preferable to 

 leeches. The almost universal mention in text-books of one or more 

 venesections, in the treatment of sciatica, appears to be merely out of 

 respect to old medical authorities, particularly Cotugno, for at present 

 no one ever bleeds for sciatica. In cases not very recent we should 

 use derivatives to the skin, particularly blisters. We apply the first 

 blister to the small of the back near the vertebra?, on a level with the 

 points of exit of the nerves forming the sciatic plexus ; the second 

 behind the trochanter, and so gradually pass down to the foot, applying 

 blisters to the places where the nerve lies close under the skin. Be- 

 sides blisters, superficial linear cauterizations of the skin in the course 

 of the nerve, the energetic application of the hot iron and of moxae to 

 certain points in the course of the nerve, as well as the actual cautery 

 to the dorsum of the foot and between the outer toes, and finally, 

 even the cauterization of the ear, particularly of the helix, have often 

 been tried. After the use of the last-mentioned remedy there is 

 almost always temporary benefit, which it is difficult to explain. Even 

 in the most obstinate cases of sciatica, the induced, or still more the 

 constant, current of electricity rarely fails. Among specific remedies, 

 oil of turpentine as an electuary (ol. terebinth. 3 i, mell. f i, a table- 

 spoonful twice daily), plays a very important part in the treatment of 

 sciatica. Among others, Romberg speaks very highly of it. Neurot- 

 omy should only be performed on small branches, in whose peripheral 

 terminations we can clearly Icrate the starting-point of the morbid 



