MEDICAL NOTES.

New Zealand Herald, Volume XLIX, Issue 14984, 4 May 1912, Page 7 (Supplement)

MEDICAL NOTES.

;tQc''f£y, . . SCIATICA. -, ; r v S&ATJCA .derive!} its nam© from the fact r l ' ihafc its t'-hief symptom, is a. very'- intense "■ : gad often lasting pain, which follows tho • -onrse of ho sciatic nerve. This is a very targe nervous trunk, which is given off item the spinal cord, passes from the liauaoh region to the outside of tho thigh, 'v id thus itonhs tho main lino of nervous Vrawnunicaftion between tho lower limbs and tho trquik. We can well understand m th 6 diffusion of pain , which takes place 1 «hen the nerve is ' specially affected, for whilst being' itself a trunk 1 lino of the nervous system, so to speak, it also gives off ]■■■ very largo number of branches, which are liable in torn to be affected to-a ■creator or lees rfegra*. This ..subject has s ; Ijgn chosen by mo lor treatment at the I.■ -aaent time because it* the winter months Specially sciatica soei»s to bo more proh7 sent than in tho milder seasons of the Say. Ono explanation of this fact' is probably to bo found in- tho circumstance that a " rheumatic condition of body seems to - affect the- oncoming of. sciatica, ,and as rheumatism is an ailment of more freauent occurrence in the inclement season of the year, one may therefore expect that an connection "between this two aihnents ' jll bo accentuated and rendered mow likely of • occurrence in - the • winter _ and K; spring seasons. ' Of course sciatica is an ailment which; when onoo established in 'the system. may -be : present at other asascoa, and, indexed, in the case of sufferers in whom tho ailment .has assumed a lasting V or chronic form; one of its characteristics is that they may bo rarely free from maniTestations of its presence. i Considerable discission has taken place in medical circle "regarding the exact nay tore of sciatica, viewed as a disease. On the ono hand it has been regarded as a species of neuralgia, and therefore is unaccompanied by any change in the structure of the nerves themselves., From this point of view the special treatment ? adapted to relieve neuralgia has naturally been adopted. S«ch treatment has, however, not always been successful; hence a second opinion has been expressed to the effect that sciatica realty represents an inflammatory condition, not so much of the nerve fibres themselves as of the sheaths in which these delicate fibres are each contained. A fact connected with v sciatica which seams, to lend support to this second opinion is that in many severe 5 and lasting cases of the affection the muscles supplied by the nerves involved >«m to exhibit a tendency to undergo a process of wasting. This result is not one which attends purely neuralgic affections, and it may therefore bo said that at the i . present day sciatica, especially viewing its connection with gout and rheumatism, may he considered as a disease essentially consisting in f some inflammatory changes of the nerve sheaths themselves. The Symptoms. The occurrence of pain first attracts attention to the existence of the disease. This "pain docs not come on suddenly, but begins ; with slight twinges- along the; course of the nerve. Later on this pain becomes more distinctly localised. At first it is complained of from: the hip joint and in the back of the thigh. Later ■in the pain extends through the course of the nerve and involves not merely the; thigh itself, but passes to the leg and even to the feet. Tho_ pain is described as beings of a, hot and burning character, and it certainly shares this*- feature with rheumatic pains, namely, that as a rule it-vis increased - at.night. Naturally, the existence of, the annoying gain -'tends to disturb the * patient's" 'Test and to produce it. general irritation of the system which unlit* him for the. discharge of his duties. Treatment. The treatment of sciatica has to be undertaken from two points of view, namely, from the constitutional side, whereby any errors of diet or; other aspects of living have to be corrected; and, second, local applications • intended to relieve pain.^ by direct application to the seat of the affection. Au authorities are agreed that rest is a very important condition in the - treatment of sciatica, and it will be well therefore that sufferers should note this fact. Pain is relieved by hot applications in the shape of poultices along, tie track of the nerve, whilst in some cases relief "iS experienced by tlx© application of a senesof small blisters or of mustard leaves applied , at intervals in the track of the pain; In very severe cases the doctor will probably give hypodermics injections of morphia or some other soothing.substance. Liniments rubbed along' the track of the nerve are also useful ';" whilst in some cases a series of needlesv inserted) into- the' nerve by > the surgeon-has been; found to produce a curative effect. On© frequently-employed liniment is Composed of chloroform and belladonna. * A ; Turkish bath has often been found useful, and it is recommended , that bob and -: cold douches " should be* after: a bath played cm the ".coarse, of., the .nerve. Massage is often found, beneficial. Having regard -to the - idea Chat rheumatism may be a predisposing cause, salicylate of soda "has been administered in doses of at least 20 grains three times a day between meals. In lasting cases • iodide of potash is a favourite remedy ; but as regards the constitutional treatment it will be well to. rely on the doctor's advice, seeing that he alone is capable of forming a judgment regarding the exact condition of body to be considered in respect both of medicines and food.