Sciatica

“ The first of these is obscure in its origin, but may be said, in general terms, to be connected with a nervous temperament of the highly impressible kind, which is more or less like what we call "hysteric," not only in the female, but also in male patients. The subjects of this kind of sciatica are mostly young persons, and hardly ever more than middle-aged; they are generally found to be liable to other forms of neuralgia; and the actual attack of sciatica is produced by some fatigue or mental distress, which at other times might have brought on sick headache, or intracostal neuralgia, etc. ”

“ The second variety of sciatica occurs for the most part in middle-aged or old persons who have long been subject to excessive muscular exertion, or have been much exposed to damp and cold, or who have been subject to the combined influence of both these kinds of evil influence. One must also include, I think, in this group a considerable number of cases where the age is not so advanced, but the patient has been obliged, by the nature of his business, to maintain the sitting posture daily, for hours together, exercising pressure on the nerve ”

“ Sciatica is a word employed much by Shakespeare in a certain connection. ’Tis true, he was no physician, but as I read, he had smarted in his day. I, too, do smart. And yet this keen soprano agony, these veins of fire and bombshell explosions in the knee, are as nothing to a certain dull, drowsy pain I had when my kidneys were congested at Nice; there was death in that; the creak of Charon’s rowlocks, and the miasmas of the Styx. I may say plainly, much as I have lost the power of bearing pain, I had still rather suffer much than die. ”

“ Yet in a sort of way, I suppose, a man would realise himself more completely if he had sciatica all over him, and could count up his nerves, and tell all his bones by the aches and pains attaching to them. ”

“ Under the general heading of massage a number of manipulations may be grouped which are of value in the treatment of neuralgia, even of long-standing cases of sciatica and the like.34 When, as often happens in the case of sciatica, the nerve is the seat of congestion and exudation, strong and deep kneading along its course, with vigorous stroking upward in the direction of the lymph-vessels, is the important part of the treatment. ”

“ So, again, there is a variety of sciatica which belongs mainly to the period between puberty and the twenty-fifth to thirtieth year, and which seems really to belong, pathologically, to the age of unsettled and irregular sexual function, the tendency to it usually disappearing after the patient has settled down happily in married life. ”

“ Eulenburg states that neuralgia caused by cold more frequently attacks the sciatic nerve than any other, and thinks that the tendency to sciatica is characteristic of the relations of rheumatism to sensory nerves. For my own part, I see no reason to call in the rheumatic diathesis as a deus ex machina to explain the frequency with which sciatica follows comparatively trifling peripheral impressions like that of cold. ”

“ Sciatica in man is, however, rarely a simple neuralgia, but partakes rather of the nature of a neuritis, and there is no good reason for supposing that the disease of this nerve in the lower animals is other than an inflammatory condition. ”

“ John Rogers to his friend and patient, Benis Hamilton Spence.
DEAR Idiot: I knew you would get it—and you got it. Perhaps after this you will learn to treat your sciatic nerve with proper respect. But there is a worse complaint than sciatica. It lasts longer. Certain symptoms of it are indicated in the things which your letter leaves unsaid. Beans, old thing, you alarm me.
Now here is a sporting offer. If you'll drop it and come home at once I'll promise never to tell Aunt Caroline. Come the moment you can put foot to the ground. ”

“ It may result also from the pressure of an abscess or an aneurysm either inside the pelvis or in the buttock, and is sometimes associated with disease of the spinal medulla, such as tabes. Gluteal fibrositis may be mistaken for sciatica. It is also necessary to exclude such conditions as disease in the hip or sacro-iliac joint, especially tuberculous disease and arthritis deformans, before arriving at a diagnosis of sciatica. A digital examination of the rectum or vagina is of great value in excluding intra-pelvic tumours. ”

“ The doctor explained the summoning of two nurses, and the frequency of his own visits, by saying that his chief anxiety was to minimise the fearful pain as much as possible, and that this end could only be secured by incessant watchfulness. The pain was certainly formidable. But then Constance was well habituated to formidable pain. Sciatica, at its most active, cannot be surpassed even by rheumatic fever. Constance had been in nearly continuous pain for years. ”

“ Restriction of the movements of abduction and adduction, the presence of cracking and of grating of the articular surfaces, and the aggravation of the pain and stiffness after resting the limb, are characteristic of arthritis deformans. The prominence of sciatic pain may lead to the disease being regarded as sciatica.
The greatest difficulty is met with in cases in which the disease occurs as mon-articular affection in adolescents, for the resemblance to tuberculous disease of the hip and to coxa vara may be close. Skiagrams do not always enable one to differentiate between them. ”

“ Sciatica, or hip-gout, is another frequently occurring neuralgia, which has its seat in the hip-nerve and its branches, and is thence transmitted through the whole lower part of the system, from the pelvis to the toes. The pain is usually confined to certain points, and rises on motion, and often at night, to great heights. It is a disease of middle age, prevailing with men and women, and originates from a variety of causes. The hip-nerve is exposed by its situation to be easily injured by cold and accidents ”

“ To give you an idea of what real things nerve-trunks are, this sciatic nerve is as large as a small clothes-line, or, more accurately, as a carpenter's lead pencil, and so strong that when the surgeon cuts down upon it and stretches it to cure a very bad case of sciatica, he can lift the lower half of the body clear of the table by it. This strength, of course, is not due to the nerve-fibres and cells themselves but to the tough, fibrous sheath, or covering, with which all the nerves that run outside of the brain and spinal cord are covered and coated. ”

“ Sciatica is a disease from which youth is comparatively exempt. Valleix had collected one hundred and twenty-four cases, and in not one was the patient below the age of seventeen, only four were below twenty. ”

“ The prematurely and permanently gray hair (it will be seen hereafter that permanency of grayness is an important point) , together with well-marked inelasticity of arteries, very often tells a tale which is most useful in informing us, not only of the vital status of the patient, but of the kind of sciatica under which he labors; and also influences our prognosis seriously. ”

“ I have seen the flexors of the toes of the affected limb violently cramped, and in one case there was agonizing cramp of the gastrocnemius. It is chiefly at night, and especially when the patient is falling asleep, that this kind of affection is apt to occur.
A third variety of sciatica is the rather uncommon one so far as my experience goes, in which inflammation of the tissues around the nerve is the primary affection, and the neuralgia is mere secondary effect, from mechanical pressure on the nerve, which, however, is not apparently itself inflamed. ”

“ Cold to the head is of signal advantage when there is persistent headache, or a tendency of blood to that part. In cases of acute sciatica, congestion of the liver, spleen, and kidneys, accompanied by a general sluggishness and torpidity of the portal circulation, frequently very painfully indicated by internal or external hemorrhoids, the hot sitz bath gives very speedy relief. ”

“ These exercises, which may be preceded by massage, are carried out night and morning, and should be practised systematically by those who are liable to sciatica.
Benefit has followed the injection into the nerve itself, or into the tissues surrounding it, of normal saline solution; from 70-100 c.c. are injected at one time. If the pain recurs, the injection may require to be repeated on many occasions at different points up and down the nerve. Needling or acupuncture consists in piercing the nerve at intervals in the buttock and thigh with long steel needles. ”

“ There are few inflammations of the internal organs in which blisters to the surface are not serviceable, but much has yet to be done to ascertain the exact points at which they ought to be applied in order to produce their maximum effect. Thus it is said that in sciatica a blister to the heel will sometimes afford relief, while one applied in the neighborhood of the nerve itself has little or no effect. ”

“ Change in the size and texture of the hairs, in neuralgia, has been noted by Romberg and Notta, and has been several times observed by myself. Occasionally the individual hairs near the distribution of the painful nerve become coarsely hypertrophied; at times the number of hairs appears to multiply, but I imagine this is only a case of more rapid and exuberant development of hairs that would be otherwise weak and small. In one very remarkable instance of sciatica this came under my observation ”

“ Another had made pathological studies, learning up the few conjectural symptoms of maladies that show no outward trace; as science advanced to the point of recording detectively the true state of the heart he had deftly changed ground, relinquished rheumatism of that organ and done some work of research into pains in the head; much faith did he put, too, in the sciatic nerve. When a couple of these savants slept in one tent they would argue after Lights Out—was sciatica safest, or shell-shock, or general debility? ”

“ It affects the great sciatic nerve which emerges from the pelvis and runs down the leg to the foot. It is in most instances traceable to exposure to cold or damp, to overuse of the limbs in walking, &c. Any source of pressure upon the nerve within the pelvis, such as may be produced by a tumour or even by constipation of the bowels, may excite an attack of sciatica. It is often connected with a rheumatic or gouty constitution. In general the nerve of one side only is affected. ”

“ The door and window open at a right angle cause a draught of thirtytwo feet per second according to the law of falling bodies. I have felt this instant a twinge of sciatica in my left glutear muscle. It runs in our family. ”

“ Case XVII. Spinal Irritation and Loss of Use of Right Leg—Five Years’ Illness—Operation—Cure. M. B., æt. 30, single; admitted into the London Surgical Home Nov. 15, 1861.
History.—Five years ago first began to suffer pain in the right leg, which was ascribed to sciatica. Fourteen months since this pain became so bad that she could not walk, and she lost all use of her right leg, at the same time felt great weakness and pain in the back, preventing her sitting. For eight months has been confined to a “spinal couch.” Is a spare anæmic woman; dark hair and eyes; dilated pupils ”

“ I agree with Eulenburg in thinking that anæsthesia is more frequent in sciatica than in other neuralgias.
6. Secretion is often very notably affected in neuralgia; the phenomena are necessarily more easily observed in connection with affections of the trigeminal than of other nerves. In the great majority of cases the affection is in the direction of increase; at least, the watery elements of secretion are often poured out in profusion. Thus, profuse lachrymation is exceedingly common in ophthalmic neuralgia ”

“ Other groups of muscles may also be the subject of these painful conditions. The large group in the loins, called the lumbar muscles, which are so important for stooping, for the erect posture and for lifting, are so commonly the subject of discomfort that a special name has been applied to their affection—lumbago. In the leg the large group of muscles supplied by the sciatic nerve are likely to be affected, and this affection is so common in men who have to bend the knee and flex the hip at their work that it, too, has received a special name—sciatica. ”

“ Re hysterical pains, the most frequent are probably those of hysterical pseudo sciatica, in which true signs of sciatica are absent, namely, (1) loss of Achilles jerk, (2) scoliosis, (3) Lasègue’s sign (pain on thigh flexion with leg extension) , (4) Neri’s sign (with trunk bent forward, affected knee flexed) , and (5) Bonnet’s sign (pain on thigh adduction) .
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Shell-shock: Emotional crises; twice recurrent mutism; amnesia. A comrade in the same explosion gets off with transient phenomena.
Case 330. (Mairet, Piéron and Bouzansky, June, 1915.) ”

“ As you will see by the picture, the spinal nerves, which are given off from the cord in the lower part of the neck and between the shoulder blades, are gathered together into a great loose bundle to form the long nerve-wires needed to supply the shoulders and arms. Those given off from the small of the back just above the hips also run together to form, first a network and then a big single nerve-cord, called the sciatic nerve, which many of you have probably heard of from the frightfully painful disease due to an inflammation of it, called sciatica. ”

“ You know I had my right hip put out last fall at the rising of Deacon Jones' saw mill; its getting to be very troublesome just before we have a change of weather. Then I've got the sciatica in my right knee, and sometimes I'm so crippled up that I can hardly crawl round in any fashion.
What do you think that old white mare of ours did while I was out plowing last week? Why, the weacked old critter, she kept a backing and backing, on till she back'd me right up agin the colter, and knock'd a piece of skin off my shin nearly so big. ”