FEMORO-POPLITEAL 
NEURALGIA. 
NEURALGIA ISCHIADICA, 
SCIATICA. 
BY J. MARTINE KERSHAW, M. D., 
ST, LOUIS: 
PROFESSOR OF MENTAL AND NERVOUS DISEASES IN THE 
HOMCEOPATHIC MEDICAL COLLEGE OF MISSOURI, 
AND CLINICAL PROFESSOR OF DISEASES 
OF THE NERVOUS SYSTEM IN THE 
MISSOURI SCHOOL OF 
MIDWIFERY. 
CINCINNATI, OHIO: 
JAS. P. GEPPERT, PRINTER AND BINDER. 
1878. PREFACE. 
I have endeavored in the following pages to treat of sciatic pain, and to do 
this in a practical, thorough and concise manner. Considerable attention has been 
devoted to both the remote and direct causes of this disease; as only by a clear 
and definite knowledge of these can one hope to properly and successfully treat 
this very distressing and formidable complaint. A few medicines only have been 
mentioned, but these few are good and well tried remedies. The surgical or 
manipulative measures have been indicated in citing the various cases. Certain 
palliative measures too have received attention-they have their place in medicine, 
and have done untold service in relieving pain. 
J. MARTINE KERSHAW. 
St. Louis, February, 1878. Femoro-popliteal Neuralgia. Neuralgia Ischiadica, Sciatica. 
By Professor J. Martine Kershaw, M. D., St. Louis. 
HISTORY. 
In speaking of this disease I refer in a general way to 
functional disturbance of the Sciatic nerve, apart from or- 
ganic change in the nerve substance. It is true, however, 
that sciatica is not unfrequently excited by mechanical means; 
of these I shall speak further on. The nerves and parts af- 
fected in the disease under consideration, are the "posterior 
femoral cutaneous nerve, and the sciatic; the pain being 
localized in the posterior surface of the thigh, and through- 
out the whole length of the lower leg and foot, (with the ex- 
ception of the parts supplied by the saphenous nerve). Sciatica 
and neuralgia of the fifth are the most common and the most 
important of all the forms of neuralgia." The disease is 
characterised by pain of a more or less severe character, fol- 
lowing the course of the nerve, or of some of its branches. 
The pains are sharp, shooting, lancinating or burning. Sci- 
atica may be developed suddenly, but the reverse is generally 
the case. ■ *Dr, Hammond relates several instances in which 
the patients were suddenly seized with the most intense pain, 
having been, to all appearances, quite well previous to the 
* Clinical Lectures on Diseases of the Nervous System. 4 
FEMORO-POPLITE AL NEURALGIA. 
attack. The first indication of disease is a slight aching 
which gradually increases until the intense pains already de- 
scribed are developed. The suffering in this disease is of the 
most extreme character, rivalling, as it does, neuralgia of the 
ophthalmic and superior-maxillary divisions of the fifth pair. 
Like the other neuralgiae, sciatica is subject to remissions and 
intermissions, more or les's distinct in character. These are 
especially well marked if the disease is due to malaria. I 
have a patient now under treatment who is quite free from 
pain during the day, but about six o'clock in the evening the 
attack begins and continues until the next morning, ceasing in 
the neighborhood of three o'clock. During this time she is 
quite unable to rest or sleep. As in convulsive diseases we 
find the so-called pressure points, so in this and in other neu- 
ralgias are to be found certain painful points or spots along 
the course of the nervous tract. They are principally found 
in the following regions: at the sacro-iliac junction; at 
the sciatic notch; behind the great trochanter; along the 
course of the nerve at the posterior portion of the thigh; 
over the articulation of the fibula with the tibia; at the inner 
and outer malleoli and the sole of the foot. These points 
are frequently well marked, especially at the sacro-iliac artic- 
ulation, behind the great trochanter, and at the external mal- 
leolus. Severe pain is frequently felt at the inner side of the 
knee joint, simulating in this respect the characteristic pain 
of morbus coxas. Uncomplicated neuralgia of the crural 
nerve is a rare disease, yet when sciatica has existed for a 
length of time, other nervous tracts of the limb are likely to 
be implicated, and sometimes the disease, primarily seated in 
the sciatic, finally spends itself on the crural branches. *"The 
extremely severe pain at the internal aspect of the knee joint 
which is such a common symptom in morbus coxre, is evi- 
dently a reflex neuralgia of the long saphenous nerve, the 
ultimate irritation being situated in the branches of the ob- 
turator nerves which supply the hip joints. For some reason 
unexplained, this happens»in a considerable number of cases 
of sciatica. I have a lady now under my observation, in 
Anstie, pp 61, 62. NEURALGIA ISCHIADICA, SCIATICA. 
5 
whom the secondary neuralgia of the saphenous nerve has 
become even more intolerable than the pain in the sciatic, 
which was the nerve primarily affected." Involuntary mus- 
cular contractions frequently occur, which greatly aggravate 
the pain. Anaesthesia is generally present in chronic cases; 
this is easily demonstrated by means of the aesthesiometer. 
Certain it is that over the painful points and during the 
height of a paroxysm, extreme pain is experienced, yet dur- 
ing the remissions tactile sensibility is very much diminished, 
it being necessary to place the points of the aesthesiometer 
several inches apart before each can be separately distinguish- 
ed. The temperature of the affected limb is not unfrequent- 
ly considerably lowered as compared with the opposite mem- 
ber. Atrophy of the muscles of the diseased limb is likely 
to occur if the disease continues a length of time. *Dr. 
Hammond mentions a case in which the diseased limb was 
one-third smaller than the healthy one. Paralysis sometimes 
follows in chronic cases. Shortening of the tendons is a com- 
plication of serious import, and may be expected where the 
limb is retained in a flexed or semi-flexed position for time 
without change, and permanent injury result. A case under 
treatment a few years since gave me a deal of trouble because 
of this tendency to shortening of the tendons, but was finally 
overcome by general treatment and manipulations. Neural- 
gia frequently affects the hair in a marked manner, such, for 
instance, as changing it to gray, (during the paroxysms or 
permanently) making it coarser, more brittle, and causing it 
to fall out. With respect to this subject. jDr. Anstie men- 
tions a curious case: "Occasionally the individual hairs near the 
distribution of the painful nerve become coarsely hypertro- 
phied; at times the number of hairs multiply. * * 
In one very remarkable instance of sciatica that came under 
my observation, the whole front of the painful legs, from the 
knee nearly to the ankle, became clothed, in the course of 
about six months, with a dense growth of hair, which strongly 
reminded me of similar abnormal hair growths that have 
Lectures on Diseases of the Nervous System, p. 264. 
+On Neuralgia, Anstie, pp. 122, 123. 6 
FEMORO-POPLITEAL NEURALGIA. 
been occasionally seen in connection with traumatic injury of 
the spinal cord." 
Among other accompaniments of sciatica or pain in the 
sciatic nerve, from whatever cause, should be noticed pain of 
a burning character. In several cases mentioned by Drs. 
Mitchell, Morehouse and Keen,* was this burning pain es- 
pecially marked. In two of them the burning was confined 
to the top of the foot. They were both gun shot wounds of 
the sciatic nerve. With this burning pain there was fre- 
quently to be seen "eczematous eruptions, which appeared 
as minute vesicles thickly scattered over the thin and tender 
cutis, or else showed themselves in successive crops of larger 
vesicles in the skin about the altered parts." It was remark- 
able that "recurrence of the eruption gave ease to certain 
painful symptoms, * * * or to speak more cau- 
tiously, when the eczema came back the pain declined." This 
was markedly shown in the cases of sciatica mentioned 
above. Among the curious consequences of nerve lesions 
may be mentioned a glossy condition of the skin beyond the 
point of injury. jThe authors quoted above state, "that in 
fifty partial nerve lesions it existed in different degrees in 
nineteen cases." The following is quoted from a paper by 
Mr. Paget, in the Medical Times and Gazette, 1864: "Glossy 
fingers appeared to be a sign of peculiarly impaired nutrition 
and circulation due to injury of the nerves. They are not ob- 
served in all cases of injured nerves * * but they are a 
very notable sign, and are always associated, I think, with 
distressing and hardly manageable pain and disability.Drs, 
Mitchell, Morehouse and Keen give quite a minute descrip- 
tion of this glossy skin and its attendants, a few lines of 
which I shall incorporate in this paper before closing: "The 
skin affected in these cases was deep red or mottled or red 
and pale in patches. The epithelium appeared to have been 
partially lost, so that the cutis was exposed in places. In the 
ECZEMA BURNING PAIN GLOSSY SKIN. 
*Gun shot Wounds and Other Injuries to Nerves, pp. 92, 93. tp. 78. 
tp. 19. NEURALGIA ISCHIADICA, SCIATICA. 
7 
fingers there were often cracks in the altered skin, and the in- 
tegument presented the appearance of being tightly drawn 
over the subjacent tissues. The surface of all the affected part 
was glossy and shining as though it had been skillfully varn- 
ished. In most of them the part wasndevoid of wrinkles and 
perfectly free from hair. * * The dorsum of the hand, 
as a rule, was in that member the part least subject to the alter- 
ation, while the dorsum of the foot was in that region the 
part most liable to suffer. * * In some form, pain 
has been an invariable attendant upon the diseased state of the 
skin just described, and as a rule it was of a burning char- 
acter." 
CAUSES. 
For some reason sciatic pain very frequently follows, or 
can be traced more or less directly to congestion of the por- 
tal vessels, and especially so when this condition is due to 
malaria in some form. Dr. Thomson says: *"We shall soon 
show, also, that mere mechanical obstruction in the lower 
bowel has often proved to have a connection with the oc- 
currence of sciatica, by the prompt cure of the nerve-ache 
after the dislodgment of the obstacle, and hence, such facts, 
a fortiori, make the surmise highly probable that the far 
reaching effects of portal congestion may induce sciatica in 
many ways. But of all causes of portal congestion * 
* ague is one of the commonest and most persistent. 
Liver and spleen alike seem to escape from the control of 
their vascular nerves almost as surely by the operation of this 
poison in weakening their vaso-motor ganglia, as the circula- 
tion of the face and head is unbalanced for years by the in- 
jury of a sun-stroke. In every case of sciatica, therefore, I 
would recommend you carefully to investigate the condition of 
the portal circulation, and if the patient admits a prolonged 
experience of troubles of malarial origin, that you pay good 
heed to the matter thereafter." The same author believes 
that like the other neuralgias, sciatica, with the wasting of 
the muscles, which is commonly observed in connection with 
this disease, is frequently due to an insufficient supply of 
* American Clinical Lectures, Ed. by E. C. Seguin, M. D., pp. 108,109. 8 
FEMORO-POPLITEAL NEURALGIA. 
blood to the parts, and that as soon as this difficulty is over- 
come, the pain subsides, the temperature is raised and the 
muscles regain their former healthy condition. He says: 
*"That the atrophy and pain, therefore, of many cases of 
sciatica, are owing to vaso-motor irritation mainly, and not 
to mere affection of the sciatic trunk itself, has long been a 
conviction in my mind, and I always commence the treat- 
ment of those cases where atrophy and ridigity are present, 
with measures directed towards remedying this supposed 
lesion. To do this we begin with attempts to blunt or para- 
lyze the irritant-sensor impression, which is the starting point 
of the whole trouble; for, so long as it persists, so long will 
it be reflected through the ganglia it reaches upon the motor 
filaments which proceed from them to regulate the calibre of 
arteries. It was, therefore, for this purpose, and not for cur- 
ing his sciatica, that we ordered the subcutaneous injection 
of Morphia and ,J.£rqpia together for this patient. After 
every such injection, the limb would grow one or two de- 
grees warmer, thus indicating a return, for the time being, of 
blood, from corresponding relaxations of the arteries. But, 
by themselves, these neurotics would have proved totally in- 
adequate, for like all other real neurotics, their effects are 
transient, and hence, in a few hours, you will note the arter- 
ies contracting again, and the coldness and rigidity returning 
as before." The fabove position is undoubtedly correct in 
many instances and a knowledge of such conditions will 
readily lead us to the proper remedy. 
For some reasons men are more liable to this disease than 
women. Children are seldom attacked with it.' It is rarely 
observed before the twentieth year, but is developed from 
this time until old age. Debility and general weakness, from 
whatever cause, strongly predispose to sciatica. Most neu- 
ralgic patients are in poor health, below par, so to speak; lack- 
ing in quantity and quality of blood; wanting in appetite-the 
assimilative processes being imperfectly carried on, and the 
general functional processes being to a greater or less degree 
at fault. Because a patient looks ruddy, because he or she 
''American Clinical Lectures, Ed. by E. C. Seguin, M. D., pp. 114, 115. NEURALGIA ISCHIADICA, SCIATICA. 
9 
has the appearance of being healthy it does not follow that 
such is the case; such appearances are very deceptive. A 
patient of mine suffering from anaemia of the posterior col- 
umns of the spinal cord is a very stout looking person, yet 
there are few people more weak than this lady. An anaemic 
or chlorotic patient is especially liable to neuralgia of some 
kind. There are few exceptions to this rule, apart from me- 
chanical irritations. Sedentary habits, impure air, poor food 
and want of sunlight are predisposing causes. Sexual ex- 
cesses, or its opposite, entire abstinence from sexual inter- 
course, with frequent excitement, these are instrumental in 
producing this disease. *"Certainly I have observed it with 
special frequency in women who have remained single long 
after the marriageable age, and in several male patients there 
has been either the certainty or a strong suspicion of venereal 
excess." Another not uncommon cause of sciatic pain is the 
pinching or imbedding of the terminal fibers of the great 
sciatic or one or more of its branches in a cicatrix following 
an amputation, a burn, the seat of an ulcer, or an injury to 
the soft parts along the course of the nervous trunk or one of 
its branches. Some of the severest of the neuralgias are 
due to the imbedding of a small fiber of a nervous trunk in 
a cicatrix. jin a remarkable little book, the joint work of 
Drs. Mitchell, Morehouse and Keen, may be found a report 
of several cases in which sciatic pain was directly attributed 
to a formation of a cicatrix over the site of a gun shot wound. 
They were relieved, after various remedies had been tried, by 
exercise, passive motion and the douche. Whenever ting- 
ling or numbness (paresthesia) is markedly felt after the re- 
ception of a punctured, incised or lacerated wound, especial 
care should be taken to cleanse the parts nicely, and to neatly 
approximate the edges of the wound, that healing may take 
place by first intention; if not, and foreign matter remain in 
the wound with the ulceration which naturally follows, this 
taking place over the partially or entirely divided nerve, a 
nerve fibril is extremely likely to become firmly imbedded in 
Anstie, p. 63. 
tGun shot Wounds and Other Injuries to Nerves, pp. 59, 60, 61. IO 
FEMORO-POPLITEAL NEURALGIA. 
the contraction which takes place at the site of the old wound. 
This pinching of a nerve fibril is almost certain to be followed 
by exquisite pain at the seat of the difficulty; and, not uncom- 
monly, at various points along the course of the nerve pro- 
per, or some of its branches. By means of reflex action vari- 
ous painful and at times very serious difficulties may be pro- 
duced from the simple irritation of a nerve such as above 
mentioned. to difficulties due to reflex action in 
consequence of nerve injuries, and bearing on this subject, Dr. 
Brown-Sequard calls attention to the fact that many cases of 
epilepsy have no other exciting cause than a burn, wound, 
tumor, inflammation or neuralgia; that a ligature applied 
above the seat of injury will often prevent the attacks; that 
pressure over the seat of the "external irritation invariably 
brought on a fit;" that the amputation of a limb, section 
of a nerve above the seat of irritation, the extirpation of a 
tumor, of a cicatrix, of a decayed tooth, of a carious bone, 
etc., have cured these patients; and he finally says that 
irritation of the sciatic nerve in certain animals by a broken 
bone, (crushing, cutting or tying) invariably produces an 
epilepsy temporary or persistent in character; and that the 
difficulty is not cured until the irritation is removed from the 
sciatic nerve. 
ENLARGED LYMPHATIC GLANDS. 
Very acute sciatic pain is sometimes due to the enlarge- 
ment of a lymphatic gland, one or more fibrils of the nerve 
being put on the stretch by passing over the gland, very 
much as a violin string is drawn across the bridge of the in- 
strument. 
SUBCUTANEOUS TUBERCLE. 
These little bodies, varying in size from a millet seed to 
that of a pea, are frequently the cause of excruciating pains 
along the course of a nerve. They are firm, compact bodies 
of a fibrous or fibro-cartilaginous structure. They are to be 
found in the subcutaneous areolar tissues and frequently 
imbedded between the fibers of the nerve. These bodies 
appeal' to be influenced by changes of the weather, mental 
*Holmes' Surgery, Vol. IV, pp. 186, 187. NEURALGIA ISCHIADICA, SCIATICA. 
II 
emotions, etc., and, enlarging, put the nerve fibrils on the 
stretch, thereby producing intense neuralgic pain. 
During the enlargement of one of these tubercles, the 
fibers of the nerve are not only stretched but separated from 
one another; and the amount of pain experienced is in di- 
rect relation to the size attained by the tubercle, and the con- 
sequent fibril separation and stretching of the nerve. 
*The following is quoted from papers by Mr. William 
Wood, entitled, "Observations on Painful Subcutaneous Tu- 
bercle:" "Immediately under the skin, upon the shin bone, I 
have twice seen little tumors, less than a pea, round and ex- 
ceedingly hard, and so painful that both case's were judged 
to be cancerous. They were cured by extirpating the tumors. 
But what was more extraordinary was a tumor of this kind 
under the skin of the buttock, small as a pin's head, yet so 
painful that the least touch was insupportable, and the skin for 
one-half an inch around was emaciated; this, too, I extirpat- 
ed with so much of the skin as was emaciated, and some fat. 
The patient, who before the operation could not endure to 
set his leg on the ground, nor turn in his bed without exquis- 
ite pain, grew immediately easy, walked to his bed without 
any complaint and was soon cured. An eminent author says:f 
"Although pathologists have failed to discover anything like 
nervous structure in these tumors, I still incline to the opinion 
that they are connected with the minute filaments and ulti- 
nrate ramifications of the nerves. Upon any other supposi- 
tion it is, I conceive, impossible to offer a rational explanation 
to account for the dreadful severity of the sufferings which 
they induce." It should be remarked that where a number 
of tubercles are scattered along the course of a nerve, they 
cause little or no inconvenience, whereas a single one may 
cause the most frightful agony. 
NEUROMATA. 
These bodies are of variable size, some as small as a grain 
of wheat and others as large as an orange, and even larger. 
"In shape they are round, oval or fusiform; they are dense 
*J. Warburton Begbie, M. D., F. R. C. P. E., Reynold's System of 
Medicine, p. 728. 
tDr. Robert Smith, Reynold's System of Medicine, p. 727. 12 
FEMORO-POPLITEAL NEURALGIA. 
and more or less hard in character, and of a fibro-cartilaginous 
structure. They are generally found either between the neur- 
rilemma and the nerve, or in the connective tissue between 
the bundles of nerves." These bodies, like the tubercles just 
mentioned, are often the direct cause of most acute pains 
along the course of the sciatic nerve, by the stretching or gen- 
eral nerve irritation which they produce. 
The accidental ligation of a nerve after amputation, or some 
operation in the soft parts, has not seldom caused neuralgia 
of a severe form. I call particular attention to this subject, 
because, although at times of little consequence, at others it 
may prove a matter of grave importance. The operation of 
neurotomy (dividing a nerve), and of neurectomy (double 
division of a nerve and removal of the central piece), and 
even amputation of the affected member, has been, in some 
cases found necessary to secure relief. *A case is related 
where, after amputation of the forearm, the most intense 
neuralgia set in, which obstinately resisted all the known 
remedies tried for its relief. Mr. Langstaff removed the arm 
above the elbow joint, and, after securing the arteries, drew 
out each nerve about one-half an inch from the stump and 
divided them; the patient was at once relieved of her troub- 
les, f Sir B. Brodie relates a case where the subject suffered 
acute pain inside the knee joint. Examination revealed an 
aneurism of the femoral artery above this point; the vessel 
was ligated, followed by entire cessation of pain. It may 
be well to remark just here, that aneurism is not an uncom- 
mon cause of neuralgia where the nerve and artery follow 
the same course for any distance. 
LIGATURE OF A NERVE. 
"Romberg calls particular attention to neuralgia of the ob- 
turator nerve caused by crural hernia." A patient under my 
charge suffered extreme neuralgic pain along the anterior 
aspect of the thigh while w'alking or standing, but was at 
once relieved by assuming the recumbent posture, and by the 
reduction of an inguinal hernia. 
HERNIA. 
by Terrell, Holmes' Surgery, Vol. IV, pp. 163, 164. 
fDr. J. Lockhart Clark, Holmes' Surgery, Vol. IV, pp. 160. NEURALGIA ISCHIADICA, SCIATICA. 
J3 
HYSTERIA. 
Extremely severe pain located about the hip and posterior 
portion of the thigh is frequently due in great measure to 
hysteria, or to that hyper-sensitive condition which seems to 
be the ordinary state of some people, especially women. 
There is a tendency to shortening of the painful limb, and a 
general irritable condition of the patient extremely difficult 
to overcome. A slight injury once received at the point of 
irritation is greatly magnified-the patient being firmly con- 
vinced that the difficulty is one of very serious import. To 
remove this impression will often tax both the ingenuity and 
patience of the physician. |Sir B. Brodie relates the case of 
a young lady, who having suffered long with hysterical neu- 
ralgia of the hip joint, was at once relieved of all her symp- 
toms by being thrown from a donkey. *J. Lockhart Clark 
mentions the case of a girl who was completely cured of 
hysterical paraplegia by receiving a fright at seeing a mouse 
run across the room. Such cases are due to no organic 
change in the nervous trunk, nor is there any mechanical ir- 
ritation to account for the difficulty. On investigation, how- 
ever, we find that a highly sensitive and impressible organism 
-an hysterical disposition, or a tendency in that direction, is 
at the bottom of the trouble, and that treatment calculated 
to remove the hyper-sensitive condition cures the patient. 
Chronic endo-metritis in delicate subjects, with the conse- 
quent profuse and long continued discharge characterising this 
disease, is likely, sooner or later, to be followed by neuralgia in 
some form. Long continued and frequent nursing frequent- 
ly provokes an outbreak of neuralgia. The habit of nursing 
a child the entire night, as is commonly done, is exceedingly 
pernicious, and will lower the tone of any woman, however 
strong she may be prior to indulging in such practice. The 
loss of animal fluids continued for a length of time, from 
whatever cause, interferes very sensibly with the nutrition of 
the general nervous system, impoverishing it to such a de- 
gree that an outbreak in the form of some nervous complaint 
is almost certain to take place, if the drain on the nervous 
*Holmes' Surgery, Vol. IV, p. 166. 14 
FEMORO-POPLITEAL NEURALGIA. 
system continues long enough to provoke a reaction. Sitting 
constantly on a hard chair has induced it in a few instances. 
An enlarged prostate gland, intra-pelvic tumors, pregnancy, 
constipation, haemorrhoids, neuromata, deposits about fora- 
mina with consequent narrowing of the canal, syphilis and 
rheumatism, these may prove a cause of the disease. A pa- 
tient of mine suffered intolerably during pregnancy in conse- 
quence of pressure on the hyper-sensitive nerves. With re- 
spect to syphilis causing or influencing this disease, an emi- 
nent author says: *"One of the most violent attacks of sciatic 
pain which ever came under my notice, was in a syphilized 
subject, a discharged soldier, who had been the victim of se- 
vere tertiary affections, and had been mercilessly salivated into 
the bargain. This unfortunate man suffered dreadful agony, 
which was aggravated every night, but was never totally ab- 
sent. The pain started from a point not far behind the great 
trochanter; pressure here caused intolerable darts of pain, 
which ramified into every off-shoot of the sciatic nerve, as it 
seemed, and made the man quite faint and sick. Large doses 
of Iodide of potassium, together with the prolonged use of 
Cod liver oil, completely removed the pain and tenderness." 
A case under my care a few years since, resisted all ordinary 
medical treatment, but was immediately and permanently re- 
lieved by the replacement of a partially prolapsed and latero- 
flexed uterus, and its retention in position by means of an or- 
dinary rubber inflating pessary. The careless use of the for- 
ceps has more than once produced sciatica. Sleeping on the 
damp ground, falling on the buttocks and gunshot wounds of 
this region have excited this complaint. 
DIAGNOSIS. 
■["This affection is most likely to be mistaken for muscular 
rheumatism of the thigh or leg, and although the character- 
istic diagnostic sign given by Valleix, that in rheumatism the 
patient indicates the seat of the pain with his whole hand, 
while in neuralgia he points to it with his finger, does not 
hold good in all cases, yet a correct diagnosis may in general 
*Anstie on Neuralgia, p. 68. 
tProf. Erb, Ziemsson's Cyclopaedia, Vol. XI, pp. 176, 177. NEURALGIA ISCHIADICA, SCIATICA. 
15 
easily be deduced to the already enumerated signs of rheuma- 
tism, etc. It is especially in the insidious and slowly devel- 
oping forms of coxitis and coxarthrocacia, which run on for 
a time without fever, without perceptible deformity of the 
pelvis, and without any marked local sensibility, that errors 
are likely to be made. Positive conclusion can only be ar- 
rived at by the exercise of the greatest care in the examina- 
tion of the patient. The position and mode of carrying the 
leg; the situation of the points that are painful on pressure; 
the absence or presence of pain when the head of the femur 
is pressed against the acetabulum; the elongation or short- 
ning of the leg; the configuration of the lower pait of the 
back; the paroxysmal character of the pain, its distribution 
and the condition of the general health, are all circumstances 
that must be carefully considered in forming the diagnosis 
which becomes still more difficult in those cases of nervous 
coxalgia (hysterical articular neurosis) that have been des- 
cribed by Brodie, Esmarch, Wernher, Stromeyer and others. 
The precise localization of the pain in the hip joint, and the 
absence of inflammatory symptoms must constitute the princi- 
pal data on which the diagnosis must rest." 
PROGNOSIS. 
Iii recent cases and in those in which the cause can be re- 
moved, the prognosis is favorable. Of old chronic cases so 
much can not be said, although many of these can be cured 
with time and patience, and, with our present knowledge of 
the disease, and the various palliative measures and applian- 
ces, all may be relieved. 
Apart from what has already been said with regard to 
diagnosis, I may be permitted to observe that too great care 
can not be exercised in the questioning and examining of 
these cases, that the direct or indirect cause of the disease be 
learned. It is plain that a mechanical cause of irritation is 
not likely to be removed by medicines; and yet I have known 
more than one case to which medicines had been given with- 
out effect, when there was an easily removable mechanical 
cause at the bottom of the difficulty. The situation of the 
sciatic nerve renders it more liable to suffer from mechanical 16 
FEMORO-POPLITEAL NEURALGIA. 
irritation than any of the other nervous'trunks. For this 
reason inquiry should be made with respect to the condition 
of the lower bowel; whether constipation or hsemorrhoids 
exist; also, with regard to the condition of the intra-pelvic 
cavity, whether there be displacement of the uterus, conges- 
tion, hypertrophy, or other altered condition of this organ; 
or whether there be an ovarian or other tumor within the 
pelvic cavity. Hernia, neuromata, subcutaneous tubercles, 
a cicatrix or other cause of irritation should also be looked 
for. Finally, a careful inquiry should be made as to the ex- 
istence of syphilis, as this disease has more than once been at 
the bottom of frightful attacks of sciatica and other neuralgia. 
A mechanical difficulty, if such exists, must be removed; a 
hernia reduced, a displaced uterus restored to position, a neu- 
roma or tubercle removed, etc. 
TREATMENT. 
Sciatica should be treated by removing the mechanical 
cause, if such an one exists; by administering good food, the 
properly indicated remedy, and, as a rule, by the application 
of electricity. The food should be good and plenty of it; 
milk, eggs, beef, etc. Most of these patients need stimulants, 
they are below par, and must be brought up the health line 
to be pel mane ntly relieved. Whisky, Wine and Beer help 
these patients. 
FOODS. 
Apart from those already mentioned, there are certain 
agents commonly used as medicines, that to my mind, should 
better be used as foods. At any rate such is my practice. I 
refer especially to Cod liver oil. Iron, Strychnia and Phos- 
phorus. Permit me to quote from Dr. Hughes: *"For my 
own part I have long been in the habit of giving Iron as 
food in all cases of anasmia. I believe natural Chalybeat wa- 
ters the best mode of its administration. But when these are 
not to be had, I am well satisfied with giving two or three 
grains of Ferrum redactum of the British Pharmacopoeia, once 
daily, at meal time." 
♦Manual of Pharmacodynamics, p. 282. NEURALGIA ISCHIADICA, SCIATICA. 
17 
"You will see from this that I regard Iron as a food rather 
than as a medicine, and administer it accordingly." 
This is my way of using Iron (the acetate) except that I 
think it just as well to use the first trituration. It is given as 
a food, an appetizer, a blood maker, and it does build up the 
patient, gives him an appetite and increases the number of 
red globules of the blood. Strychnia and Phosphorus may 
also be used in this manner. I have frequently administered 
China in this way, and with excellent results. The 2X tritu- 
ration of Cod liver oil has done me good service in some 
cases, patients taking it without hesitation who were quite 
unable to bear the pure oil. It is not a difficult matter to re- 
lieve a patient of a paroxysm of sciatica, but it is quite an- 
other thing to prevent his having a return of one. The hom- 
oeopathic remedy should be selected for the attacks and ad- 
ministered, but apart from this treatment the patient should 
be built up by means of good food, light, air, exercise and 
sunshine. 
ADMINISTRATION OF MEDICINES DOSE. 
As external applications the tinctures of medicines are 
used. Few dissent from this practice. With reference to the 
administration of medicines internally, my experience has 
taught me to rely to a very great extent on the higher poten- 
cies in the treatment of the neuralgias. The proper remedy 
may be given, but of a low potency, and fail to act altogether, 
or if it does, it is in a very slow and unsatisfactory man- 
ner. I have prescribed a remedy of low potency in numer- 
ous instances without effect, and then relieved the patient al- 
most instantaneously by the exhibition of the same remedy 
highly potentized. There is nothing theoretical about this, 
for I have repeatedly tested various preparations of remedies 
on particular individuals to my entire satisfaction, and in 
favor of potentized drugs. It is not a question with me how 
they are made, how, or why, they act, but enough to know 
that they do act. This is my experience in the treatment of 
functional nervous affections. I refer especially, however, to 
Sulphur, Colocynth, the so-called constitutional remedies; 
Aconite, Bryonia, Belladonna and Bhus appear to act very i8 
FEMORO-POPLITEAL NEURALGIA. 
much better when of low potency. The three grand reme- 
dies in the treatment of acute sciatica are Aconite, Bryonia 
and Bhus, to be used low, from the tincture to the 3d dilution. 
MEDICINES. 
Aconite.-In acute cases, the result of exposure to wet, a 
draught of air and the consequent suppression of perspira- 
tion, with hot, dry skin; full, bounding pulse; great thirst, 
restlessness, with sharp, acute darting pains in the affected 
limb, together with an extreme hyper sensitive condition of 
the mental and physical, Aconite is the remedy. Should be 
used externally also, a few drops of the tincture in hot water 
to be applied directly to the limb, or by means of hot cloths. 
Bryonia.-In recent cases complicated with, or dependent 
on rheumatism. The right limb is the one generally affected, 
and the pains sharp, stitching, aggravated by motion, and re- 
lieved by quiet and by lying on the affected side. Should be 
given internally and applied externally. 
Chamomilla.-I can give but one or two definite indications 
for the use of this remedy, and they apply to neuralgia gen- 
erally. A patient suffering excruciating pains of a sharp, 
shooting, lancinating character-purely neuralgic-one who 
tears frantically about, or races frantically up and down the 
room, unable to rest a moment on account of the extreme 
pain, such a patient wants Chamomilla. The above symp- 
toms would ordinarily be sufficient for me, but if a violent 
emotional disturbance preceded the paroxysm, such as anger 
or vexation, there would belittle doubt about it. 1 have seen 
cases presenting the above symptoms relieved almost instan- 
taneously, many of them within ten minutes, by means of 
this remedy in a high attenuation. With respect to the at- 
tenuation, I may say that Chamomilla has done me little ser- 
vice below the two hundredth potency, while the results have 
been all that could be desired when employed above that 
potency. 
Arsenicum.-Sciatic pain of a burning character, lancinat- 
ing at times; very restless; little thirst; worse about midnight 
and relieved by heat. The complaint is frequently due to an 
anaemic condition of the patient. Malaria is not unfrequent- 
ly at the bottom of the difficulty. NEURALGIA ISCHIADICA, SCIATICA. 
19 
Cimicifuga.-A remedy to be thought of when the difficul- 
ty appears to be connected with ovarian or uterine disease. 
There is likely to be some muscular rheumatism too. The 
left side is commonly affected. An hysterical tendency is 
likely to be discovered in a patient calling for this remedy, 
with a strong leaning toward profound melancholia. 
Ledum.-Several patients whom I have had under observa- 
tion, with pain in the limbs, sciatic and otherwise, have been 
relieved by the use of Ledum applied externally. One patient 
was decidedly improved, her symptoms closely resembling 
those of locomotor ataxia. The feet were clammy and heavy, 
yet excessively tender. She was unable to stand with her eyes 
shut, and her walk was staggering. She simply bathed her 
feet and limbs in water in which was mixed twelve or fifteen 
drops of the tincture of this remedy. This was done twice 
a day. I know of no remedy to compare with Ledum for 
extreme tenderness of the soles of the feet. This tenderness 
seems to depend on an hypercesthetic condition of the termi- 
nal fibers of the nerves of the lower extremities, apart from 
any inflammatory or other altered condition of the feet. The 
pain commences below and passes upwards. 
Lihus tox.-An excellent remedy. Left limb generally af- 
fected, attended with formication, soreness and aching; with 
frequent sharp, excruciating pains along the nerve trunk, 
greatly aggravated by rest, and relieved by slow motion and 
external heat. The pains are generally worse about midnight 
or a little later, and during a heavy condition of the atmos- 
phere, especially just before a storm. Rheumatism is gener- 
ally present, and the effects of wet and dampness the cause. 
Colocynth.-*Dr. Hughes says: "But the nerves about the 
hip joint suffer most severely, the pain darting sometimes 
down the anterior crural, and sometimes down the sciatic 
trunks, even to the foot." Again: "The grand sphere of 
Colocynth lies among the neuroses, especially where pain is 
the most prominent feature." There is much of truth in the 
above, as many who have used this remedy carefully can tes- 
tify. The left limb is the one most likely to be affected. 
of Pharmacodynamics, pp. 242, 243. 20 
Eemoro-popliteal neuralgia. 
There is a rheumatic taint in many cases calling for this re- 
medy. Ovarian or intra-pelvic tumors should be looked for. 
Emotional excitement, especially anger (suppressed) and 
vexation influence cases calling for Colocynth. The pains 
are sharp, darting, lancinating, the least motion causing in- 
tolerable pain. There is a tendency to shortening of the 
tendons. 
Phytolacca dec.-*Dr. A. R. Smart says: "In the rheu- 
matic irritation of the sheaths of the nerves, as in sciatic 
rheumatism, it'is specially useful; also in periosteal rheuma- 
tism and in periostitis. A leading indication for its use in 
periosteal rheumatism, is the presence of a syphilitic taint." 
My limited experience with Phytolacca in the treatment of 
sciatica leads me to believe the above quite correct. It should 
be used externally as well as internally. 
Valerianate of zinc.-Dr. Hale recommends this remedy in 
the treatment of sciatica, and of the neuralgias generally. I 
deem it extremely useful, especially in those cases where the 
suffering is in most part due to an extreme hypersensitive 
condition of the general nervous system, bordering on the 
hysterical. 
Other remedies might be mentioned, but the above are the 
most frequently indicated. If syphilis be present, the prepa- 
rations of Mercury, Nitric acid, Iodide of potash, etc., should 
be thought of. Uterine engorgements or displacements: Cim- 
icifuga, Sepia, Belladonna, Calcarea c., Pulsatilla, Nux vom., 
Natrum mur., Sulph., Caul., Aletris, llelonias and Lil. tig. 
Constipation: Sulph-, Nux vom., Sepia, Natrum mur., Lyco., 
Opium, etc. Haemorrhoids: Sulph., Nux vom., Aloes, AEscul. 
hip., Collin., Hamamelis. 
ELECTRICITY. 
j-"In painful affections, such as the neuralgias, migraine, 
sciatica, tic douloureux and the like * * electricity 
is often of considerable service. It is the continuous gal- 
vanic current which you should use, and it should be only of 
such strength as to be just perceptible by the patient. It 
*Hale's New Remedies, Therapeutics, p. 501. 
tClinical Uses of Electricity, J. Russell Reynolds, M. D., p. 103. NEURALGIA ISCHIADICA, SCIATICA. 
21 
should be applied to the part with well wetted sponges, and 
it should be applied for a short time only, but with frequent 
repetitions. I know of nothing more distinct or more satisfac- 
tory in therapeutics than the relief which may often thus be 
given to suffering of the most intense character, the relief 
being very rapidly induced, and in many cases permanent." 
*An eminent author says: "But above all local means, not 
only for relieving the pain of any paroxysm, but also for ef- 
fecting a permanent cure, electricity stands first." It is in- 
deed a useful and remarkable agent, but to do good must be 
used intelligently. I have a patient under treatment, who has 
been absolutely tortured by her physicians, they using the 
interrupted current when she was already suffering extreme 
pain. It is my custom to use in this disease the constant cur- 
rent, placing the anode over one of the painful spots, behind 
the great trochanter at the sacro-iliac articulation, or above 
the sacral plexus, and the cathode in the popliteal space, or 
over a painful spot in the course of the nerve on the posterior 
partof the thigh. The current is to be increased very grad- 
ually, a few cells to be used only, and then as gradually de- 
creased. No pain should be produced; this but aggravates 
and prolongs the disease. The applications should not be 
longer than ten minutes at a time, but should be repeated 
frequently, several times a day in severe cases, and once every 
other day for some time. Used in this way electricity will 
prove of great service, and there are few of the neuralgias 
that will withstand its action. |Dr. Hammond speaks highly 
of electro-puncture as a means of curing this disease. He 
says: "I prefer, however, to pass the current directly through 
the nerves by means of needles introduced down to its sheath. 
These needles should be insulated except at their points, and 
then, being attached to handles which can be brought into 
communication with the battery, are rapidly passed with a 
rotary motion down to the nerve. I generally select a point 
at the upper part of the posterior aspect of the thigh for one, 
and a point two or three inches be'ow for the other. * 
*Diseases of the Nervous System, Hammond. 
tClinical Lectures on Diseases of the Nervous System, p. 272. 22 
FEMORO-POPLITEAL NEURALGIA. 
* I have several times succeeded in breaking up a parox- 
ysm of intense sciatica, and effectually curing the patient by 
a single application, but usually several are required. I have 
never witnessed the least untoward result from the use of 
galvanism in this way." 
As a palliative measure the Turkish bath has proven in some 
cases extremely useful. It will seldom fail to relieve the most 
urgent symptoms of sciatica, and will indeed sometimes ef- 
fect a cure. I call to mind a severe case which was perma- 
nently relieved of all difficulty by means of this procedure. 
Where the Tuikish bath is not available, the hot sand bath 
may be employed, the affected limb being entirely imbedded 
in heated sand. The wrapping of the affected limb in warm 
cotton batting is frequently useful. Moist heat is sometimes 
preferable to dry; in such cases, flannels wrung out in hot 
water and applied is frequently serviceable. Another excel- 
lent plan by which moist heat may be applied directly to the 
diseased limb is to envelope this member loosely in a heavy 
blanket, and then to the nozzle of a tea kettle of boiling water 
attach a piece of rubber hose, the other unattached end to be 
passed under or between the folds of the blanket, care being 
taken t>' prevent injury to the patient by the direct contact of 
the steam 
Among the palliative and sometimes curative agents must 
be ranked Warm water. Many times haVe I known a most 
violent neuralgia relieved in a few moments by means of 
warm, or even extremely hot water. Severe cases of facial 
neuralgia, due to an exposed nerve in a decayed tooth, may fre- 
quently be cut short by filling the mouth with warm or quite 
hot water, and holding it there for some little time, until the 
sedative effect of the applied heat is produced. Dr. Thomson 
says of this agent: *"Much more effective, however, than 
any medicinal agent for paralyzing irritant, affected or sen- 
sory impressions, is a remedy which can be obtained anywhere 
and to any desired extent, and that is simple warm water. 
The contact of water near the temperature of the blood which 
PALLIATIVES. 
♦American Clinical Lectures, E. C. Seguin, M. D., Ed., pp. 116, 117. NEURALGIA ISCHIADICA, SCIATICA. 
circulates about the cutaneous nerves, produces on those 
nerves a sedation, almost, if not quite, equal to the effects of 
a general bleeding, * * In distinction from cold, 
which is a nerve irritant, moist heat is a pure sedative. By 
a nervous irritant we mean an agent which produces a low- 
ering devitalizing impression, but which impression the nerves 
react against as soon as they can. By a pure nervous seda- 
tive, we mean an agent which produces a lowering impres- 
sion from which the nerves may recover, but never react 
against; and precisely such an effect is caused by the contact 
of water at eighty-five to ninty-five degrees to the surface 
nerves. * * Now my own experience leads me to 
rate this property of warm water as more certain and power- 
ful than any agent with which I am acquainted, for relax- 
ing tonic contraction of either voluntary or involuntary 
muscular fiber whenever such contraction is induced in re- 
sponse to sensory irritation. * * Even in those sad 
cases of tonic muscular contraction of the lower limbs, caus- 
ed by pressure on the cord from vertebral disease or injury, 
the relief from this simple measure is often very great."