revived in 1890 by Dr. E. G. Garvens, who reported three cases of cardiac lesion resulting in severe dropsy, in which the use of calomel produced the most striking relief, prescribed in 1 grains every two hours. The same year, at the meeting of the American Medical Association, before the Section on Practice, Dr. George Fackler, of Cincinnati, reported three cases of heart disease resulting in edema, in which calomel exhibited in doses of about 4 grains, three times daily, usually continued four days or longer, caused the disappearance of ascites and edema. His conclusions are as follows: (1) Calomel possesses diuretic action; (2) if given in proper doses the effect of calomel becomes evident from the second to tenth day; (3) its action is most marked in dropsies due to heart disease; (4) small doses are of no avali.

At one time calomel was much thought of as an antiphlogistic, but recently its use, in this direction, has been discontinued to a certain extent. Dr. H. C. Wood has this to say of the antiphlogistic

property of calomel: "All important evidence as to the antiphlogistic value of mercurials at present available is clinical. It is the general judgment of the profession, founded upon the thousand daily observed bedside facts, that endorses the use of mercury as an antiphlogistic. In inflammations of the serous membranes where there is a tendency to fibrinous exudation, in pleuritis, peritonitis and pericarditis mercury is constantly employed with good effect. Calomel is useful in severe laryngitis, and especially in the pseudo membranous variety, and no time should be lost in bringing the system under its influence."

Gould and Pyle say: "Mercury is indicated when the pulse is soft, skin relaxed and moist, and when there is general tendency to restoration of the secretions and not before. It reduces the plasticity of the blood and causes absorption of the embryonic tissue. It is of great benefit in membranous croup, hepatization of the lungs, iritis, etc."

Following is some of the very recent literature on this subject:

Sulphuric Ether Hypodermically. James (British Medical Journal) injects direct into the sciatic nerve by means of a long hypodermic needle sulphuric ether in doses ranging from fifteen to thirty minims. He reports having cured some very obstinate cases with this method.

Pathology of Sciatica.

Bruce (Lancet, November 3, 1906) calls attention to hip-joint disease as a cause of sciatica. He thinks we make great mistakes by resting satisfied by such terms as lumbago and sciatica. We are too much inclined to mental laziness, to settled opinions, while we are too seldom ready to study thoroughly, point to point, the individual case we have before us. Great mistakes occur because medical men do not take the trouble to examine their patients systematically and thoroughly, misled by erroneous pathologies and leaning on words, mere words, trusting to books and not their own brains.

Static Electricity in the Treatment
of Sciatica.

Webb (Lancet) says the results ob tained in the treatment of a number of cises of sciatica with static electricity led him to take the stand that all forms of

neuritis or neuralgia, provided they are not due to pressure of tumors or other irremovable causes, are the most satisfactory of the many cases that can be cured or relieved by this agent.

Oxygen Injected Hypodermically for

Sciatica.

Massalonga and Antis (Il Policlinco, September, 1906) describe their success in the treatment of sciatica by this method. They explain sciatica and other neuralgias as a result of disordered metabolism, the by-products of which poison the nerves. The presence or absence of neuritis is thus simply a question of degree. They state that the frequent injection of oxygen under the skin and deeply amongst the muscles influences the local and also the general metabolism, stimulating the circulation in the nerve trunks and the nerve sheaths,

and thus facilitating the elimination of morbid products. By experiments on the cadaver and on animals they have satisfied themselves that oxygen injected by their method spreads deeply and comes in contact with the nerve trunk near the place of injection. The result of the treatment is twofold-the relief of the pain immediately and the improvement of the anatomical condition of the nerve. All cases treated were severe, either in intensity of the pains or from their long duration. Twenty cases are recorded. Nine were completely cured with ten or twelve injections and in less than a month, the quantity of each being from 250 to 400 cubic centimeters of gas. The other eleven cases were completely cured in less than two months. Each injection was made deeply with the long needle of a Pravaz syringe, inserted usually into the most painful point of the skin. The needle communicated by means of an india-rubber tube with gasogen. Antiseptic precautions were employed and no ill-effects, local or general, followed in any case. A case reported was that of a man, aged fortythree, who suffered for six years from a right sciatica. For two months he was treated without benefit with blisters and frictions. Pressure along the sciatic nerve was very painful, especially between the trochanter and the tuberosity of the ischium, at the outer side of the hip and over the external malleolus. Six injections of oxygen were made at the most painful spots and three deeply over the course of the sciatic between the muscles. Cure followed and was completed in twenty-two days.

The writers did not attach much value to theories by which such treatment is sup: posed to act by stretching the terminal nerve filaments or by forming a protective cushion of gas over the nerve endings.

The Contro-Lateral Sign in Sciatica. Moutard-Martin and Parturiet reported at a recent meeting of the Socéité Médicale des Hopiteau de Paris that they had observed a hitherto undescribed sign in five cases of sciatica. The patient reclines on the bed without a pillow, and the thigh on the sound side is raised and flexed on the pelvis as he lies still. At a certain point the flexion causes a sharp pain in the buttocks on the affected side. The pain is generally at the sciatic point, but

not always, and it was noticed with both neuralgia and neuritis of the sciatic nerve. They call it the "induced controlateral pain," and regard it as an important differentiating sign.

Alcoholic Sciatica.

Dr. John V. Shoemaker gave a clinical lecture on this subject recently (Medical Review of Reviews, March, 1907), in which he gives some good points as to treatment. First, of course, remove the cause, which in these cases is alcohol. Relieve the excruciating pain, which at first must be done with hypodermics of morphine and atropia at or near the situation of the sciatic nerve. Internally he ordered the following prescription: Tincturæ nucis vomicæ, fluid extracti hydrastis, fluid extracti cimucifuge, aa, oz. 88 or 15.00. Misce. Signa: Begin with twenty drops three times daily after meals and at bedtime, increasing the dose one drop every day. When the sciatica is due to gout, rheumatism or syphilis, treat the cause and the sciatica will soon disappear. Baking the limb in a heating apparatus is one of the best means to cure the disease. Counter-irritation, the galvanic cautery being the best, and blisters of cantharides and iodine are often of great value. Complete. rest in bed and often the application of a splint are very conducive to recovery.

The Treatment of Sciatica.

This is discussed by Fowler, in the Practitioner for March, 1907. He considers it a pain of the sciatic nerve, due to a primary localized interstitial neuritis. It may also be secondary to pressure, growth, or inflammation in structures contiguous to the nerve. It may also be simulated by various conditions. Toxemia, sepsis, rheumatism or gout often predispose to it. It may be excited by pressure, strain, cold, etc. Active inflammation in the nerve sheath has been actually observed. Voluntary movement is seldom lost and the muscles, though weak, seldom deteriorate. Herpes and edema of the leg are occasional symptoms. Rest in bed is the initial requirement in the treatment of this disease, and the support of a splint is frequently helpful. The diet should be liberal, alcohol being exclude d For aperients use the salines and the blue. pill.

Counter-irritation by the various

methods is usually effective, but if this fails the nerve may be stretched. Galvanism and other forms of electricity are often beneficial, as also X rays. Massage may be used in the later stages, but is contraindicated early. Hot baths are highly Hot baths are highly recommended. If anodynes are necessary, a daily injection of hyoscine is preferable to any other narcotic.

Sciatica Cured by Correction of Uterine Displacement.

Offengeld (Deutsch. med. Woch.) reports the case of a woman of forty-two years, who had been married fifteen years without becoming pregnant. For the last three years she had suffered from very severe pains in the regions supplied by the right sciatic nerve. She had been treated by competent physicians and neurologists without effect, and an operative stretching of the nerve was contemplated. Offengeld discovered a retroflected uterus, shortened the round ligaments and cured the sciatica completely within a few days. The beginning atrophy of the muscles disappeared and the woman was able to return to her work. Incidentally, she was cured of her sterility and gave birth to her first child a year later.

Unequalled Combination of Drugs. Harburn (Lancet, February 4, 1905) has found no combination of drugs in the acute stage to equal the following: Aspirin, gr. 6, or 0.36; phenacetine, gr. v, or 0.33; salicylate of quinine, gr. 2, or 0.12; and codeine, gr. to, or 0.015 to 0.03. First clean out the bowels with calomel, followed by salines. In the subacute stage nothing is more serviceable than the half-combined bath. Patient sits in a vapor bath which comes up to the waist line only. This, while it does not exhaust the patient as much as the full bath of vapor, allows a higher temperature to be borne by affected part. A temperature of 110° F. can be tolerated for from ten to fifteen minutes. At the end of this time the patient sits in a bath of the Buxton mineral water heated to a temperature of 95° F. for eight minutes, and during the last three minutes a hot undercurrent douche at 102° to 110° F. is applied to the affected limb.

Chronic Form.-Where neuritis is not present the Aix massage baths with the douche applied to the painful parts is of

great value, as are also dry and electric massage, followed by gentle stretching of the nerve in cases where adhesions are present. The Buxton swimming bath at a temperature of 82° F. is one of the most valuable means of treatment at our disposal. In true neuritis, however, massage is, as a rule, not beneficial, and nervestretching is contraindicated. The combined bath, alternating with the natural swimming bath and the application of electricity in the form of the constant current (five to fifteen milliamperes), ascending or descending over the affected nerve, or in the form of the constant current bath, are of much service. The affected limb should be kept warm by wearing double-legged pants of wool. The hypodermic injection of pilocarpine nitrate on alternate days for two or three weeks, except when there is organic heart disease, is highly praised.

Atropine Injections in Region of Nerve.

Shoemaker (Virginia Medical SemiMonthly) recommends deep injections in the region of the nerve of atropine sul phate, 1/150 gr. three times daily; also injections of cocaine as near the nerve as possible. Baking the limb once daily is one of the best means of assisting in the cure of the disease. This should be done in a heating apparatus. The limb is wrapped up in a blanket and placed in an apparatus and the temperature is gradually run up to 300° or 400° F. and kept there for at least an hour. When gout or rheumatism is the cause treat that first, and often the sciatica needs no special treatment. The same is true when the disease is due to other causes. Pathologically speaking, traumatic sciatica is perineuritis. The nerve looks red and inflamed from hyperemia of the vaso-nervorum. Sciatica, especially in women, is often due to pelvic tumors; hence a vaginal and rectal examination should be made in intractable cases in women.

Alcohol-Cocaine and Alcohol-Stovaine.

Ostwald (Berliner klin. Wochenschrift) has found the deep injections of alcoholcocaine and alcohol stovaine in sciatica, trigeminal and other neuralgias to be very beneficial. He uses 80 per cent. of alcohol, to which is added o.or of cocaine of stovaine. He obtains relief in 90 per cent. of the cases in from two to four injections.

Relapses occurred in about one third of the cases, but succumbed readily after one or two injectious. These relapses occurred usually after the fourth or fifth month.

Daily Injections of Strychnine.

Retrivor (Vratchebenaya Gazetta, 22, 1906) reports nine cases in which the most favorable results followed the daily injection of gr. 1/60 or 1/30 or 0.001-0.002 strychnine in the region of the painful part. While previously ordered remedies had proven worthless, all cases improved after the strychnine injections.

Hypodermic Injections of Sterilized Air. The treatment of sciatica and neuralgia by hypodermic injections of sterilized air has been tried not only at Lyons, but also at Bordeaux and Paris. The Journal de Med. de Bordeaux has recently published thirteen cases-three sciatica and ten intercostal neuralgia-which had proven quite refractory to treatment and had been cured by this means. All who have employed the technique indicated note that they have had no complications. The technique is very simple. After sterilizing the region where the injection is to be made a sterilized hypodermic needle is inserted under the skin, and as soon as one is sure that no blood vessel has been punctured a rubber tube is joined onto the needle and air from a rubber bag is injected from simple-compression. To be quite safe it is best to place a little glass tube with cotton wadding between the needle and the bag. The injection should be stopped when the patient no longer complains of pain. A slight amount of massage should be carried out afterwards and repeated every day till crepitation has disappeared.

Sciatica Surgically Treated.

Pers, Copenhagen (Deutsche med. Wo chenschrift), reports two cases which were permanently cured by operation. The surgical treatment consists of laying the nerve free and making it clear from all adhesions. These were loosened and extirpated so that the nerve presented again a normal white appearance. Both patients complained only a short time of pain, which, however, was less than before the operation. After about thirty days the patients were well and could leave the institution. Both after the lapse of two years have found themselves entirely free

from pain. On account of these two typical cases Pers thinks that the surgical treatment of this trouble has a future.

Electricity in Sciatica.

Juettner, in his modern Physio Therapy, says: "Pressure, compression bandage, massage and vibration; dry heat; rest; limb in elevated position; galvanism as before; static spray (positive) locally; local sun baths. The local treatment of any neuralgia must always be secondary to the general treatment of the system. Local treatment is desirable, general treatment is necessary. Even in old obdurate cases, good results can be achieved if the physician will persist in handling his patient generally and locally according to the directions and suggestions given above.

"Faradic.-The apparent anodyne action of the faradic current in neuralgic cases (i.e., sciatica) is due to its alterant action on the muscular tissue and through the latter on the circulation. The blood supply is regenerated and the cry of the nerve for healthy blood is stilled. The use of violent faradic shocks is never indicated except in paralytic conditions, when it is a question of making an im pression on the tissue that has hardly any vitality left in it. Painful applications of the faradic current are never proper."

Compresses and Scottish Douches.

Dr. Ernst Somer, of Winterthur( Wurtzburger Abhandlung ad. gesammten geb. d. pract. med., vi, 4). The principle rôle of treatment reported was that played by compresses, Scottish douches, complete baths with movements, warm packs, massage. The author places the percentage of cures at from 80 to 90. The remarkable results attained by the treatment in the Brieger Hydropathic Institute in Berlin were described in particular. The work of the author demonstrated what we know about cause, treatment and cure of sciatica.

Injection Treatment of Sciatica.

Lange (Muenchner med. Wochenschrift), after trying in vain various medical and surgical means for relief in sciatica, finally found complete cure in five cases by the injection treatment. He injected a solution of Beucaine in the region of the sciatic notch dissolved in

0.8 per cent. salt solution. When a large weal appeared under the skin the needle was pushed down until a jerking showed that a nerve had been touched. Then 70 to 100 c.c. were rapidly injected. Mild local pain lasted for two or three days. In three of his cases a second injection was required for complete cure. Functional and complete relief was almost instantaneous and quite permanent in all cases.

Sciatica.

Potasii iodidi, dr. iv, or 16 00; sodii salicylatis, dr. vi, or 24.00; tinct. cimicifuge, syr. sarsaparilla compositæ, aa, (z. ii, or 60.00; aquæ q. s. ad., oz., vi. M. S. One teaspoonful in water after meals. Indicated in rheumatic subjects - The Prescription.

Paquelin Cautery.

The

Lisznsky (Medical Record) calls attention to the fact that superficial linear cauterization with the Paquelin cautery along the course of the nerve trunk and over the sacral region is often remarkably effi. cacious in relieving the pain. The continuous galvanic current has also proven serviceable in the author's hands at the end of the first week. Mild cases may be treated by application of massage, hot cloths and rectal irrigation. Most of the acute cases under proper management recovered promptly, but with the probability of recurrence. Systematic preventive measures should be kept up for some months. Change of occupation is often necessary from the sedentary to the active. The sedentary individual should sit on a soft cushion or an air cushion to protect the nerve from pressure and injury. Those whose vocation necessitates violent muscular exercise of the extremities find the rest cure essential in many cases. Hydrotherapy, judiciously administered, should never be omitted. It has many cures to its credit. The wet pack applied at night is a very excellent means for relieving the pain, as well as for influencing favorably the neurotic process. For this purpose we make use of the leg of a heavy pair of drawers which is dipped in water at 65° F. and placed in position like a stocking. A roller bandage is then applied so that the leg can be kept in perspiration all night. This is removed in the morning and followed by a warm water ablution and massage. Ten or twelve packs result

in much improvement. A certain percentage of patients prove unamenable to treatment when afflicted with the chronic form. This is usually due to their inability to pursue a persistent or systematic plan of treatment, or the physician, or more probably physicians, who have had the case in charge have not sufficiently studied the case. In long standing and permanent cases the author is in favor of exploratory incisions for the purpose of exposing the nerve trunk, in incising its sheath and freeing it from the surrounding adhesions. Prognosis is better in the young than in the old, and in those of fair general health than in those of renal disease or diabetes. The more pronounced neurotic processes are not so rapidly amenable to treatment as the milder type, and one attack predisposes to another.

Treatment of Sciatica.

Boucék (Revue v. Neurologi, Psicatri, etc.), from an analysis of seventeen cases studied by him, and his experience and favorable results in the same, recommends the following treatment:

1. Faradization of the entire sciatic nerve, followed by placing one electrode upon the affected sciatic, the other on the healthy nerve; repeated faradization of the affected sciatic nerve and the gluteii.

2. Active and passive motion, the former to consist of forced walking.

3. The diseased extremity is kept at a uniform temperature (furs around the gluteii and thighs; later on hardening by cold ablutions).

in

4. Extension for the relief of pain. 5. Narcotics are to be avoided except very severe cases.

Perineural Saline Injections in Sciatica.

Grossman (Wiener klin. Wochenschrift, October 18, 1906) reviews the history of this method of treating sciatica and then describes his experiences. He treated fifteen patients with severe and chronic sciatica and all were relieved at once of the pain. This striking result he found not always permanent. The pain returns sometimes in a milder form, but is then amenable to such measures as superheated air, mud baths, hot packs, leeches and the like. No by-effects were noted in any case. The prompt action in banishing the pain, he declares, certainly justifies the use of this simple and harmless