–The two sciatic nerves are the largest nerves in the body. They pass out of the spinal column, at its lowest part, by several heads, and pass down the limbs behind the hip-joints, descending to the feet. They gradually diminish in size, as they give off branches to the various muscles and parts of the limbs as they descend. When one of these nerves becomes the seat of neuralgia it is called “sciatica.” The pain of it is often intense, and is felt in the course of the nerve, the tenderest point being at the back of the hip.
Rheumatic pain in the hip-joint may be mistaken for sciatica at times. Sciatica itself may be of rheumatic origin. If often follows a chill, and those who are of a rheumatic constitution are more liable to be affected than others.
Diagnosis.–Sciatica must be distinguished from hip rheumatism and from paralytic affections in the spine. In rheumatism of the hip-joint many of the symptoms can be referred to that region. The pains may extend down the limb, but the tenderest part is the hip-joint, and the pains are worse when the joint is moved or pressed upon. Paralytic diseases of the spine are more apt to be two-sided than sciatica, which affects one side only as a rule; and presence of paralysis or loss of power in the lower limbs, independently of the pain in these cases, is an additional distinguishing feature.
General Treatment.–In the way of general treatment, keep the limb warm and avoid anything likely to lower the general health. Generous diet should be prescribed and the patient’s health kept up. Massage by a skilled masseur or nurse will often help greatly.
Medicines.–(Three or four times a day.)
–Pains aggravated by rest, and better by motion.
–When in the right hip; when induced by anger or indigestion; pains worse by movement.
–When accompanied by numbness in the limb or toes.
Arsen. 3.–Pain acute, dragging, sensation of cold in the part affected; pains periodical, in weak and emaciated persons.
Nux vomica 3.
–When the pain is attended by a sensation of stiffness or contraction of the limb; torpor, with chilliness in the affected parts.
–Cutting pains, especially on moving the limb.
–Pains worse at night; with excessive sensitiveness.