Volume 1
A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper.
- Date:
- 1893-1894
Licence: Public Domain Mark
Credit: A text-book of the theory and practice of medicine / by American teachers ; edited by William Pepper. Source: Wellcome Collection.
868/962 (page 848)
![In this connection may be mentioned, a.s possibly dne to a neuritis of the nerves, the condition described by Weir Mitchell as erythromelalgia, which is accompanied with great pain in the heel or in the sole of the foot, and vascular change, either an acute hyperseraia or cyanosis. It is an alFection similar in most respects to Raynaud's disease. Sciatica. This is either a neuritis of the sciatic nerve or of its cords of origin. It is regarded sometimes as a functional neurosis. It occurs most frequently in adult males. Rheumatism or gout is present in many cases. Exposure to cold, particularly after heav}^ muscular exertion, or a severe wetting is not an uncommon cause. The nerve-cords of the sacral plexus may be compressed by ovarian or uterine tumors, by lymphadenomata, or by the fcetal head dur- ing labor. Occasionally lesions of the hip-joint induce a secondary sciatica. The condition of the nerve has been examined in a few cases. In the opera- tion of stretching it has been found swollen and reddened. Histologically, an interstitial neuritis has been present. The affection may be most intense at the sciatic notch or in the nerve about the middle of the thigh. Of the symptoms, the most constant and troublesome is pain, which, as a rule, sets in gradually, and for a time may be slight and confined to the back of the thigh, and felt particularly in certain })ositions or after exertion. At the onset there may be fever. Soon the pain becomes more intense, and, instead of being limited to the upper portion of the nerve, extends down the thigh, reaching the foot and radiating over the entire distribution of the nerve. The patient can often point out the most sensitive spots, usually at the notch or in the middle of the thigh, and on pressure these are exquisitely painful. The ]>ain is described as gnawing or burning, and is usually constant, but in some instances is paroxysmal, and often worse at night. On walking the knee is bent and the patient treads on his toes, so as to relieve the tension on the nerve. In protracted cases there is wasting of the muscles, but the reaction of degeneration can seldom be obtained. In these chronic cases cramps may occur and fibrillary contractions. Herpes may develop, but this is unusual. In rare instances the neuritis ascends and involves the spinal cord. The duration and course are extremely variable. As a rule, it is an obstinate affection, lasting for months, or even, with remissions, for years. Relapses are not uncommon, and the disease may be relieved in one nerve only to appear in the other. In the severer forms the patient is bed-ridden, and such cases prove among the most distressing and trying which the physician is called upon to treat. In the diagnosis it is important, in the first place, to d.etermine whether the disease is ]iriraarv, or secondary to some affection of the pelvis or of the spinal cord. A careful rectal examination should be made, and in women pelvic tumor should be excluded. Lumbago may be confounded with it. AflFections of the hip-joint are easily distinguished by the absence of tender- ness in the course of the nerve and the sense of pain on movement of the hip-](https://iiif.wellcomecollection.org/image/b20413920_001_0868.jp2/full/800%2C/0/default.jpg)
