Text-book of nervous diseases for physicians and students / by Professor H. Oppenheim.

  • Oppenheim, Hermann, 1858-1919.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Text-book of nervous diseases for physicians and students / by Professor H. Oppenheim. Source: Wellcome Collection.

    625/640 (page 591)
    Ehret states that he applies these blisters over an area 20 to 30 cm. long and 4 cm. broad, along the nerve, with very satisfactory results. Cauterisation with concentrated hydrochloric acid, and with nitrate of silver, are recommended for producing cutaneous irritation. The button cautery produces a stronger effect ; superficial blisters are raised with the hot iron above the sciatic nerve, and especially over the tender points. It is not advisable to keep up the suppuration too long. Cauterisation at distant sites, even on the lobe of the ear, was among the methods of the old school. Empl. oxycroceum (Pharm. Belg.), which produces an eczema on the skin, is an old remedy which should not be discarded. Williams' porous plaster may also render good service. If the diaphoretic methods have failed, we may at once, or after trying counter-irritation, resort to electricity, which is almost unanimously regarded by the profession as a valuable method in these cases. Galvanic electricity is the most useful form. One large electrode is placed upon the nerve at its point of emergence, the other upon one of the peripheral tender points, in the popliteal space, the calf, etc. Currents of medium intensity are usually required, although some writers recom- mend weak, others strong applications. It is well to commence with the weaker currents and to vary the strength according to the result. One may modify the treatment by moving the electrode gradually along the n^rve so that a portion of it is always directly under the current. It is also advisable to apply one electrode to the gluteus maximus above the great sciatic foramen, and the other opposite to it in the lumbar region, sending a strong current through them. Stanowski has achieved great success by using large electrodes and prolonging the application for a half to a whole hour. The faradic brush is not more efficacious than the other modes of cutaneous irritation, but it permits of the stimulation being renewed daily, and it causes no discomfort. Very strong currents are necessary for any effect. Energetic faradisation of the muscles has been successful in longstanding cases. Bernhardt and others have employed Frank- linisation with advantage. Cataphoric treatment and constant wearing of a galvanic element may also be suggested. Krefft approves of the magneto-electrical method. Massage deserves special commendation. It is particularly good for chronic, slowty yielding forms. It is often also of great use in recent cases, although it is too frequently forced, and the nerve which is already injured becomes further irritated. It is advisable to begin with gentle rubbing and kneading, and to limit this as much as possible to the neigh- bourhood of the nerve. In the rheumatic and gouty forms massage is often splendidly successful. Negro recommends treatment by means of compression of the tender points, especially of the one on the sciatic notch, and Arullani has constructed a special apparatus for the employ- ment of this method. Cramer (Z. f. ortho. Chir., xiv.) recommends that the extremity be fixed by means of plaster of Paris bandages in the flexed, abducted, and externally rotated position. In obstinate cases Schmidt (M. /. U1906) has obtained good results from extension by weight. As to treatment by drugs, we may mention the anti-neuralgics : salicylate of soda, ol. terebinth, (best given in capsules of TO, three times a day), arsenic, quinine, antipyrin, and phenacetin. In some cases (even