Remarks on sciatica and morbus coxae senilis : especially with regard to their treatment / by Karl Petrén.

  • Petrén, Karl Anders, 1868-1927.
Date:
1909
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Licence: In copyright

Credit: Remarks on sciatica and morbus coxae senilis : especially with regard to their treatment / by Karl Petrén. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    varying according to the nature and course of each case. The great majority of authors seem to agree as to the enforcement of rest in bed when dealing with the first stage of an acute sciatica. Some English and American writers (Gowers, Clarke. Harburn, Herter) recommend, in accordance with the suggestion of Weir-Mitchell and Hammond, complete immobilisation of the affected limb by means of a long splint. I have never found any necessity for this. As to the treatment try drugs, the majority of text-books recommend the use of salicylates, but without, as a rule, laying any special stress on these, mentioning them sometimes along with many other drugs (Oppenheim). For my own part I have for long taken a different position on this point, having treated all cases, without exception, with salicylates. Of recent years I have regularly used acetylosalicylic acid, in considerable doses, com- mencing as a rule with 6 grams a day. Even if the effect of the aspirin treatment is undoubtedly greater and more rapid in acute rheumatic fever than in sciatica, I am convinced from experi- ence that the consistent treatment of sciatica with large doses of aspirin, in combination with confinement to bed, exercises a considerable influence on the progress of the disease. Feddersen and Schultze have recently expressed similar opinions, as well as V. Hoorden and Treunel at the Congress at Wiesbaden in 1907. During the last few years I have also frequently employed the external applications of salicylates (such as mesotan, un- guentum salense, salite, spirosal), and I believe not without good effect. Treatment with drugs other than salicylates seems unnecessary in acute sciatica. In my experience, the use of narcotics of any kind may almost always be entirely omitted, when vigorous aspirin-treatment is employed along with con- finement to bed. I need not dwell on the advantage of dispensing with narcotics in dealing with a disease, the duration of which is so uncertain as sciatica. As to the physical treatment of sciatica, massage is, in my ■opinion, the most important method. There is greater diversity of opinion on this point than on any other detail of treatment. Some writers are strongly against the use of massage in acute and subacute sciatica, allowing it only in chronic cases (Chris- tiansen, Eulenburg). Others, again, admit that it may be used at an earlier stage (Oppenheim, Edinger, Levison). According to my own experience, massage may be employed with the greatest