f the fibula. The muscles of
the thigh are often wasted and are liable to twitch.

The clinical features vary a good deal in different cases; the affection
is often obstinate, and may last for many weeks or even months.

In the sciatica that results from neuritis and perineuritis, there is
marked tenderness on pressure due to the involvement of the nerve
filaments in the sheath of the nerve, and there may be patches of
cutaneous anaesthesia, loss of tendon reflexes, localised wasting of
muscles, and vaso-motor and trophic changes. The presence of the
reaction of degeneration confirms the diagnosis of neuritis. In
long-standing cases the pain and discomfort may lead to a postural
scoliosis (_ischias-scoliotica_).

_Diagnosis._--Pain referred along the course of the sciatic nerve on one
side, or, as is sometimes the case, on both sides, is a symptom of
tumours of the uterus, the rectum, or the pelvic bones. It may result
also from the pressure of an abscess or an aneurysm either inside the
pelvis or in the buttock, and is sometimes associated with disease of
the spinal medulla, such as tabes. Gluteal fibrositis may be mistaken
for sciatica. It is also necessary to exclude such conditions as disease
in the hip or sacro-iliac joint, especially tuberculous disease and
arthritis deformans, before arriving at a diagnosis of sciatica. A
digital examination of the rectum or vagina is of great value in
excluding intra-pelvic tumours.

_Treatment_ is both general and local. Any constitutional tendency, such
as gout or rheumatism, must be counteracted, and indigestion, oxaluria,
and constipation should receive appropriate treatment. In acute cases
the patient is confined to bed between blankets, the limb is wrapped in
thermogene wool, and the knee is flexed over a pillow; in some cases
relief is experienced from the use of a long splint, or slinging the leg
in a Salter's cradle. A rubber hot-bottle may be applied over the seat
of greatest pain. The bowels should be well opened by castor oil or by
calomel followed by a saline. Salicylate of soda in full doses, or
aspirin, usually proves effectual in relieving pain, but when this is
very intense it may call for injections of heroin or morphin. Potassium
iodide is of benefit in chronic cases.

Relief usually results from bathing, douching, and massage, and from
repeated gentle stretching of the nerve. This may be carried out by
passive movements of the limb--the hip being flexed