Sciatica is now generally treated by massage in all Teutonic countries, and there are many reports concerning the value of the treatment, which has markedly increased the prospect of recovery.

We might equally well have dealt with sciatica in the chapter on Diseases of Muscles, for it is, to a great extent, of myogenic origin, and is caused by myositis in the neighbourhood of the nerve trunk, especially in gluteus maximus and medius, while anaemia, chlorosis, hysteria, and the neurotic tendency are here of less aetiological importance than in other forms of neuralgia (especially those arising in the nerves of the head). Of the general causes diabetes is the most common, and the possibility of its existence should not be forgotten. The possibility of pressure from tumours (either in the uterus or elsewhere in the pelvis) as a cause must also be considered. It is evident that massage is of the greatest value when rheumatic changes in the muscles are the cause of neuralgia.

* In one or two severe cases, where no changes on palpation were to be found, in experimenting with strong frictions over the supra-orbital foramen I succeeded in stopping the-neuralgia; in one case only, which I had the opportunity to see again, the freedom from pain remained for at least several weeks after treatment. In a third case, where I adopted the same treatment, I only brought about a violent attack of migraine, for which reason I have not again used this method, though it may be of some value.

In sciatica the most important examination by palpation is to decide how much infiltration there is in the gluteal muscles, and this is done by the method already explained. Such infiltration, however, for anatomical reasons may easily escape the masseur, and here, therefore, especially for myself, I make it a rule, even if no changes are palpable, to apply strong massage with frictions over the gluteal region. Besides this it is necessary to give strong vibrations over the great sciatic nerve from the popliteal space upwards, and it is also well to give strong eflleurage over the whole leg. (It is of course important to examine for myositis all along the course of the nerve.)

Finally, "Nerve-stretching" plays an important role, for anatomical reasons, in the treatment of sciatica. It is best given, after turning the patient from the prone to the supine position, by the masseur placing the patient's leg on his own shoulder and his hands on the patient's thigh just above the knee in order to prevent flexion of the knee joint; he then performs flexion in the hip joint as far as the patient can bear it.

The treatment of sciatica by massage, when the causes are not of a permanent nature, gives a fairly good result. During the last eleven years my experience in these cases has considerably increased in my mechano-therapeutic clinic, and I can definitely say that a negative result is rare, and that a temporary cure or improvement is more usual than permanent cure. The same result appears in many other papers on the same subject by Berghman, Craith, Douglas Graham, Faye, Gussenbauer, Johnsen, Norstrom, Winge, Zabludowski, Bum, and others. The treatment, however, must often be continued for some months.

Later experience has justified in cases of sciatica the injection under the glutei of about 100 grm. of a weak solution of novocaine, which is often said to have a markedly curative effect.