§ 176. Ischias, coxalgia, coxagra.

This is a pain in the region of the hip-joint, which frequently extends down to the foot. The pain sometimes is very great, impedes the motion of the foot, induces rigidity, contraction, and, by continually disturbing the nightly rest, general marasmus and consumption.

By coxagra (coxarthrocace) we understand an inflammatory affection of the hip-joint itself, painful when pressing the foot to the floor or moving it, but not felt during rest. It is distinguished from ischias by this last characteristic, by the pain extending along the anterior surface of the thigh, (whereas in ischias it extends along the external surface,) and by the subsequent elongation of the foot.

This affection is not always arthritic; it has more frequently a rheumatic origin, following the ischiatic nerve, (in whose neurilema exudations are discovered after death;) or it is an affection of the joint, which may in a few days assume an inflammatory character, and speedily terminate in exudation, suppuration in the joint, dislocation of the head of the femur, elongation of the limb. This affection may likewise result from psora, scrofula, and various metastatic processes, particularly in children, where it frequently occurs in the form of spontaneous limping, (claudicatio spontanea.)

§ 177. Aconite is to be given first when there is synochal fever, to be followed by Mercury when the patient is obliged to limp, (claudicatio spontanea,) unless Bell. or Sulph. should be more particularly indicated. Mercury is particularly suitable when the affection sets in very suddenly, in children. When there are evening or night exacerbations, give Puls. If there be urinary difficulties, use Cantharides. Bell., Rhus t, Nux v., Ars., Nitr. ac, Phosph., Graph., Sepia, are useful in this affection; Sil., Staphys., Mercur., Hep. s., Natr. mur., are to be employed when symptoms of suppuration should be present.

§ 178. Another form of arthritis is the so-called nervous ischias, (ischias nervosa Cotunni, neuralgia ischi-adica,) a very painful disease, which is seated in the ischiadic and crural nerves. This affection is never attended with fever or suppuration. At first the pain is continuous, then it intermits and returns again with renewed violence, is disposed to exacerbate in the evening, so that the patient has to leave his bed, and is attacked with a violent cramp in the affected side. We distinguish,

(a.) Ischias nervosa postica, which is the most common form of the disease. There is a seated pain in the hip, particularly behind the trochanter major, extending upwards to the os sacrum, and the third, fourth, and fifth vertebras, and downwards along the outer side of the thigh as far as the bend of the knee, and sometimes even beyond the head of the fibula; anteriorly it descends along the spine of the tibia and disappears in front of the outer malleolus in the dorsum of the foot. This shows that the pain follows the course of the great ischiatic nerve.

(b.) Ischias nervosa antica, which is less frequent and painful. The pain is seated in the anterior portion of the hip, towards the groin, and extends along the course of the crural nerve, down the inner side of the thigh and calf.

If the pain should last long, a sort of paralysis, atrophy of the limb, limping, and contraction, may be the result.

§ 179. Beside the remedies indicated for arthritic affections, the following remedies are recommended for that affection: Nux. v.. Puls., Chamom., China, Bryon., Bellad., Mercur., Rhus t., Colocynthis, Canthar., and Arsenic, the latter particularly when the pain exacerbates after dinner, or is burning. In this case, Carbo veg., Lycop., Calc. c, Petrol., and Zinc, may likewise prove useful. It is difficult to point out a certain remedy for the particular forms of this pain. The physician has to be guided by the kind of pain, the time when the pain appears, intermits, or exacerbates, by the individuality, character, constitution, etc., of the patient. I have cured one case of ischias by Cha-mom., which I selected because the pain became intolerable a quarter of an hour after the patient had been in bed.