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 while the knee is kept extended; and by active movements—­the patient flexing the limb at the hip, the knee being maintained in the extended position.  These exercises, which may be preceded by massage, are carried out night and morning, and should be practised systematically by those who are liable to sciatica.

Benefit has followed the injection into the nerve itself, or into the tissues surrounding it, of normal saline solution; from 70-100 c.c. are injected at one time.  If the pain recurs, the injection may require to be repeated on many occasions at different points up and down the nerve.  Needling or acupuncture consists in piercing the nerve at intervals in the buttock and thigh with long steel needles.  Six or eight needles are inserted and left in position for from fifteen to thirty minutes.

In obstinate and severe cases the nerve may be forcibly stretched.  This may be done bloodlessly by placing the patient on his back with the hip flexed to a right angle, and then gradually extending the knee until it is in a straight line with the thigh (Billroth).  A general anaesthetic is usually required.  A more effectual method is to expose the nerve through an incision at the fold of the buttock, and forcibly pull upon it.  This operation is most successful when the pain is due to the nerve being involved in adhesions.

#Trigeminal Neuralgia.#—­A severe form of epileptiform neuralgia occurs in the branches of the fifth nerve, and is one of the most painful affections to which human flesh is liable.  So far as its pathology is known, it is believed to be due to degenerative changes in the semilunar (Gasserian) ganglion.  It is met with in adults, is almost invariably unilateral, and develops without apparent cause.  The pain, which occurs in paroxysms, is at first of moderate severity, but gradually becomes agonising.  In the early stages the paroxysms occur at wide intervals, but later they recur with such frequency as to be almost continuous.  They are usually excited by some trivial cause, such as moving the jaws in eating or speaking, touching the face as in washing, or exposure to a draught of cold air.  Between the paroxysms the patient is free from pain, but is in constant terror of its return, and the face wears an expression of extreme suffering and anxiety.  When the paroxysm is accompanied by twitching of the facial muscles, it is called spasmodic tic.

The skin of the affected area may be glazed and red, or may be pale and moist with inspissated sweat, the patient not daring to touch or wash it.

There is excessive tenderness at the points of emergence of the different branches on the face, and pressure over one or other of these points may excite a paroxysm.  In typical cases the patient is unable to take any active part in life.  The attempt to eat is attended with such severe pain that he avoids taking food.  In some cases the suffering is so great that the patient only obtains sleep by the use of hypnotics, and he is often on the verge of suicide.