question. There have been running through the Journal of the American Medical Association a group of articles among the editorials for the last ten or twelve editions that have been dealing with the subject of uric acid, and they have summed up all the work of recent years on the question, and one can not help but be disappointed in reading these articles, because it leaves the question as in the old Scotch verdict-not proven. Whether there is a retention of uric acid or an increased production, one is not able to say certainly, but one thing is certain, that the nucleins in foods, such as the pancreas, the kidneys and the different organs of the body used for food, and certain vegetables, such as peas, beans, etc., produce increased excretion of uric acid, and the amount in the urine is increased greatly. That has been proven, but the estimate of uric acid in the urine, such as we are accustomed to make in the laboratory, is a very unreliable thing to go upon.

Dr. A. S. Jaeger, of Indianapolis: When we understand and consider the self-limited course which acute articular rheumatism runs we can not get past the fact that it is a germ infection or an infection by micro-organisms. I think we make a mistake in attempting to make a distinction between acute and chronic rheumatism. I do not think there is such a thing as chronic rheumatism. We have the effects of the acute condition, but we do not have it going into the chronic form. This point I have proven time and again to my own satisfaction. Now, the presence of uric acid is not important, because by the time the uric acid is formed the damage is done. It is secondary. I have treated a few cases of rheumatism. I let the system take care of the uric acid. We give a bland diet, of course. We would in any other infectious disease. The preponderance of opinion is that it is not an infection, but I think the latest investigators have proven beyond a doubt that it is an infection.

Dr. L. P. Drayer, of Ft. Wayne: I think the time is ripe for the medical profession to recognize this one fact, that acute articular rheumatism has definite prodromata, a definite symptomatol

ogy, definite sequela, and that it is an acute infectious process caused by a specific infection. It is an unfortunate thing that medical men will try to consider an acute process such as this from a chemical standpoint. It has been demonstrated time after time that when a patient's body is surcharged with uric acid and urates that he may be relieved almost immediately by an additional quantity of urea in some form or another. To Dr. Walsch, of New York city, belongs the credit of introducing this subject, and at the New Orleans meeting he read a paper on "The Passing of Chronic Rheumatism." At the meeting were the best men in the country, and with Tyson and Anders present no one dared to stand before the society and say there was such a thing as chronic rheumatism.

Dr. Theo. Potter, of Indianapolis: It is really unfortunate that the term rheumatism has come to be applied in such a way as it has. It is applied both popularly and professionally to a whole series of aches and pains involving the locomotive apparatus and fibrous structures of the body, until really the term means absolutely nothing. It is applied to affections which are evidently toxemias. That group of disorders which complicate tonsilitis, scarlet fever, diphtheria, gonorrhea and the whole list of infectious diseases may have affections of the fibrous structures and of the joints, to which the term rheumatism is applied. These are really cases of arthritis. We do not know exactly how they come about, but this we know, so far as we can know in the absence of specific diagnosis, that they are not the same thing as rheumatism. Their pathology is not the same; their clinical history is not the same; and the treatment especially distinguishes acute articular rheumatism from that whole group of affections. And so with chronic rheumatism. It is a chronic arthritis, which is entirely different in its clinical history and treatment. And so with the so-called gouty affections. Then there is a series of disorders, the seat of which is the nervous system, to which the term rheumatism is unfortunately applied. For example, sciatic rheumatism, which so commonly misleads, and which in the majority of cases has nothing to do with rheumatism at all. While

it is true that we are not yet certain just what acute articular rheumatism is, we believe more strongly that it is an acute infection. We ought to limit the term to that particular disease and then speak of arthritis, gonorrheal, post-scarlatinal, etc., for so long as we go on applying the term gonorrheal rheumatism, sciatic rheumatism, etc., so long will we mislead ourselves in the line of therapeutics. The time has come to limit the term to one particular disease, and when we do that we shall at least have started on the road toward a more accurate diagnosis of many of these other things.

Dr. W. H. Patton, of Orleans: I hope not to take exception to anything said, and while I have heard the discussion and have read some of the latest articles on rheumaitsin, for me to try to think that chronic rheumatism is a disease separate and distinct from acute articular rheumatism, it is a theory rather hard to believe, for this reason: I do not know of any symptom that is common in chronic rheumatism, except as an exaggerated condition of the acute. For instance, we have pain in the joints, muscular soreness and slight stiffness in the acute form, whether articular or muscular, and as the disease progresses on and on it becomes chronic, and we have the anchylosis and the tophi deposited within the system. And while I am not disputing that the acute could not become chronic, there must be a cause, and there must be uric acid, and whether it produces the rheumatism, we have the same conditions in other cases, and I do not think of a case that does not give a history of once having an acute attack. And I would like, if we had time, to have a few symptoms how we diagnose the difference if we never had the acute disease,

7-Ind. Med. Assn.

SCIATICA.

BY JOHN LITTLE MORRIS, M. D., OF COLUMBUS, IND.

In all probability one of the most troublesome diseases to relieve and cure is the condition usually designated as sciatica, and whether it confronts the family physician or the specialist this class of cases is as a rule unsatisfactory and the physician is very liable to get discouraged, and certainly the patient.

The term sciatica is misleading in the sense in which it is originally used, and does not describe the essential condition which confronts us. In a tabulated list of two hundred cases of pain in the sciatic nerve and its branches, eighty per cent. are proven to be sciatic neuritis, and the remaining twenty per cent. can be considered under the two heads, sciatic neuralgia and sciatic rheumatism. The term neuralgia according to Foster's dictionary, is "a nervous disorder characterized solely by pain." Neuritis is designated as "an inflammation of a nerve or its sheath, and its branches." The symptoms that make up the diagnosis of neuritis are tenderness on deep pressure over the nerve, disturbance in the function of the muscles supplied by the nerve, atrophy of muscles, and disturbance of electrical response. Sciatic rheumatism may occur after a case of general rheumatism, or in one who is predisposed to rheumatism. However I do not believe that it is possible for rheumatism to be confined to the nerve alone, hence when we find a case of so-called sciatic rheumatism, it will be found to be more or less muscular in character, including the muscles of the thigh and back. In fact these cases may at the very first, have been a sciatic neuritis, and owing to the disturbance of the nutrition of the muscles, especially in patients who have had a previous attack of rheumatism, the rheumatism begins in the muscles, and it would be more proper to call the condition sciatic neuritis, and the muscular symptoms, constituting simply an attendant muscular rheumatism.

In order to make a careful study of pain in the sciatic nerve it might be well to review the anatomy of the nerve and its branches. The great sciatic nerve starts in the sacral plexus of nerves, which is formed by the lumbro-sacral cord, the anterior divisions of the three upper sacral nerves and part of the fourth. They all unite into a single broad, flat cord, triangular in shape, its base being towards the sacrum, and its apex at the lower part of the great sacro-sciatic foramen. It rests on the anterior surface of the pyryformis muscle, and it is covered in front by the pelvic fascia which separates it from the sciatic and pudic branches of the internal iliac artery. The branches of the sacral plexus are six in number: Muscular, inferior gluteal, superior gluteal, pudic, small sciatic and great sciatic. The muscular branch supplying the pyryformis muscle arises from the first sacral nerve before it enters the sacral plexus. This anatomical fact will be noted further on in this paper.

The great sciatic nerve supplies the muscles of the back of the thigh, the leg and foot. It is three-quarters of an inch wide and passes out of the pelvis through the great sciatic foramen, beneath the lower border of the pyryformis muscle, descends about midway between the trocanter major and the tuberosity of the ischium on the back of the thigh to about its lower third, when it divides and becomes the external and internal popliteals and supplies the parts around the knee joint, and the internal popliteal becomes the tibial, and supplies the foot and heel.

Some au

Sciatica is more common in men than in women. thorities claim as much as four out of five cases, and others, sixty-five per cent. My own practice has shown five women to twenty-one men. The prevalent age is between thirty and sixty, seldom after sixty, and never before puberty. The liability of the condition depends on climatic conditions, occupation, mode of living, and liability to injury. The purely neuralgic form of sciatica is oftentimes closely associated with pregnancy, lactation, and diabetes.

The cure of sciatica has long been a source of trouble to the therapeutist. Many methods have been in vogue and had their day, and it has seemed what will cure one case will fail in the very