THE SYMPATHETIC SYSTEM 339 



no relation to meals, or movements, differing in this way 

 from gastric ulcer or stones in the kidney. 



The pain is frankly epigastric (it occasionally starts at 

 the level of the llth and 12th ribs on the left side, then 

 gradually localizes on the median line), radiates towards 

 the thorax, the back and the shoulders. 



These paroxysmal attacks, lasting longer and longer 

 and often becoming more and more painful, end up by a 

 state of visceralgia or of constriction around the waist. 

 These patients have a characteristic attitude: they sit 

 down, bend forwards with the knees flexed. 



No food can be tolerated during the attacks. Vomiting 

 is frequent and in the intervals between the attacks the 

 patients complain of a sensation of abdominal distension. 



2. Coelialgia. The stimulation of the nerves of the 

 solar plexus manifests itself by abdominal painful spots 

 the topography of which has been studied by Loeper and 

 Esmonet and which can be brought out by means of the 

 esthesiometer of Roux and Millon, or by a moderate 

 pressure of the finger. 



These painful spots are above, at, or below the umbilicus. 



Painful spots above the umbilicus are common in gastric 

 affections. One is the epigastric spot, at the lower limit of 

 the upper third of a line from the umbilicus to the xyphoid. 

 Pressure at this spot will sometimes bring out a corres- 

 ponding painful spot on the spine. Another point, called 

 the solar point, corresponds to the lower limit of the middle 

 third of the segment on this line, and corresponds to the 

 coeliac region and to the solar plexus itself. 



The para umbilical spots are found nearly always in 

 intestinal affections. There is a superior mesenteric spot 

 and an inferior mesenteric spot, which correspond to the 

 origin of the two mesenteric arteries of this name. 



The spots under the umbilicus are: 1. The promon- 



