THE SYMPATHETIC SYSTEM 343 



following typhoid, and scarlet fever and influenza, are due 

 to inflammatory or sclerous lesions of the solar plexus. 



IV. DIAGNOSIS. 



Whatever the form, acute, subacute or chronic, the 

 solar syndrome is characterized chiefly by paroxysmal 

 attacks of pain accompanied by gastric intolerance, vomit- 

 ing and occasionally diarrhea. 



We must differentiate them from the other painful 

 abdominal syndromes: 



1. Gall or kidney stone crises. These are usually 

 easily localized after a patient has been under observation 

 for some time. 



2. Slow intestinal stenoses, only rarely give rise to 

 sharp pains. 



3. The gastric crises of tabes resemble very much 

 solar syndrome. Between the attacks, however, all pain- 

 ful sensation disappears, while there is still a vague pain 

 between the attacks in solar crisis. The diagnosis is 

 usually made by the observation of the clinical signs 

 of tabes and the examination of the spinal fluid. 



Once the solar syndrome is recognized the cause must 

 be determined. 



1. Chronic ulceration or cancer of the lesser curvature 

 must be looked for, by the examination of the gastric 

 contents, the determination of blood in the stools 

 and X-rays. 



2. A pancreatic lesion can be suspected when there 

 is severe pain over the pancreatic spot described by 

 Chauffard and Rivet, two fingers above and to the right 

 of the umbilicus, on a line bisecting the angle formed by 

 the median line and a horizontal line passing by the umbili- 

 cus. The alimentary glycosuria test, the examination of 



