SPASM OF THE STOMACH -NEK VOUS CARDIALGIA. 553 



ally there is a regular type, so that the attacks recur at the same hour 

 daily, or every second or third day. 



It is impossible to describe a cardialgic attack more strikingly, or 

 briefly, than has been done by Romberg. 



" Suddenly, or after a precedent feeling of pressure, there is severe, 

 griping pain in the pit of the stomach, usually extending to the back, 

 with a feeling of faintness, shrunken countenance, cold hands and feet, 

 and small intermittent pulse. The pain becomes so excessive that the 

 patient cries out. The epigastrium is either puffed out, like a ball, or, 

 as is more frequently the case, retracted, with tension of the abdominal 

 walls. There is often pulsation in the epigastrium. External pres- 

 sure is well borne, and not unfrequently the patient presses the pit of 

 the stomach against some firm substance, or compresses it with his 

 Hands. Sympathetic pains often occur in the thorax under the ster- 

 num, in the cesophageal branches of the pneumogastric, while they 

 are rare in the exterior of the body." 



" The attack lasts from a few minutes to half an hour ; then the 

 pain gradually subsides, leaving the patient much exhausted ; or else 

 it ceases suddenly with eructation of gas or watery fluid, with vomit- 

 ing, with a gentle soft perspiration, or with the passage of reddish 

 urine." 



Besides these severe attacks, we often see painful sensations, of 

 various varieties and degrees of intensity, in the stomach, which also 

 alternate with intervals of rest and freedom from pain, which are less- 

 ened, not increased, by external pressure, or by the introduction of 

 food ; these also are accompanied by sympathetic pain in the breast 

 and back, reflex motions of the abdominal muscles, etc. It is these 

 mild attacks, without " the feeling of faintness and impending death," 

 that Romberg styles neuralgia of the pneumogastric, in contradistinc- 

 tion to neuralgia cceliaca." 



DIAGNOSIS. The character of the pain gives no aid in distinguish- 

 ing cardialgic attacks, accompanying an ulcer of the stomach, from 

 those due to neuralgia of the gastric nerves. In the former we also 

 see the extension of the pain to the back and breast, and see them 

 subside with vomiting and eructation, and the depressing effect of the 

 pain on the patient. The following factors are important in judging 

 between the two states : 1. In most cases, pains induced by ulcer of 

 the stomach are increased by external pressure or by introduction of food 

 (" pressure from within ") ; while, on the other hand, nervous cardialgia 

 is usually relieved by pressure over the stomach, and by eating. 2. In 

 chronic ulcer of the stomach, dyspepsia and other symptoms of dis- 

 turbance of the functions of the stomach are present during the in- 

 tervals ; these do not appear in nervous cardialgia. In accordance with 



