Gustralyia Of Stomachic Origin

Besides occurring in connection with gastric affection, as for instance ulcer, cancer, hyperchlorhydria, peritonitic adhesions, gastralgia may exist as a primary affection of the stomach, either without any visible cause or after the ingestion of certain unusual or unaccustomed articles of food or spices; thus very strong black coffee or icecream may provoke an attack in people not accustomed to these substances.

Gastralgia Of Central Origin

Diseases of the brain are very seldom accompanied by gastralgia. Spinal disorders are much more frequently associated with the latter condition. In tabes especially gastralgia frequently occurs. Charcot deserves much credit for having first recognized the dependence of these gastric pains upon the spinal trouble. He described these attacks under the name of "crises gastriques." The pathological basis for the latter condition was found to consist in a sclerotic degeneration of the vagus nucleus or the vagus trunk (Kahler,1 Demange,2 Landouzy and Dejerine,3 Oppenheim4). The gastric crises differ but little from the usual gastric attacks. As a rule, they begin with a prodromal period of lancinating pains in the limbs or in both upper and lower extremities, and also with excessive vomiting. The attack in many points greatly resembles that of continuous periodic hypersecretion, and lasts just about as long. Examination of the stomach contents before and during the attack has not revealed anything characteristic (Von Noorden5 and Ewald6).

Besides tabes dorsalis, other lesions of the spinal cord which involve the vagus nucleus may also provoke gastralgia. Thus Leyden7 describes it among the symptoms of subacute myelitis, and Oser8 in a case of pressure myelitis. This type of gastralgia accompanying spinal troubles appears of special importance, inasmuch as it is frequently one of the first symptoms of the real trouble. The gastric crises may in some instances precede for several years the other symptoms of locomotor ataxia. It is hardly necessary to mention that in all cases of periodic gastralgia we should examine the condition of the nerves and of the cord (knee reflex, Romberg's symptom, sensitiveness of the skin, and reaction of the pupils).

1Kahler: Prager Zeitsch. f. Heilkunde, Bd. ii. 2 Demange: Revue de medecine, 1882. 3 Landouzy et Dejerine: Soeiete de biologie, 1884. 4Oppenheim: Berl. klin. Wochenschr.. 1885. 5C. von Noorden: "Pathologie der gastrischen Krisen." Charite Annalen. 1880.

6C. A. Ewald: l. c. p. 403.

7K. I.eyden: Zeitschr. f. klin. Medicin. 1882. Bd. iv.. p. 605.

8Oser: "Die Neuroseu des Magens," Wien und Leipzig, 1885.

Neurotic Gastralgia

Gastralgia often occurs as one of the symptoms of either hysteria or neurasthenia. Both conditions are characterized by the peculiar symptoms which, if present in a sufficient number, will make the diagnosis easy. Sometimes, however, the gastralgia may exist for a long time as the only symptom of either neurasthenia or hysteria. It is then more difficult to recognize the real nature of the trouble.