less acute during inspiration than during expiration; hence an indication to draw long and full breaths at the beginning of a headache. In attacks of moderate severity, a walk in the cool pure air, having the neck lightly dressed and the superficial veins free from compression, may distribute the blood from the brain, and, with further exercise, may re-establish the equilibrium of the circulation when no mechanical lesion exists.

7. NEURALGIA CELIACA.-NEURALGIA OF THE CELIAC OR ABDOMINAL

NERVES.

GENERAL REMARKS.-It was first fully described by Autenrieth. After precursory premonitions, slight pains, gradually becoming better defined; the patient feels for some minutes, or even hours, an apprehension of an impending paroxysm. Suddenly he is seized with a violent pain in the pit of the stomach; this is burning, gnawing, tearing, stitching, aching as if a hot coal were lodged there, or as if the flesh were being forcibly torn. After lasting for a few minutes or a half hour, with such severity as to excite perfect phrenzy or fainting, the pain shifts its seat, shooting upward under the sternum towards the neck like a flame; or, dividing into two currents, which follow the course of the sympathetic nerve, ascend to the neck on both sides of the spine; otherwise the pain suddenly branches off in different directions, "particularly towards the hypochondria, following the course of the plexus lienalis and hepaticus. As the paroxysm subsides in severity, partial relief is accompanied by eructations and accumulations of water in the mouth. These symptoms are followed by a feeling of emptiness in the abdomen; languor and lassitude of the whole body; the tongue remaining clean, the appetite and digestion good. The paroxysms recur at various intervals, sometimes every day, seldom oftener, more frequently at night, and in changeable weather, as in spring or autumn. (Hartmann, iv. p. 48.)

CAUSES.-Hereditary abdominal weakness, sedentary life, suppression, or imperfect appearance of hæmorrhoids, itch, or mismanaged gonorrhoea. We have seen several cases in which similar paroxysms to that above described formed the prominent feature of intermittent fever.

TREATMENT.-Belladonna and Aconite alternately, every half hour, sometimes afford prompt relief. Should these medicines disappoint us, we may resort to any of the following: Nux-vomica, Nux-moschata, Arsenicum, Stibium, Colocynth, Pulsatilla, Mercurius-corrosivus, Colchicum, Cocculus, Helleborus-nig.

Nux-vomica.-Sanguine, bilious temperament; subject to hæmorrhoids; pain of true neuralgic character, excessively severe; seden

tary life; mind much occupied by literary pursuits; pain begins in the morning, and a heavy sleep follows the paroxysm, which ends in general exhaustion; pain relieved by lying down. It is tearing, stitching, hard aching; gastric symptoms, as eructations, pyrosis, &c., following the paroxysm.

Arsenicum.-Nervous melancholy temperament; the pain causing swooning; the paroxysms begin about midnight, and rouse the patient from sound sleep; relieved by walking about; pain of burning character; anguish extreme; nervous symptoms following the paroxysm.

Sabadilla.-Burning pain at the pit of the stomach, flashing upwards in the chest towards the throat; intolerable oppression of the breathing, threatening suffocation immediately upon waking; constrictive sensation deep in the fauces; eructations and emptiness of the abdomen, general languor after the paroxysm.

Cicuta-virosa. In nervous irritable females; burning-stitching throbbing pain in the pit of the stomach, with spasmodic and ungov ernable hiccough.

Aconite in all neuralgias, with general nervous irritation and hys. teria.

8. CARDIALGIA.

1. Idiopathic Cardialgia.-This is a primary affection of the stomach without general fever or much constitutional disturbance. A predisposition to it may be hereditary; it is most common among females possessing irritable nerves, who are feeble, hysterical or chlorotic, much disposed to spasms at the menstrual periods, or about the time of life when they are about to disappear.

Cardialgia, as we have seen, is usually a symptom of dyspepsia, although writers have classed it as a distinct malady, having no necessary connection with this disorder. The intimate relation between the nerves and membranes of the stomach and liver, and those which their functions sustain towards each other, incline us to the opinion that derangement of either of these parts of the organism must involve, to a greater or less extent, each of the others. The seat of cardialgia .s in the nerves of the stomach; and as the healthy tone of the mucous membrane, &c., is dependent upon the normal integrity of the nerves which supply this organ, their mutual dependence will be readily perceived.

DIAGNOSIS.-Pinching, gnawing, and cramp-like pains in the stomach often extending into the back and loins, relieved on pressure of the epigastrium, or when the abdominal muscles are relaxed, faintness, anxiety; appetite natural, or but slightly impaired, pulse natural, food may be taken into the stomach with impunity; pains of a more

severe character than those which occur in chronic gastritis, although there is no feeling of heat or thirst.

CAUSES. Abuse of cathartics; highly seasoned and indigestible food; food kept too long after being cooked; soured food, sour wine, beer, fruit, fat meats, pastry, &c.; abuse of stimulants, as coffee, tobacco, irregularity in eating; suppression of cutaneous eruptions, foot sweats, or habitual discharges of blood; sudden emotions; mental anxiety; exposure to cold when the body is heated; in the most unmanageable cases there is organic disease of the stomach.

PATHOLOGY.-This disorder has been supposed to be dependent on an abnormal condition and disturbed function of the sympathetic and par vagum; upon perforating ulcer of the stomach; commencing schirrhus; an altered condition of the coats of the organ; and upon disease of the pancreas, with which we are at present but imperfectly acquainted. None of these opinions have been established as generally true. Dr. Meyer says he has "most strictly examined each case of cardialgia." In only a few of the cases was he satisfied of the pathology. "Certainly, when there has been an induration in the epigastrium, with the characteristic vomiting, the constitutional affection and the external appearance, I have ascribed the disease to the carcinomatous diathesis; and to an ulcer of the stomach, when there has been frequently recurring vomiting of blood." In twenty-five cases treated at the Polyklinik, at Leipzig, "there was only one in which existed considerable enlargement of the liver." In the rest he "could not discover any organic change, and was, therefore, justified in considering the gastralgia as a primary disorder."

TREATMENT.-Nux-vomica.-This is the counterpart of the above train of symptoms. The patient has been long dyspeptic, is sometimes hungry without appetite, and is at the same time disgusted at the sight of food; has a distaste for his favorite coffee, increase of thirst; the tongue covered with a whitish mucus, bad taste, putrid or sour; after eating, a swollen state of the stomach, with occasional pain on pressure; when he has putrid taste and sour eructations after eating; nausea early in the morning when fasting; frequent retching; stools hard, and not as usual daily; sleep disturbed by nightmare; when he complains, occasionally, of a pressing aching pain in the forehead, on awaking in the night, when he is of a depressed or excitable humor, without any remarkable decrease of strength; Nux hardly ever fails in these cases, though it often makes a slow "symptomatic process, especially noticeable in drunkards. Often, in cases of constipation, says Meyer, "I have seen the greatest benefit from Nux-vom. 30°, when the first and second had failed.

*

* Dr. V. Meyer, Wissenschaftlicher Bericht der hom. Poliklinik zu Leipzig, 1857

Nux-vomica is appropriate for cardialgia caused by abuse of coffee or by suppressed eruptions, even if of several years' standing; the cardialgia of drunkards, which is only partially relieved by vomiting; heartburn, and hysteric cardialgia, or that caused by the use of coffee or chamomile tea.

Symptoms by which it is indicated.-Contraction, pressure, cramp, griping or spasm of the stomach, feeling of oppression from the pressure of clothing; pain from flatulence retained by spasmodic contrac tion of the stomach or duodenum, increased by taking coffee or food; oppression and constriction of the chest, spreading to the spine, between the shoulders or small of the back, and feeling like a band drawn round the chest. Pains early in the morning, rousing the patient from sleep; nausea during the attack; accumulation of water in the mouth; eructation of sour or bitter fluid; vomiting of partially di gested food, or ineffectual retchings, with burning cardialgia; palpita tion of the heart; anxiety; sour, putrid taste in the mouth; constipation; flatulent distention of the abdomen; hemicrania; sick headache; cardialgia, beginning in females at the time of too profuse menstruation. (Hartmann, &c.)

Chamomilla.-Cardialgia in persons of irritable nerves, easily excited by anger; pain in the pit of the stomach, or under the short ribs, as if a stone were there; pain attended by shortness of breath and anxiety; worse at night, causing loss of sleep and great distress pain in the top of the head; partial relief from rising from bed, from sleep, by bending double, or from drinking coffee when the pain has no been caused by it. When the cardialgia has been caused by drinking chamomile tea, Ignatia, Pulsatilla, and Coffea.

Pulsatilla.-Absence of thirst; complete loss of appetite, combined with aversion to flesh-meat, and longing for sour things; the bitter taste not constantly present, but depends much upon the kind of food and the occasionally occurring eructation, with, at times, risings up in the mouth. When, further, the white or yellow coating of the tongue is adhesive and difficult to remove, the region of the stomach is not distended, the patient only complaining of an uncomfortable feeling, when there is neither nausea nor retching, but shivering after each meal, especially towards evening, the patient feeling worse at that time.

Aconite. In most cases, says Hempel, cardialgia is a simple state of venous congestion, which yields to Aconite and the application of warm flannel to the stomach.

Bryonia.-The taste is more insipid, the tongue presents only a slight coating. The prominent symptom is dryness of the mouth, either constant or occurring shortly after eating, without much thirst, unless for cold drinks. Appetite deficient, not entirely wanting; eructations

often cause the remains of the food to rise into the mouth; pain, pressure, and shooting in the stomach present only in a slight degree, but increased by motion; bowels generally constipated; general health tolerable, disposition not much changed; when there is headache it is generally one-sided.

Phosphorus.-"Gastritis complicated with heartburn, which, after it had ceased, annoyed the patient with an invincible scratching in the throat. It is especially useful when there is "loss of appetite, accompanied with a feeling of emptiness and want, together with an impossibility of eructating, apparently seated at the orifice of the stomach, with tendency to diarrhoea.

China.-Healthy appetite always absent; the patient can, nevertheless, eat on making an effort, though quickly satisfied. When there is appetite, it is capricious. Notwithstanding the absence of any desire for food the tongue is clean, the taste normal, or sometimes bitterish. There is an uncomfortable feeling after eating, without any assignable cause. This uneasy feeling is somewhat relieved by eructations, with the taste of food taken. Pain in the stomach not present, though in rare cases there was a feeling of coldness, a symptom common to China and Berberis. Debility is peculiar to China.

Belladonna.-Cardialgia in females of irritable nerves; gnawing pressure, spasmodic tensive pain in the pit and region of the stomach, inducing loss of consciousness or fainting, (hysterical,) usually connected with wind in the stomach, torpid state of the bowels; sleeplessness and increased thirst, which aggravate the pain.

ANTI-PSORIC TREATMENT.-Carbo-vegetabilis-Burning sensation in the stomach; painful pressure in the stomach, with anxiety, aggravated by contact; contractive spasmodic sensation in the stomach, obliging the patient to bend double, arresting the breathing, heartburn, nausea, loathing of food, constipation; feeling worse when lying down.

Carbo-animalis.-Fullness, malaise, and coldness of the stomach after a slight meal, relieved by laying the hand upon the stomach. A state of debility of the stomach, in which everything eaten gives distress.

Nitrum.-Burning pain in the stomach, with violent stitches, continuing after the paroxsym is over; or feeling as if ice were in the stomach; externally painful to the touch.

Calcar.-carbonica.-Weak digestion; cutting, compressing, spasmodic, pinching or choking pains, with great anxiety.

Graphites.--Weak digestion; wrenching and griping in the stomach, relieved by eating; accompanied with nausea and accumulation of water in the mouth.

Nitric-acid.-Cardialgia with diarrhoea, or following syphilis,

VOL. 1.-33.