Synonyms.—Gastrodynia; Cardialgia.

Definition.—A sudden intense pain, situated in the epigastric region, without sufficient gastric lesions to account for it, and due, no doubt, to irritation of the filaments of the gastric nerve.

Etiology.—The causes giving rise to gastralgia are numerous. In all cases, however, the pain follows either the direct or reflex irritation of the gastric filaments of the pneumogastric nerve. In some it is a secondary reflex, as where the irritation is at a distant part, as the reproductive apparatus, or rectal or urethral irritation. In locomotor ataxia we have an example of pneumogastric irritation followed by attacks of gastric pain. It may be due to local causes, as hypersecretion, or hyperacidity of hydrochloric acid. It may also be attributed to that vague condition, neuralgia, that is made to answer for so many unknown causes, or that equally abused condition, rheumatism.

The distinct periodicity manifested in some cases would suggest malaria as a cause, as it yields to antiperiodic treatment. The excessive use of tobacco and whisky may also be mentioned while coffee and tea drinkers often suffer in the same way. Deep grief, mental strain, or sudden and severe shock to the nervous system, also give rise to it. It is more frequently seen in nervous, hysterical women, especially about the menopause. Men, however, are not exempt.

Symptoms.—Although due to a variety of causes, the symptoms are quite uniform and characteristic. The attack comes on suddenly, the paroxysms lasting from a few minutes to an hour or more, and consists of a burning, lancinating, or boring pain in the epigastric region, passing through to the back and around the ribs; or it may extend upward over the sternal region, passing to the arms.

The attack may be preceded by anorexia, nausea, and vomiting, though usually not, for it is almost always independent of the taking of food. Eating, however, sometimes relieves the suffering. Firm pressure usually affords some relief, though deep pressure may add to the suffering. The attack passing off, the patient may seem no worse for the seizure, unless the paroxysm be of long duration and excruciating in character, when he seems greatly exhausted. The attack frequently terminates with eructations of gas, and rarely by vomiting.

Diagnosis.—The history of previous attacks, the absence of local disease, the sudden onset, and the paroxysm, render most cases easily diagnosed. The variety of causes that give rise to it, however, will render some cases more obscure, and require careful examination to reveal their character.

Prognosis.—This will depend entirely upon our ability in removing the cause. The disease of itself is not dangerous.

Treatment.—This will be twofold; first, to afford relief to the paroxysms of pain; second, to effect a cure by relieving the conditions which give rise to the lesion.

The first will be accomplished, where the suffering is agonizing, by a hypodermic injection of morphia, one-fourth grain, or chlorodyne, one teaspoonful to nine teaspoonfuls of water; of this a teaspoonful may be given every fifteen minutes till three doses are given, then at longer intervals, depending, of course, upon the character of the pain. The old compound tincture of cajeput, in thirty-drop doses, is also very efficient. Where the pain extends to the abdomen, and there is tenderness on pressure, dioscorea will be the remedy.

Locally, a mustard-plaster over the seat of the pain answers a good purpose, though a few drops of chloroform on a cloth, and held over the affected part, will give much quicker relief; in fact, its effects are almost instantaneous.

Where there is gaseous distention, colocynth, ten drops; compound spirits of lavender, two drams; water, four ounces—a tea-spoonful every five, ten, or twenty minutes—will soon start the patient to belching, which gives relief to the exquisite pain.

For a permanent cure, the case will need careful study, determining in each case the cause of the attack. If due to malaria, as will be seen by the distinct periodicity, quinia, gelsemium, arsenicum, etc., will be the treatment. If from menstrual derangements, cimicifuga, viburnum, and pulsatilla will be the better remedies. If due to stenosis of the uterine cervix, dilatation will afford relief; or if endometritis be present, a thorough curetting will either cure the gastralgia or place the patient in condition where medication will be beneficial. Of course, a lacerated cervix will need repairing, and a urethral stricture will have to be corrected, while hemorrhoids, pockets, fissures, papillae, ulcers, and fistulas will need to be removed.

If the patient is of a rheumatic diathesis, we would give such remedies as bryonia, rhus tox., cimicifuga, apocynum, phytolacca, and rhamnus californica, as symptoms calling for these various remedies would indicate. Thus muscular soreness would suggest cimicifuga; sharp lancinating pain, bryonia; sharp stroke of pulse, with irritability, rhus tox.; edema of eyelids or puffiness of feet, apocynum: while rhamnus californica will be useful where constipation is marked.

Some patients will need to be placed on a spare diet, while others will be compelled to abstain from tea and coffee. Tobacco and whisky will have to be given up, if the gastralgia be due to this cause. Galvanism is of marked benefit in some cases, the positive pole being placed over the epigastrium, while the negative pole is over the lumbar spine.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.