The Gulstonian Lectures, on Neuroses of the Viscera
Authors: T. C. Allbutt
Journal: BMJ (1884)

gastrlgia, sharpest arrows in the armoury of pain, many d'ismissed with a few words as a miialady of " hysterical women;" women, that is, wxhose sufferings are due in part lhabits and constitution, anld in part to a kind of which prompts them to cherish or to imagine pain, or to bitter cry about matters.oulght kniow that gastralgia is common enough in man also, though writers appear to deny that this or any other visceral neurosis exist where no uterus is; and in my first have endeavoured to formulate a distinction between what I may the upper class of neurotics and their degenerate relations the hysterics ; asserting therein that, in hysterics, pain is not a more but a less iniheritance, and that to neurotics it is chiefly given to suffer psins and the renewal of pain, and to bear all with singular and spirit.As such a zealous neurotic the Sompnour posed describedl himself thius: I am litel sustenance, slpirit hati, hisfostring in the Bible, My bodly ay redy and so penible waken, my stonmk is destroled." of the stomachl gastralgia is the clhief ; but around gather, in mnore close association, flatulence, vomiiting, hyper- .Tsthesia, anld iniscries sulch as (listensioni, sinkings, cravings or loath- ings food, antd these may exist in various associations, or may exist singly.angina pectoris andl the pseudo-angina, so in gastralgia, the spinal nerves may be included in the paroxysms, or may take even a chief part in them, visceral andl overlyinig spinal nerves being grouped in function and in suffering together.In order to study tlls class of cases carefully, I have gone over the case-books of my chamber- consultations tenl years past, niamely, from the year 1874 to the year 1883, inclusive.From them I have extracted 139 cases of gastric andl neuralgia.These cases remain after eliminatiiig all doubtful or comparatively trivial in degree ; all cases attended with important uterine disorder, or coinplicated with substantial defect any organ whatsoever, or with disease; all hysterical cases, and all cases fretful or whimsical persons pronie to expand or to exaggerate symptoms.selected cases, then, are the cases of persons of whom 1have some tolerable notes, who were sti-aig.ltforwardand truthful, are, or were, the subjects of neurotic or neuralgic affectioins lying under the diaphragm an(l above the pelvis.Now, the great majority these cases are gastralgics, the region of the stomach beinig by very far the commonest seat of abdominal neuralgia.Of the gas- tralgics majority are women, in tho ratio of two to one.In men and women gastralgia is by no mecans confined to middle life, as Leared supposed, but is found at all ages, from 14 to 60, being most common between 20 and 45.Like migraine it tends to die out in middle life; and, like migraine again, it is attended less and less with vomiting age increases.Gastralgia coiiies on earlier in woman than in man, apparentlyby some ten years.A gastralgic man is rarcbefore twenties; girls often begin in their teens.earlier maturit of the girl suifficiently explains this difference, which is also remarkable, though I think in less degree, in migraine.Migraine may, however, begin at very early ages in either sex.Of associated affections migraine is by far the commonest; and, if we associate migraine and neuralgia of the head and face together, the number of