The pain is usually of an intense, boring character, and does not dart like the pain of superficial neuralgia, but is either constant or comes in waves, which swell steadily to a maximum and then die away, often leaving the patient in a state of profound temporary prostration.
Deep pressure often brings relief. A patient of the writer, who is subject to attacks of this kind in the right hypochondrium, will bear with her whole weight on some hard object as each paroxysm comes on, or insist that some one shall press with his fists into the painful neighborhood with such force that the skin is often found bruised and discolored.
The functions and secretions of the visceral organs are apt to be greatly disordered during a neuralgic attack, and it is often difficult or impossible to tell with certainty which of these conditions was the parent of the other. Undoubtedly, either sequence may occur, but the pain excited by disorder of function, or even organic disease of any organ, is not necessarily felt in that immediate neighborhood. Thus I have known the inflammation around an appendix cæci, of which the patient shortly afterward died, to cause so intense a pain near the edge of the ribs that the passage of gall-stones or renal calculus was at first suspected.
There seems to be as much variation as to modes of onset and duration among the visceralgias as among the superficial neuralgias, but the tendency to short typical attacks of frequent recurrence seems to be greater with the former.
The visceral neuralgias are quite closely enough related to certain of the superficial neuralgias to show that they belong in the same general category. The two affections are often seen in the same person, and not infrequently at the same time or in immediate succession. Thus in the case of the patient just alluded to above, the attacks of deep-seated neuralgia in the neighborhood of the right flank are at times immediately preceded by severe neuralgia of the face or head. Similarly, intercostal neuralgia may occur in immediate connection with neuralgias of the cardiac or gastric nerves.
The phenomenon of tender points is not entirely wanting in the visceralgias, though less constant and definite than in the superficial neuralgias.
The liver and the uterus especially become the seat of more or less localized tenderness, and possibly the tenderness in the ovarian region which is so common, and so often unattended by real inflammation, is, in part, of this order.
The secondary results of the visceralgias are not easy to study. Besides the disorders of secretion and function above alluded to, swelling of the liver with jaundice and paresis of the muscular walls of the hollow viscera may be mentioned as having been ascribed to neuralgia.
It is not known to what degree neuritis occurs as a cause or complication of these neuralgias, and this is a question which is greatly in need of further study.