On the shoulder-tip pain, and other sympathetic pains, in diseases of the liver / by D. Embleton.
- Dennis Embleton
- Date:
- 1870
Licence: Public Domain Mark
Credit: On the shoulder-tip pain, and other sympathetic pains, in diseases of the liver / by D. Embleton. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![Dr. Murchison* notices the pain under the heads of conges- tion and of cancer, and gives a case of hydatids of the liver implicating the right side of the chest in which the same symptom occurred. Dr. Aitkeii-f and Dr. Tanner;]; both mention the pain. The occurrence, then, of this pain in the top of the .shoulder, scapula, clavicle, arm, or side of the neck—in one or more of these parts, and in connection with intlaramation, ab.scess, near both the convex and the concave surfaces, cancer, and hydatids of the liver, and with the ptissage of gall-stones, has been well ascertained, both in ancient and modern times ; and although not always present, it is sufficiently often so, and then frequently so severe, as to arrest the attention of patient and of physician. It is, thei'efore, of sufficient importance to demand a serious investigation, and a proper explanation, if such can be found, the more so as there appears to be a prevalent feeling that its occurrence has not as yet received a .satisfactory elucidation. The explanations of this pain that I have seen are these :— 1. AretiBus,|| in treating of acute and of chronic affections about the liver, says, that in abscess, a sharp pain is felt in ♦ Clinical Lectures on Diseases of the Liver. &c., 1868. p. 121. Congestion.—“The pain and feeling of uneasiness may stretch up to the right shoulder ” p. 11)0. Cancer.—“ A cancerous liver is almost always painful and tender on pressure, and very often the pain radiates to the shoulder, back, :ind loins.” p. 196. Case of Cancer of Liver and Ovary. — “ Sudden jiaiu in epigastrium, and right hyjMx;hoiidrium, and both shoulders, accomjMiuied with great languor.” “ Liver greatly enlarged, and studded all over with cancer nodules ; its interior coiitained similar matter.” t Dr. Aitken relates that the most prominent sjTnptoms of hejiatitis are “ some tumefaction, pain, or uneasiness of the liver, or of the adjoining parts, as the thorax, abdomen, or right shoulder, &c. ; ” and again, “ frequent, settled, and increasing pains in the shoulder and back,” ai'e, with others, “ pathognomonic signs of suppurative inflammation going on in the liver.”—(The Science and Practice of Medicine, 3rd Edit., 1864, vol ii.„ pp. 815 and 816.) J Dr. Tanner tells us, “ it is well known, that in hepatic affections, the right collar bone and shoulder become the seats of gnawing and aching sympathetic pains ; while sometimes also (probably when the left lobe or the liver sutlers) pain is refeiTed to the left shoulder.” lie also quotes Annesley, who says, “ pain in the right shoulder is a sure indication tlmt the disease is in the right lobe.” Again, when treating of hepatic calculi, “ They may give rise to dull pains about the liver, sometimes shooting to the shoulder.”—(The Practice of Medicine, 6th Edit., 1869, vol. i., pp. 109 and 139.) II The Extant Works of Aretseus, by Adams, 1856. Chron. Dis. book i., chap, xiii., p. 319. Syd. Soc.](https://iiif.wellcomecollection.org/image/b22471911_0014.jp2/full/800%2C/0/default.jpg)
