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.
16/26 page 14
![neck, this sensitiveness appears to be continuous with that of the spinal accessory.* Pressure applied* upon one or both of these nerves will now and then give rise to an increase of ))ain in the shoulder, or to pain in the head, and upon the vagus will excite or increase pain in the liver. The above observations have been often repeated in the presence of clinical students and others at the Newcastle Infirmary, and are full of interest, as they seem to afford the real or chief clue to the difficulty of accounting for the shoulder-tip pain in (piestion. Before, however, concluding that this clue has really been found, it is necessary to trace the courses of the spinal accessory and of the ])ar vagum, their connections with each other, and their relations to the shoulder and the liver. On referring, tlierefore, to the best and most recent anato- mical works, in English, French, and German, that I have been able to consult, I find that all pretty well agree as to the connections of the par vagum and spinal accessory,—that they are more intimately connected with each otlier than cither of them is with the glosso-i>haryngeal, and that they have, in the foramen lacerum posterius, a common vascular network, from whicli the glosso-pharyngcal is excluded.*)*^ The course, distribution and otHce of the external division of the spinal accessory appear not to be in doubt. That the * As it has been matter of dispute whether or not the par vagum is sensitive to iiTitatiou or violence, the opposite views on this question are here appended. J>r. Carpenter, in his Human Physiology, 4th Edit., p 519, has the following passage, “ Now if this nerve e.xcites the motions of respiration, by its powerful action in jiroducing ssn»ition, we should e.xi)ect to tind its trunk endowed with consiilerable sensibility, which is mt the case; for all experimenters agi-ee in stating that when its trunk is pinched or pricked, tlie animal does not e.xhibit signs of ].ain nearly so acute, as wlien the trunks of the ordinary spinal nerve.s, or of the 6th pair, are subjected to similar treatment.” , . • i n i • i a On the otlier si<le, Dr. John Reid, in his Pliysiolomcal, Pathological, and Anatomical Researches, p. 193, states that “ Haller Briiiin, Dumas Dupiiy Mollinelli, lAlayo, .Majendi, Bracket, and himself, all concur in stating that the pinching, cutting, and even stretching of the iiervous yiigus in the neck, arcj in the majority of instances, attended by indications of seveie ®“ln Uie 'ordiiiary and healthy state of the body the vagus in the neck, as any one may satisfy himself, is usually not at all tender. Under oidinaiy deLees of pressure by the finger or thumb, no pain is ].roduced In aubuals whin the nerve is in icked, cut, or ligatured, great pain, as 1 know from experiment, is the immediate consequence. , i i t See Quaiu’s Anat., 7th Edit., pai-t in, p. 618, and plate, p. 019 ; also, Flower’s Plates of the Nerves.](https://iiif.wellcomecollection.org/image/b22471911_0018.jp2/full/800%2C/0/default.jpg)
