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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![hence the pains in the walls of the chest, the loin, hip, and thigh. The diaphrngm will suffer, more or less, owing to its contact with the inflamed organ, and through the irritation carried to it along the phi*enic twigs of the liver, and so the influence may pass up the trunk of the phrenic nerve to the brachial, and even the cervical plexus, and thus the subclavius nerve and others be affected, which may account for pain about the clavicle, and partly for that in the side of the neck, and even in the arm. But, it is not difficult to conceive that the inflammation, or irritation, will travel at least as readily along the nerves of the pueumogastric system as along those of the sympathetic or spinal systems, and that it will ea.sily be projiagated to the trunk of the vagus on the oesophagus from the gastro-hepatic branches, and pass up the chest; and if the hypothesis of the right vagus going to the right lobe of the liver be correct, then, in the ca.se of the hepatitis and abscess being in the right lobe, the right vagus trunk wdll suffer more than the left, the nerve iiritation running up higher and higher, till the Ciirdiac, pulmonary, laryngeal, and pharyngeal nerves are reached, and eventually the base of the skull and the side of the medulla oblongatii, and si)inal cord, whence the par vagum and spinal accessory take their origin. Hence, w'e might expect, and do actually find, pain running up the inside of the chest, dyspnoea, and cough, palpitation of the heart, throat affections and thirst, cephalalgia, vertigo, &c. Again, we know that the internal division of the spinal accessory forms a part of the trunk of the vagus in the chest and in the neck, and that, under the base of the skull it has intimate connections wdth the external division, and this again with the pneumogastric. The suj)po.scd inflammation, therefore, or irritation, is propagated along this lateral com- munication also, as far {is the teiTninations of the external division of the spinal accessory in the sterno-cleido-mastoid and in the trapezius muscles, wdiere, particuhirly in the latter ; situation, it is felt as active pain, or merely as tenderness on ; pressure. It is worthy of reiteration, tlmt the pains and other ' disturbances in the organs and ])arts named, are precisely those which we meet with in liver diseases that are not latent. • The shoulder pain varies with the affection of the liver in ■: intensity : as the latter increases, the pain corresponds ; as it ' diminishes, the pain subsides. After the pus of an iibscess has ’ been evatamtcd, and tension is removed, the shoulder-pain ^ les.sens or disappears.](https://iiif.wellcomecollection.org/image/b22471911_0025.jp2/full/800%2C/0/default.jpg)
