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.
25/26 page 23
![imply the presence of inflammation in the par vagum durmg life, and if there is any peculiar state of a nerve which, without being inflammatory, will produce pain, I confess my ignorance of its nature, though I cannot deny that such a state may exist. If the sympathy of the shoulder with the liver in its diseases consist in an inflammatory state of the nerves connecting these parts, as I believe its does, then the mystery which has so long hung over morbid sympathies is dissolved and disappears, and we get rid of an ancient incubus. With regard to the diagnostic value of the shoulder-tip pain in liver diseases: It has only attracted attention in cases in which it has been severe, but as has been previously remarked, it often exists when it does not amount to a jnomiuent symptom, and may be detected when the patient is questioned, and the shoulder and neck are examined by pressure, and as ))atients are un- acquainted with the knowledge of the track of the nerves, it is not easy for the observer to be deceived. It is a symptom corroborative of the others, and must be taken into account with them. In proportion to its severity, in hepatic disease, it indicates the amount of inflammatory action going on in the liver, and the extent of damage done to the structure of the organ ; it may, however, occur in disease of the corresponding lung, or of the corresponding wall of the stomach. W'e must then attend to and estimate the other symptoms present in the case before us. Full credit, how’ever, appears due to Hunter, Sir Thomas Watson, and other-s, who say tliat a right shoulder-tip pain indicates disease in the right lobe of the liver, and that a left shoulder-tip pain points to mischief in the left lobe, whilst if the pain be in both .shoulder-tips, both liver lobes are involved. The observations of some authors quoted, as Dr. Copland and Professor Andral, show that no faith can be placed in the assertion of Roche and others, that pain of the right shoulder- tip is clear evidence that the upper ajid not the lower surfac^e of the liver is the exact seat of disea.se, for in affections of the lower surface the very same sign is recorded.—See Copland and Andral loc. citat. It is highly probable, from what has been ])reviously stated, that the nerves are distributed .symmetrically according to the lobes, rather than according to the surfaces of the organ. In case.-; of calculi, impacted in the gall ducts, the shoulder- tip pain recorded has been that of the right side, but closer](https://iiif.wellcomecollection.org/image/b22471911_0027.jp2/full/800%2C/0/default.jpg)
