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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![John Hunter* * * § in his Essay on Gun Shot Wounds, published in 1794, says“ From a wound in the liver there will be pain in the part, of the sickly or depressing kind; and if it is in the right lobe, there will be a delusive pain in the right shoulder, or in the left shoulder from a wound in the left lube.” The same illustrious Physiolo£,dst and Surgeon, in his Lectures on the Principles of Surgery, chap, x.. On Sym- pathy,*f in which he treats copiously of the various kinds of natural and diseased sympathy, mentions more than once the shoulder pain in liver disease. He says, however, very truly, that the sympathy is not reciprocal, that “the liver never sympathises with the shoulder.” Abercrombie I also mentions the shoulder pain as occuiring in acute and chronic inllammation, and in “ Encephaloid RamoUissement ” of the liver. Annesleyll as well, as having been often observed in hepatitis and abscess of the liver, and he believed that the pain indicated with certainty that the convex portion of the right lobe was diseased. W. Thomson § names it as being by some considered as peculiar to hepatitis, but shows that it had been observed also in cases of passing gall stones, and points out the fact that it had never been properly explained. * The works of John Hunter, F.R.S., by James F. Palmer, 1837, voL 3, p. 560. t Jbid, vol. 1, p. 317. X Acute Injlam.—“There is generally fever, but this is often in a slight dem'ee ; there is sometimes jaundice, but this is often entirely wanting ; and, frequently, there is pain extending to the right shoulder, but this is by no means a uniform .sym])tom.”—(Pathol, and Pract. Itesearches on Dis. of Stom., Intestinal Canal, Liver, &c., p. 347, 2nd Edit., Edinb. 1830). Chronic Infiam.—“ There is generally a feeling of distension and oppres- sion in the e])iga.strium and riglit hypochondrium, often vomiting, and pain or a dragging sensation refeired to the right shoulder.”—Ibid, p. 365. Encephtd. Ravioli.—Pain of right shoulder is a symptom.—Ibid, p. 362. II Sketches of Diseases of India, &c., 1831. § Tweedie’s Library of Medicine, vol. i\'., p. 178, no date, but last vol. of series, 1842.—“It is well known that in hepatic affections, the i-ight shoulder is frequently the seat of spnjmthetic ])ain ; a fact of which no satisfactory explanation has yet been proposed ; nor is it well ascertained what are the affections of the biliary organs in which it occurs. Its fre- quent occuiTence in hepatites has led to the idea of its being a pathogno- monic symptom of this disease. It is, however, far from being uniformly 1)resent in this affection, although when it does occur in a case resembling lepatitis in other resjjects, it may be considered conclusive of the nature of the disease. But though hepatitis may be the affection in which this symptom is most commonly observed, it does not follow that it is exclu- sively confined to it ; most authors concur in stating that it also accom- panies the passage of gaU stones through the gall ducts.”](https://iiif.wellcomecollection.org/image/b22471911_0010.jp2/full/800%2C/0/default.jpg)
