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. Copland* in his deservedly celebrnted Dictionary of Medicine, under the head of hepatitis shows his familiar acquaintance with the pain in question. The pain is noticed by Sir Thomas Watson f as occurring in the clavicle and shoulder, not only of the right side, when the right lobe of the liver is diseased, but also of the left side when the left lobe is affected, thus exactly agreeing with what Hunter, as already quoted, says with regard to the pain after gun shot wounds. Dr. Budd:|: has had his attention pointedly arrested by this ♦ Diction, of Med. vol. ii., p. 733.—“ It (the pain) is sometimes referred to the top of the right shoulder, frequently to the right shoulder blade, occasionally to both scapulse. In a few instances, it is felt in the right chavicle and side of the neck. It more rarely affects the left slioulder and shoulder blade only. When j)ain is present at the top of the right sho\ildcr, it indicates disease of the right lobe of the liver ; but this symptom is often absent.” p. 734.—“ When the outer surface and pai’t of the right lobe is chiefly affected, the jjain is most severe in the right hypochoudrium, and at the margins of the ribs, sometimes extending to the right scapula and top of the shoulder. When the concave suiface is the seat of disease, sometimes the pain extends to the right shoulder, and right side of the neck.” Tlie saiqe testimony is given at p. 766, under “ Organic Lesions of the Liver.” t “ The pain sometimes extends to the right clavicle, and to the top of the light shoulder. The existence of this pain makes it probable that the inflammation afiects the convex surface of the right lobe of the liver. Occasionally, the left shoulder is painful ; the left lobe of the liver being involved in the disease.”—(Lectures on Principles and Practice of Physic, 4th Edit., vol. ii., p. 587.) I “ The |iaiu of the shouldei- is far less frequent in such cases (of abcess .of the liver) than is generally imagined, but it existed in flve of the fifteen cases I had to treat at the Dreadnought. In one of these there w;is a small abscess on the convex surface of the right lobe, and the jieritoueum cover- ing the abscess adhered for the space of a shilling to the reflected layer of of the ]ieritoueum. There were old adhesions of the lung to the pleura costalis. The Imigs were sound. “ In another, in which the abscess was on the convex surface of the liver, and formed a prominent tumour, the pain of the shoulder was so severe as to cause the patient to moan. It continued extremely severe for a long time, and at length was relieved on our 0{>ening the abbess.” In a third case, where the abscess likewise formed a prominent tumour, the ixitient complained of an aching jiain in the right snoulder, extending to the shoulder-blade, and up the right side of the neck. In a fourth, pain in the shoulder varied in intensity with j)aiu in the right side. When the side was easy the shoulder was easy also The two pains were evidently related. In this case there were live or six abscesses of various sizes in the liver—one ojjened into the lung ; another wiis on the convex surface of the right lobe. In the fifth case, the abscess was single, and was likewise situated on the convex surface of the right lolje. There was no recent inflammation of the lung or pleui'a. The pain is iisuaUy described as a gixawing, aching pain. There is no swelling or redness of the shoulder, and the pain is not much incieased by](https://iiif.wellcomecollection.org/image/b22471911_0011.jp2/full/800%2C/0/default.jpg)
