The Anticipation of Post-Partum Haemorrhage
BMJ (Clinical Research Edition)
The pain, however, may be reasonably expected to be occasionally present, in acute and painful diseases of this organ, in one or the other shoulder. As the "head ' of the pancreas is the part most commonly diseased, either the right or left vagus may be affected, according to the lobe attacked; or both nerves, if both lobes suffer. There is confessedly no group of symptoms that can be relied upon as pathognomonic of pancreatic disease pure and simple. I have consulted all the authors within my
... authors within my reach to see if any had noticed the shoulder pain as one feature of the group. The usual account goes to show that the pain is seated in the gland itself, and radiates or extends to the spine, the wall of the chest-often on the right side, and running up as far as the lower part of the shoulder-radiations doubtless along the course of the nerves of the organ back to the solar plexus, and thence to the splanchnic and intercostal nerves, and to the spine. The only authors who, to my knowledge, distinctly mention the shoulder pain in these diseases, are Dr. J. R. \Vardell and Dr. G. Andral. The former, in the third volume of Reynolds's System ofM1edicine, states that, of inflammation of the pancreas, "the cardinal symptoms are a dull, heavy, aching pain, deep down below the centre of the epigastric region, which radiates through to the back, left shoulder, and left lumbar space, simulating the pain experienced in renal calculus." But this pain of the shoulder is not said to be in the top of the shoulder. The pain in pancreatic, as in liver diseases, may perhaps be more frequently discovered on a more attentive and minute examination of the cases as they occur. I cannot say that I have myself had occasion to notice its presence. In splenic diseases, however, the pain is often present.