332 SURGICAL APPLIED ANATOMY. [Chap. xvu. 



the lesion is to the stomach the graver, other things 

 being equal, are the nervous phenomena produced. 

 It would appear that some lesion of these nerve 

 plexuses is sometimes active in producing a remark- 

 able pigmentation of the skin. This is seen in 

 Addison's disease, a disease marked by a general 

 bronzing of the surface, and usually associated with 

 some disintegration of the suprarenal capsules. The 

 very direct relation of these bodies to the solar plexus 

 is well known. In pregnancy also, in abdominal 

 tuberculosis, in cancer of the stomach, and in liver 

 diseases, a pigmentation of the face is sometimes seen, 

 that may in such instances be probably ascribed to a 

 disturbance of the great abdominal nerve centres. 



In some diseases of the liver and stomach, " sympa- 

 thetic" pains are complained of between the shoulders 

 or about the inferior angles of the scapulse. These 

 parts are supplied with sensation by the fourth, 

 fifth, and sixth dorsal nerves. The great splanchnic 

 cord can probably explain the peculiar seat of these 

 pains, since it is connected on the one hand with the 

 plexuses that supply the stomach and liver, and on 

 the other hand with these very dorsal nerves that are 

 distributed about the lower interscapular space. Much 

 discussion has taken place as to the cause of the 

 " shoulder tip " pain often complained of in liver ail- 

 ments. Some imagine that the pain is conducted 

 along the hepatic plexus to the vagus, thence to the 

 spinal accessory, and so to the point of the shoulder. 

 Others trace it from the liver plexus to the 

 phrenic, thence to the third and fourth cervical nerves 

 (from whence the phrenic is in great part derived), 

 and finally to those branches of these cervical trunks 

 that go to the shoulder tip (the acromial branches). 



There would seem to be but little connection 

 between a disease in the sigmoid flexure and a pain in 

 the knee, yet in cases of cancer of the flexure, and in 



