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Herbert Savel, M.D.
JAMA. 1960;174(17):2162. doi:10.1001/jama.1960.03030170052023.
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To the Editor:—  The occurrence of shoulder pain with upper abdominal inflammation has aroused interest in its basic physiology and clinical significance. The earlier contributions are interesting.In 1880 John Hilton suggested that irritation of the phrenic nerve might cause pain in the shoulder. However, it was Kehr, writing in German around the turn of the century, as quoted by H. Bailey, to whom credit was given for first describing pain felt in the region of the left shoulder in cases of ruptured spleen. Cope (Lancet1:415, 1922) stated in his lecture before the Royal College of Surgeons in 1922 that "shoulder-pain due to intra-abdominal disease is always due to irritation of the peritoneum..." Morley (Clin J44:617, 1925) reemphasized the importance of pain referred to the shoulder in numerous clinical conditions and called attention to its anatomic and physiologic basis. Later, F. J. Kalteyer pointed out that


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