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Download 1 File p~ Visceroptosis and its Treatment B.Sc., M.D. Senior Physician Prince of Wales's General Hospital; Physician Royal Hospital for Diseases of the Chest With Note on Chronic Intestinal Stasis from the Radiographic Aspect. By Alfred Jordan, M.D., Medical Radiographer to Guy’s Hospital and Royal Hospital for Diseases of the Chest From “ The Clinical Journal,” Wednesday, May /, 1912 152, HARLEY STREET, CAVENDISH SQUARE, W. 22nd January , 1913. Dear Sir, I am sending the enclosed monograph on ’’Visceroptosis” which you may like to put among the Library monographs. Yours faithfully. The Librarian. The Royal College of Surgeons Digitized by the Internet Archive in 2016 https://archive.org/details/b22463100 , , ; The Clinical Journal, May I, 1912. THE CLINICAIffOURNAL, CLINICAL RECORD, CLINICAL NEWS, CLINICAL GAZETTE, CLINICAL REPORTER. CLINICAL CHRONICLE, AND CLINICAL REVIEW. No. 1018. WEDNESDAY, MAY 1, 1912. Yol. XL. No. 4. CONTENTS. VISCEROPTOSIS AND ITS PAG* TREATMENT.* *Visceroptosis and its Treatment. By R. Murray Leslie, M.A., B.Sc., M.D. 49 By R. MURRAY LESLIE, M.A., B.Sc., M.D., Senior Physician Prince of Wales’s General Hospital Physician Royal Hospital for Diseases of the Chest. * Specially reported for the Clinical Journal. Revised by the Author. Visceroptosis, which may be defined as a “drop- ” ping of one or of the viscera, is ALL RIGHTS RBSERRED. more abdominal now becoming widely recognised as one of the commonest of all clinical conditions, although until recent years its significance has not been fully NOTICE. appreciated, while the importance of the sequelae upon which most of the symptomatic manifesta- correspondence hooks tions actually depend is only now beginning to be Editorial , for review , &“c., realised by a comparatively small section of the should be addressed to the Editor 36, Weymouth medical Street Telephone profession. , W. ; No., 904 Paddington ; but As far back as the great Pathologist all business conimunications should be addressed to 1853 Virchow described displacement of the intestines, the Publishers, 23, Bartholomew Close, London which he at that time ascribed to local peritonitis, E.C.; Telephone, 927 Holborn. and which appeared to be the cause of certain All inquiries respecting Advertisements should be forms of dyspepsia. It was not, however, until sent to Messrs. Adlard & Son, Bartholomew 1885 that Dr. Glenard,t of Vichy, gave the first Close, E.C. Telephone, 927 Holborn. more or less complete description of enteroptosis, and which therefore sometimes goes by the name Terms of Subscription, including postage, payable of Glenard’s disease. This observer reported no by cheque, postal or banker's order ( in advance ) : for less than 148 cases, and in most of them he the United Kingdom, 155. bd. per annum Abroad, ; associated the condition .vith a certain type of s. 6 d. 17 nervous dyspepsia. Recent writers prefer to use the term viscerop- Cheques, cry., should be made payable to The tosis or splanchnoptosis as the generic title, and Proprietors of The Clinical Journa l, crossed employ the terms gastroptosis, enteroptosis, colo- “ The Lotidon, City, and Midland Bank Ltd., , ptosis, nephroptosis, hepatoptosis or splenoptosis Newgate Street Branch, E.C. Account of the according as to whether the displacement entirely Medical Publishing Company, Ltd." or mainly affects the stomach, the bowel, the colon, the kidney, the liver or the spleen as the case may Reading Cases to hold Twenty-six Numbers of be. The Clinical Journal can be supplied at 2s. 3 d. Visceroptosis is such a common condition that each, or will be forwarded post free on receipt of probably at least one out of every three women 2S. 6 d. ; and also Cases for Binding Volumes at is. * each, A Lecture delivered at the Medical Graduates’ College or post free on receipt of is. 3d. from the and Polyclinic. Publishers, Bartholomew 23, Close, London E.C. 1 , t Glenard, Lyon Medicale,’ 1885. qo The Clinical Journal. J DR. MURRAY LESLIE. [ May 1, 1912. are affected with an appreciable degree of dis- Mr. Lane, indeed, states that in civilised countries placement of one or more organs, particularly the the erect or semi-erect posture is maintained during right kidney and intestine. Einhorn found the all one’s waking hours, for no less than sixteen or condition in no less than 33 per cent, of all his seventeen out of the twenty-four hours each day, female patients, the accuracy of which observation during the whole of which time there exists a con- has been confirmed by others. In the majority of stant tendency to the falling of the viscera in the cases dropping of one organ is associated more or abdomen. This is in sharp contra-distinction to less with dropping of other organs. As will be the habit of life among our primitive ancestors, who shown presently the mere dropping of the organs probably spent the greater part of the twenty-four is not of such significance as its pathological hours lying or squatting on the ground. In this sequelae. connection it is possible to imagine that the Causation. different obliquity of the pelvic brim in the female As regards causation, many authorities believe would partly account for the greater frequency of that the condition is frequently cojigenital. the condition among women, the pubic arch giving Glenard himself thought that the main cause was less support to the overlying viscera, particularly a constitutional weakness or looseness of the when taken in conjunction with the wearing by mesenteric and other peritoneal attachments. them of wrongly constructed corsets — which He laid great stress upon the frequent presence Einhorn believes to be an important causal factor, of a horizontal cord-like thickening which he took particularly when the corset exerts pressure on the to represent the contracted band of the transverse base of the thorax and upper part of the abdomen colon, and believed that the starting-point in —while the more lax condition of the abdominal visceroptosis was the dropping of the hepatic walls in women would offer less resistance to the flexure of the colon due to relaxation of the downward pressure. hepatocolic ligament. Keith was of opinion that the condition is often Landau, on the other hand, was of opinion that due to wrong method of respiration, and according the primary cause was a congenital weakness of the to him the contraction of the diaphragm, and parti- abdominal walls. cularly of its crura, is the important factor in A particular body type has been described—a producing downward displacement of the under- slender skeleton, a long attenuated thorax, with lying organs. sometimes a floating tenth rib, soft, flabby An argument in favour of the frequent presence abdominal muscles, and a defective development of some congenital defect lies in the observation of the panniculus adiposus. According to Dr. that young unmarried Swedish girls who have never Harris the main congenital abnormality is a marked worn corsets, and native women who wear no contraction of the base of the thorax. constrictive bands of any kind, and even quite Other observers, however, are equally emphatic young children in civilised countries, may have in stating that visceroptosis is more often an the condition quite well developed. acquired condition. Arbuthnot Lane and one or There is no doubt, however, that such condi- two other observers explain the abnormality from tions as stretching of muscles and relaxation of the standpoint of evolution. Quadrupeds do not ligaments due to repeated pregnancies, constricting appear to suffer from visceroptosis, and accordingly bands, wasting and asthenic diseases may all be it seems conceivable that the assumption of the important causal factors in individual cases. The erect posture by man may be directly responsible solid kidney and the habitually overloaded for the dropping of the viscera owing to the effect stomach and colon, as might be expected, are of gravity coming into play, and so causing the particularly prone to prolapse. The probability abdominal viscera to tend to fall from their own is that in a civilised community we often have to weight. The abdominal walls, particularly if lax do with both acquired and congenital causes. and flabby, are often unable to support this extra Among secondary contributing causes we may strain, while the constant drag on the visceral mention strains, as in lifting weights, emaciation attachments from early childhood onwards may with loss of fat and a general constitutional con- play a conspicuous part in producing the condition. dition of neurasthenia with muscular debility. The Clinical Journal. ] DR. MURRAY LESLIE. [May 1, 1912. 51 As regards age, the majority of cases occur abdomen empties the caecum and transverse colon, between twenty and fifty, though the condition has retains the kidneys and other viscera in position been found in quite young children. during the period of greatest strain, forces up the As regards sex, the condition is much more sigmoid, drags the rectum upwards and straightens common in women than in men. Glenard found it, so that the passing of faeces through the rectum floating kidney in 22 per cent, of his women is very materially facilitated. These physiological patients as compared with 2\ per cent, of his men facts should be brought before the notice of our patients, while the records of the Johns Hopkins sanitary engineers, who could easily give facilities Hospital showed that one out of every five women for the adoption of the natural squatting attitude, and one out of every fifty men had movable kidney, the present high seats being specially harmful in giving a proportion of ten to one. Meinert found the case of short men, women and children —a fact gastroptosis in no less than 80 per cent, of all his which is now sufficiently well recognised to make gynaecological patients, while Thompson found the provision of footstools in private lavatories an that this variety of six times frequency visceroptosis was more i accepted necessity.
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