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The Modern Treatment of Gastro-Enteroptosis

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The Modern Treatment of Gastro-Enteroptosis 25, OF GASTRO-ENTEROPTOSIS TfE BRITISH JUNE 1932] TREATMENT [IMEDICAL JOURNAL 1163 In the more severe type of non-responsive case, an even IRRATIONAL EXPECTATIONS FROM RESULTS more elaborate form of vaccine treatment may be required This is the last cause of failure to be mentioned. Too as a preliminary measure-namely, the enmployment of a much in certain cases is expected of a mode of treatment, donor to provide an autogenous immune serum. A whole- the action of which must necessarily have definite limita- blood immune transfusion may be used as an alternative in tions. Vaccine therapy is not in any sense a " cure-all," specially debilitated cases with good immediate, though and even if there are conlditions in which it may be more temporary, results, and may be followed up by the sensi- or less successfully employed as a non-specific agent in tized vaccine similarly obtained. protein shock therapy its essential sphere is that of a The other and commoner group of non-reactive and specific immunizing agent against specific infections. non-responsive cases does not show these grave signs of If a presumed infective debility, but is condition proves, on investiga- apparently impervious to any effect what- tion, to be one of metabolic derangement, and the in- ever of ordinary full doses of vaccine. Such a condition fector is only one of is often found secondary although perhaps con- in cases with marked furunculosis and other tributory importance, vaccine treatment of this must not conditions of local infection, less frequently in chronic be if catarrhal and blamed failure to correct the primary non-infective rheumatic conditions. The usual vaccine condition results. In most chronic infections it is at doses are inadequate, and will be written down as a failure unless doses of much times more important to treat the associated and resultant greater amount than usual are derangements of tissue metabolism than to concentrate employed. For instance, in certain cases of furunculosis which solely upon the infection itself, and, unless vaccine treat- have been abandoned as failures, completely satis- ment is combined with factory results have been other remedial measures, it can- obtained when the dosage has not be expected to produce the result or improvement been increased to three or four times the usual maximum amount. which is anticipated clinically. Vaccine treatment is an invaluable therapeutic measure, and all too frequently INSUFFICIENT DURATION OF TREATMENT advantage is not taken of its help in the scope of clinical This is a further cause of failure, and applies especially practice. It is either not employed early enough to be to the chronic type of infections. It is irrational to of real service, or too much is expected of its exhibition expect a few small doses of vaccine, however carefully under conditions which preclude its success. they are prepared and arranged for, to arrest an infective There are, therefore, several causes of failure in vaccine process that has been present in the system for months treatment, some of which may be avoided by a proper or years, and much less to reduce or replace pathological appreciation of the underlying difficulties which are apt processes which have been established. Good results are to exist, others which depend upon the presence of patho- usually obtained by persistent, careful treatment. But logical conditions beyond the scope of clinical control. vaccine therapy is not a simple and easy matter. It Nevertheless, when all details are considered, failures frequently demands much patience and thought, and gives occur in not more than 20 per cent. of cases, and, as scope for considerable nicety in the successful manage- pointed out above, may with proper care be definitely ment of a difficult case. Without such care, failures are less. more often due to the lack of proper administration than REFERENCES 'Jenkins: British Medical Journal, March, 1928. to any fault in the vaccine or therapy itself. 2 Crowe, Warren: Treatment of Chronic Arthritis. Although many may do well after a single course of ten SolisPCohen, M.: Joburn. Exper. Path., 1927, viii, No. 3, 149. to twelve inoculations, most cases of chronic 'Lowe, Cronin: British Dental Journ., May 1st, 1928; British infection, such Medical Journal, July 21st, 1928; ibid., July 13th, 1929. as the rheumatic group, will require many more, and it is quite usual to have to continue a systematic treatment with vaccine for at least a year. Nor should it be con- sidered extravagant to suggest that in the severe cases THE MODERN TREATMENT OF treatment may have to be carried on, perhaps with GASTRO-ENTEROPTOSIS intervals, for two or even three years before ultimate ST success is obtained, when it is considered how extensive A. P. CAWADIAS, O.B.E., M.D.DuRH. AND PARIS, the tissue damage may be, how long the infection has M.R.C.P.LOND. been present, and how debilitated the patient's general LATE CHIEF OF MEDICAL CLINIC, PARIS UNIVERSITY, BEAU'JON condition has become. If vaccine treatment in cases of HOSPITAL rheumatic infection, for instance, was commenced earlier and persisted with efficiently, a large percentage of the Inefficacy in the treatment of gastro-enteroptosis is due *permanent disabilities from this cause would be prevented. to our erroneous conception of the unity of this morbid The first aim of vaccine therapy is to arrest the infec- condition. Gastro-enteroptosis is not one disease. There tive process by raising an efficient bacterial resistance. are four distinct forms of it, and we could, in fact, from When this has been accomplished, further treatment must the nosographical point of view, speak of four different still be directed to the maintenance of an active immunity diseases. These are (a) the constitutional gastro-entero- and to the recovery, so far as is possible, of pathological ptosis, or Stiller's syndrome; (b) the neurotic gastro- tissues. These later courses of vaccine will usually allow enteroptosis, or Adler's syndrome; (c) the organic of a considerable increase of interval between doses, gastro-enteroptosis, or Glenard's syndrome; and (d) the which are themselves only increased in amount when gastro-enteroptosis complicated by perivisceritis. For further improvement is absent. In some cases the naturai a perfect individualization of our therapeutic handling- power of maintaining an adequate resistance to a par- the only safe way to success-we must consider this ticular infection appears to be deficient, and in such the division, which is based, not on a static, but on a dynamic best method of maintaining their freedom from reinfection clinical observation of gastro-enteroptosis and also on is by the persistent continuation of vaccine treatment at, the observation of the action of various therapeutical perhaps, monthly intervals. Numerous sufferers from agents. chronic respiratory, intestinal, and rheumatic infection STILLER'S SYNDROME have been changed from a life of invalidism to compara- The term " Stiller's syndrome " is applied to this form of tive normal activity by the employment of this method gastro-enteroptosis because it was Stiller (of Budapest) who of-continuous* vaccine-treatment, which, if omitted for -first pointed out the relation of gastro-enteroptosis to a too :long an interval, results inl the gradual reappearance type of constitution-that is, to a particular psycho- of some well-recognized symptoms of relapse. physical construction of the individual. OF THE BEITISTIS 1161164 JUNEJUN 25,25 1932] TREATMENT GASTRO-ENTEROPTOSTS 1932]A TRATETUFRATR-ETROTOL MEDICAL JOURNAL This form of gastro-enteroptosis is not a morbid con- in other words, to express their difficulties by what Adler dition but a special type of constitution-one of those has called organ jargon-a dyspeptic syndrome develops. special " types " into which men have been grouped Thanks to their physician, they have been furnished according to their morphological features. It coincides with a convenient form of organic expression of and is synonymous with what is known as asthenic con- their difficulties. The first rule, therefore, in handling stitution (Stiller and Kretchmer), linear type (Stockard), constitutional gastro-enteroptosis consists in the avoidance microsplanchnic hypovegetative constitution (Pende). of drawing attention to the visceral condition, but this Individuals who possess the features of this biotype have rule does not summarize the whole attitude of the internist. usually a stature below the average. Their thorax is Something more positive must be done. The life of the bigger than the abdomen, and is narrow and long. The patient must be adapted so as to make him avoid great abdomen is restricted both in the transverse and in the physical and mental strain. His diet particularly must antero-posterior diameter, and has flaccid and thin muscular be adjusted so as to be of easy digestion, substantial walls. The limbs are long, the muscles thin, showing quantitatively, and complete from a qualitative point of scarcely any outline. There is a very great scarcity of view. fat. Clinical and radiological examination of the internal ADLER'S SYNDROME organs shows a small and dropped heart, gastroptosis- The term " Adler's syndrome " must be applied to this meaning elongation of the stomach, which brings the form of gastro-enteroptosis because it is owing to Adler inferior pole of this organ into the pelvis-coloptosis, and that we understand the mechanism of the expression of the nephroptosis. These persons have a low blood pressure. mental difficulties of an individual through symptoms Psychologically-as has been emphasized by the work related to an organ in a condition of inferiority, in other of Kretchmer-they have a tendency towards intro- words, through organ jargon. version. They do not show any symptoms, and it is, From a clinical, descriptive point of view sufferers from in fact, remarkable how an intensely ptosed stomach Adler's syndrome have the morphological features may function perfectly.
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