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Of Gastroptosis, Which, Though Only an Incidental Part Enteroptosis, Is

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Of Gastroptosis, Which, Though Only an Incidental Part Enteroptosis, Is Dr. J. R. Pennington, Chicago : The general practitioner mobility of the stomach, which is affected by the posi¬ is entitled to the same information as the specialist; conse¬ tion of the individual, by the weight of the stomach quently, I intended that this paper should contain statistical contents and by the tension or relaxation of the abdom¬ information not obtained the and other readily by average inal muscles. We have endeavored to determine the physician. Dr. Hirschman is to be commended for his normal of the stomach in a of valuable suggestions, and were they put into practice "by position study 1,000 insurance companies and others they would do much for the cases, and have come to the conclusion that in the control of this dreaded disease. supine position the textbook teachings are correct ; but in the upright position there is a wide normal variation depending on the anatomic make-up of various types of individuals. there seems to be as much A CLINICAL AND ROENTGENOGRAPHIC Indeed, difference in the size, contour and position of the STUDY OF GASTROPTOSIS stomachs of men as there is of their mouths. come so as OBSERVATIONS IN ONE THOUSAND GASTRO- We have also to the conclusion that far is it matters INTESTINAL PATIENTS gastric digestion concerned, very little whether a stomach is in the high position or in the brim SEALE HARRIS, M.D. of the pelvis, so long as its muscular tonus is good and AND the intra-abdominal pressure is normal. We have J. P. CHAPMAN, M.D. repeatedly found patients whose stomachs in the BIRMINGHAM, ALA. upright position were as low as it is possible to be, and yet who had no evidences of gastric indigestion. The added much to exactness in roentgen ray has We have found with a marked of gas- the of and from others, degree diagnosis gastro-intestinal diseases, troptosis, who complained of various digestive symp¬ it we have learned that are in many things helpful toms, yet after the relief of the gastric atony or with conditions about which we did a treating formerly the use of a abdominal supporter, and deal of The use of the roent- properly fitting great guessing. general after a few weeks' of and without some misin- regimen hyperalimentation gen ray, however, has not been abdominal all their discomfort of its This is true exercises, disappeared terpretations findings. particularly the of their stomachs was not of which, an incidental though position changed. gastroptosis, though only part the location of the stomach seems to have but of a habitus and associated with Indeed, general bodily always little to do with the of its normal function ; is treated as a performance enteroptosis, being separate entity by and in our there is no one normal of many who seem not to understand the underlying opinion position factors of the human stomach. etiologic visceroptosis. The the stomach to a extent Much of the regarding gastroptosis position of depends great misconception on the of the individual. In the so-called normal comes from the of textbooks on and type teachings anatomy human the stomach which assert that the normal type of average height and weight physical diagnosis posi- will be in the so-called normal i. the lowest tion of the stomach is in the upper left quadrant of the position, e., abdomen, the dome in the vault of the point of the greater curvature being above the umbili¬ lying diaphragm, same is as a and the lower border about 2 inches above the umbili- cus. The true of stout persons, rule. On the other hand, in the slender person with the cus. Anatomists formed their opinions regarding the long flat or narrow chest and with the slender in normal of the abdominal viscera from necropsy abdomen, position the the stomach almost made on cadavers on their backs, and standing position, invariably findings lying will be found in the left lower of the abdo¬ they were correct in their statements regarding the quadrant men, a position entirely normal with this type. The average position of the stomachs of persons in the these position. They seemed not to learn, however, position of the stomach will vary from two supine extremes as there are differences in the size and that the stomach is a mobile organ, and that shape highly of the chest and abdomen. the normal stomach of a healthy person while perfectly It is not the or the of the stomach may rest in the false but when position shape standing pelvic cavity, that the need be concerned about but its tonus. he lies down may to the upper left quadrant physician gravitate If the muscular tonus of the low stomach is of the abdomen. Diagnosticians fell into the same lying good, are no the error because their examinations of the abdomen were there symptoms. However, roentgen ray has demonstrated the fact that the stomach in the also made on patients in the supine position. high is more normal in tone than one Before the advent of the roentgen ray there was a position frequently lot of about locating the position of the that is found low in the abdomen. We have repeatedly "poetry" on examination in stomach and other abdominal viscera. If one will observed fluoroscopic of persons the that the atonic stomach would be attempt to outline a stomach by percussion, ausculta- standing position into a one when the con¬ with or without inflation, or changed hypertonic patient tory percussion, by splash¬ tracted abdominal thus sounds (Obrasztow's method), and check up his his muscles, increasing the intra- ing It would seem this the ray, he will be forced to admit abdominal pressure. from observa¬ findings by roentgen tion that the in with is a very large percentage of error. With the roentgen problem dealing gastroptosis not with efforts to treat the stomach so much as with ray the location of the stomach in various positions of measures to and the abdominal the body can be studied with exactness. strengthen develop muscles, or to increase intra-abdominal pressure tem¬ ROENTGEN-RAY STUDIES OF GASTROPTOSIS porarily by means of properly fitting abdominal In our roentgen-ray studies on gastroptosis, the most supporters. have been the marked of important findings degree INFLUENCE OF BODILY HABITS Read before the Section on Gastro-Enterology and Proctology at the most contributions to the the Seventy-Third Annual Session of the American Medical Association, Perhaps important St Louis, May, 1922. literature on visceroptosis have been the series of Downloaded From: http://jama.jamanetwork.com/ by a University of Arizona Health Sciences Library User on 06/09/2015 articles by Goldthwait.1 In his Shattuck Lecture he that certain races have gastroptosis more than others, classifies man into three anatomic types : ( 1 ) the nor¬ and that the mendelian law applies to the form and mal type with the moderately full and rounded thorax position of stomachs as well as to the color of the eyes, and upper abdomen, with costal arch from 70 to 90 and to other family and racial characteristics. degrees; (2) the splanchnoptotic (Glénard), congenital If two persons with visceroptosis marry each other, visceroptotic (Goldthwait) or carnivorous (Bryant) all their children probably will have a low position of i.e., the slender individual with the flat chest, the costal their stomachs and other abdominal viscera. If a nar¬ arch being an acute angle, a narrow upper abdomen row chested person with the long, slender abdomen and bulging lower abdomen; and (3) the herbivorous marries one of the so-called normal or stout type, it is (Bryant) of heavy build, broad back and large skeleton probable that in their offspring the abdominal viscera with excessive fat throughout the body. Goldthwait will be in a position between the so-called normal and lays much stress on posture, and blames the relaxed the extreme visceroptosis, unless one or the other muscles and ligaments for many of the ills which are should be of the dominant type. If it were possible to usually ascribed to visceroptosis. He says that "the mate human beings of different types as the Austrian body is most intimately related in its different parts so monk did the Andalusian fowls, it is probable that the that no one can be used wrongly without the whole positions of their descendants' stomachs could be fore¬ suffering. For this reason if these various groups of told with the same degree of accuracy as the varying symptoms are to be considered as purely local and colors of fowls can be determined before thev are born. distinct lesions, the results If the science of eugenics are sure to be unsatisfac¬ could be applied in mating tory. The body as a the stout human beings whole should be consid¬ with the slender habitus ered and not just the chest enteroptoticus type, it is or abdomen or other part." probable it would result in Mills,2 in a comprehen¬ marked racial improve¬ sive roentgen-ray study of ment for the reason that the form and position of the slender types as a rule the stomach, concluded have brighter minds and that "certain types of phy¬ more agile bodies, while sique are constantly asso¬ the thick, broad types have ciated with certain types better mental poise and of visceral topography, greater physical endurance. tonus and mobility." He In our opinion, what is classifies them into two called gastroptosis is nor¬ dominant ones : ( 1 ) hyper- mal with a large propor¬ asthenic habitus, the indi¬ tion of men and women vidual of massive build who go through life with¬ with stout thick chest and out any digestive symp¬ long abdomen; and (2) toms.
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