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Visceroptosis As a Cause of Stomach Trouble

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Visceroptosis As a Cause of Stomach Trouble VISCEROPTOSIS AS A CAUSE OF more physicians. In the writer's opinion, the "STOMACH TROUBLE." patient, and at times the family, may all be said to be in a state of neurasthenia. And small By William D. Reid, M.D., Boston. wonder, as they often have been given as many Visceroptosis has received a large share of opinions as they have consulted doctors,—some attention from orthopedists and internists dur- advising resort to surgery and others against. ing the past two decades, and medical literature This variation in the advice received generally is not lacking in excellent articles on the sub- has an upsetting effect. ject. Nevertheless, one continues to see cases At this point a few case reports will best serve not yet diagnosed, though they have passed to picture the type of patient to which the through the hands of one or more physicians. writer would draw attention. The type to which the writer refers is that in which the comes for relief of "stomach patient Case 1. Single woman. Seen June, 1915. not will trouble." It is held that this paper Aged 34 years. Canadian ; school teacher. Said present new facts, but it is hoped that it may to have gastric ulcer, but patient believes can- lay further emphasis on an important subject. cer to be the correct diagnosis. Family History The American Illustrated Dictionary defines —-Negative. Past History—Chicken-pox, scar- let fever and measles in childhood. "Sort of as "a or the falling down, visceroptosis prolapse, until 13 years old. Sore throat once a of " It is sometiues called Glenard 's puny" the viscera. year. "Rheumatics" past four or five years in disease, splanchnoptosis, enteroptosis, or gastrop- knees, back, and posterior aspect of left thigh. tosis, but the term visceroptosis seems prefera- The backache was bilateral and low down; no of trauma. v. t.i.d. of uncer- ble, as it is well known that the condition often story Aspirin gr. tain value. colds in winter of 1913- thoracic as well as those Repeated includes the organs '14. of the abdominal cavity; of the heart or ptosis Catamenia began at 13 years, regular, two ""dropped heart," is recognized by all cardiolo- days duration, rather painful. Bowels, "bad gists. all my life," sometimes fail to respond to two A lack of good physical development is typi- heaping teaspoonfuls of Epsom salts. Micturi- cal of the individual with visceroptosis. The tion : night once, none in the past three weeks ; never Drinks of such has been de- day, four to six; painful. eight appearance patient aptly of water 140 themselves glasses per day. Weight, pounds scribed by stating that they carry at 14 years, 125 to 130 about five years ago, in the "posture of fatigue." Any medical of- 130 in the fall of 1914; present weight is 102 ficers who happened to serve with the Special pounds and has been gaining of late. Training Battalion in France, as did the writer Present Illness—Dates illness from fall of About one week of for a short period, saw many examples of un- 1914. abnormally great with burning (Aug- developed young men who were physically un- appetite, epigastric pain. 1914, "severe cramps of bowels," but al- fit for ust, military duty. most nothing passed. Pain was located in the Malnutrition is also associated with viscerop- lower abdomen, and patient thinks that it tosis. In 1918, Max Einhorn, in a paper entitled ceased in about two days. About once every has similar milder attack. and Malnutrition,"1 again em- summer had a though "Enteroptosis Isn't certain if the attacks have occurred at the of one on the other. phasized dependence other times of the year. In 1906, there was a One further notes the close between relationship severe attack which confined the patient to bed the development and state of nutrition as found for two days. Not aware that there was any in the French children examined by the Ameri- fever at that time.) can Red Cross. The report by Dr. William P. Felt well until August to November, 1914. "rheumatism" in the never Lucas gives the figures for development as : Attack of fall; any Gradual appearance 19.4% ; fair, 37.5% ; poor, 42.4% ; and objective symptoms. good, of craving after meals, which was attributed to for nourishment as: good, 19.4%; fair, 44.3%, extra studying. This "gnawing discomfort" and poor, 36.3%. was immediately after meals, at first of limited But to proceed to the case as seen by the in- duration and later constant. "Would wake up ternist. Commonly one is told that he is to with ravenous appetite, eat a large unusual and then was ravenous all the morn- be consulted about a case of "Stomach trouble," breakfast, Strict milk diet and bismuth gave relief. and that the has ing." gastric ulcer, perhaps, patient Jan. 10—Feb. 5, 1915, was a patient in a been ailing for some time but has failed to ob- small Canadian hospital. Treatment consisted tain relief in spite of the attention of one or of rest and diet, or rather patient would eat but The Boston Medical and Surgical Journal as published by The New England Journal of Medicine. Downloaded from nejm.org at SANTA BARBARA (UCSB) on April 26, 2016. For personal use only. No other uses without permission. From the NEJM Archive. Copyright © 2010 Massachusetts Medical Society. little—chiefly milk. Studies of the gastric con- food. She stated that at the Toronto General tents were made. Hospital a positive diagnosis of gastric ulcer weeks ' Feb. 6—March 25, 1915, was in the Toronto was made and yet in spite of seven treat- General Hospital. Gastric analysis and roent- ment, she obtained merely temporary relief. At gen examination were performed. Attack of the time of her arrival in Boston, this patient in of pain after taking a fruit drink (was told that was a state marked hypochondriasis and, the gastric contents did not show acid). Bak- as stated above, had fixed upon cancer in an in- ing soda did not give relief. Treated at first curable stage as her true complaint. of a by starvation and in the course of ten days the A diagnosis visceroptosis with possible diet was increased — gruel, junket, custard, chronic appendicitis was made and explained whipped white of egg; to cream of wheat, to the patient. Treatment based on this and poached eggs on toast, arrow root biscuits, etc. the mental condition was followed by a rapid On first to caused return to health ; in six weeks this lady gained starting eat, everything pain, win- but this gradually wore off. Milk and raw eggs 20 pounds and returned to Canada. By relieved the gnawing pain. Was improving the ter she had gained 40 pounds and was enjoy- last three weeks of stay in hospital, but felt as ing the snowshoeing. Save for an operation though the pain in the midepigastrium was for appendicitis, performed in 1918, her health just about to breakout. Diagnosis stated to have continues satisfactory. been gastric ulcer. March 25 to date (June, 1915) has been at Case 2. Woman, 26 years of age, single, seen home. Pain returned For three January 7, 1916. Chief complaint is "run promptly. ' ' ' ' " " a weeks remained in bed and on a restricted diet. down and indigestion. Has just had cry- and is so about her health." Since then has adhered to a soft diet, save for ing spell discouraged occasional breaks. Calcined magnesia and ant- Several "colds" this past winter and is said to No or acids have relieved at times. Some in have some nasal catarrh. cough sputum gain and this but is able to eat very little. at the present time. Gets tired easily strength, has been noticeable the four Present is, "I cannot eat without especially past complaint fair ; is apt to have gas and and so starve." There are very days. Appetite pain simply some discomfort if eats when tired. few that do not cause gastric things pain. Notes the symptoms one-half hour after meals, Liquid perolatum worked beautifully on sometimes, but are generally irregular in bowels for a while, but later diarrhea followed, they time of There are periods when so it was discontinued. The seems appearance. constipation the can eat all sorts of food without to cause Has had no emesis patient epigastric pain. discomfort. Bowels move but a since for three times daily, require December, 1914, except laxative medicine four or five days. Never noted like cof- every after calomel. anything No of "rheumatism," tonsillitis, or or food of the ; history fee grounds, blood, previous day the infectious diseases of childhood. maximum amount was less than one pint. Examination—Lying comfortably in ever a stool." Physical Doubts if passed "tarry bed. Poorly developed and thin. Chest flat, Physical Examination—Thin, nervous woman. costal arch narrow. Eyes, mouth, teethy Pupils equal and react to light and distance. glands, and lungs normal. Heart, apex impulse Mouth, glands, lungs, heart, and reflexes nor- in fifth space midclavicular line; percussion mal. Chest flat, costal arch narrow. Abdominal corresponds. Blowing systolic murmur at apex, wall shows moderate sagging. Liver palpable transmitted to base and slightly into axilla. one and on-half finger's breadth below costal Pulmonic second sound not accentuated, louder margin in right mamillary line ; upper border than aortic second. Sounds good quality, ac- at seventh rib. Right kidney easily palpable, tion regular. Pulses equal, regular, rate 81, non-tender. Slight tenderness in epigastric re- soft, fair volume and tension. Abdomen soft gion, no masses felt. Standing posture poor.
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