Visceroptosis and its treatment / by R. Murray Leslie ; with note on chronic intestinal stasis from the radiographic aspect, by Alfred Jordan.

  • Leslie, Robert Murray, 1866-1921.
Date:
1912
Catalogue details

Licence: In copyright

Credit: Visceroptosis and its treatment / by R. Murray Leslie ; with note on chronic intestinal stasis from the radiographic aspect, by Alfred Jordan. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    As regards age, the majority of cases occur between twenty and fifty, though the condition has been found in quite young children. As regards sex, the condition is much more common in women than in men. Glenard found floating kidney in 22 per cent, of his women patients as compared with 2\ per cent, of his men patients, while the records of the Johns Hopkins Hospital showed that one out of every five women and one out of every fifty men had movable kidney, giving a proportion of ten to one. Meinert found gastroptosis in no less than 80 per cent, of all his gynaecological patients, while Thompson found that this variety of visceroptosis was six times more i common in women than in men. The marked preponderance of right-sided displacement of the kidneys is attributed by some authorities to the 1 fact that the right kidney is situated in close apposition with the heavy liver, through the medium of which it is subjected to a movement of depres- sion with each inspiratory descent of the diaphragm. On the other hand, Arbuthnot Lane believes that the drag exerted upon the kidneys by the large bowel, owing to adhesions, is much greater on the right side'than on the left, and hence the mobility of the rijght kidney is correspondingly greater. According to .this observer, the other two factors in inducing dropping of the kidney are, on the one hand, the absorption of fat, which he states is often the result of intestinal auto-intoxication, and on the 1 other, enfeeblement of the abdominal walls, which may have the same origin. Indeed, he goes further, and asserts that these last two factors, namely, the rapid loss of fat and the associated degenerative changes in the abdominal muscles and supporting tissues, so commonly met with in chronic constipa- tion, affect more or less all the viscera in the abdomen, which thus lose their natural supports and a condition of visceroptosis ensues. He is of opinion that the bulky liver has been unduly blamed for much trouble which is actually pro- duced by faulty mechanics in the intestines. Mr. Lane also believes that the customary sitting posture during the act of defsecation almost in- variably adopted in civilised countries as con- trasted with the natural squatting posture, is partly responsible for forcing the viscera, and more par- ticularly the caecum and transverse colon, into the true pelvis. He states that in the squatting pos- ture the forcible apposition of the thighs on the abdomen empties the caecum and transverse colon, retains the kidneys and other viscera in position during the period of greatest strain, forces up the sigmoid, drags the rectum upwards and straightens it, so that the passing of faeces through the rectum is very materially facilitated. These physiological facts should be brought before the notice of our sanitary engineers, who could easily give facilities for the adoption of the natural squatting attitude, the present high seats being specially harmful in the case of short men, women and children—a fact which is now sufficiently well recognised to make the provision of footstools in private lavatories an accepted necessity. Indeed, the greater frequency of constipation among women and children may be more commonly due to this cause than is generally supposed, while this factor in association with con- stipation and its effects may have a larger share in accounting for .the greater frequency of viscero- ptosis among women than either the corset or the general relaxation due to repeated pregnancies. In this connection it may be stated that the abdo- men of the 'woman is placed at a considerable mechanical disadvantage as compared with that of the man in virtue of its greater relative length, while the mechanical interference exerted by an over-loaded csecum and colon is exaggerated in the woman by the constriction of the waist and by the imperfect development of the abdominal muscles. Degrees of Visceroptosis. In gastroptosis the prolapsed stomach as a rule occupies a semi-vertical position, the pyloric end descending while the cardiac end is more or less fixed (see Figs. 1 and 2). When there is much atony present in addition to the ptosis, Dr. Hertz* has shown that the lowest part of the stomach sags so deeply and the body of the stomach becomes so stretched that the lumen of the body may become actually obliterated when the patient is in the vertical position, a condition which disappears immediately after the horizontal position is as- sumed. The dilated lower end may be found right down in the false pelvis. The condition of gastroptosis is often not diag- nosed owing to the fact that it may be quite normal in position when the patient lies down on the examining couch, and yet drops down to quite a low level as soon as the erect posture is assumed. * ‘ Brit. Med. Journ.,’ February 3rd 1912, p. 225.