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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    It is readily understood how prolapse and back- ward displacement of the uterus may be produced owing to the super-position of the abdominal organs bunched into the false pelvis. Pathological Changes consequent on Visceroptosis. Mr. Arbuthnot Lane’s* epoch-making investiga- tions in regard to the mechanism of the various pathological changes induced by visceroptosis and intestinal stasis have quite revolutionised our ideas on this important question, and his observa- tions have been in large part confirmed by others, particularly by Mr. Charles Mayo, of Rochester, and other observers in America, where Mr. Lane’s brilliant exposition is hailed almost as a new gospel. Proverbially a prophet hath no honour in his own country or city, but personally I feel con- vinced, not alone from my study of Mr. Lane’s writings, but from personal experience of quite a considerable number of cases, that Mr. Lane’s theories, possibly in a slightly modified form, will emerge triumphant. It would be quite impossible in this lecture to go fully into the matter, but I shall attempt to indicate the principal points as clearly as I can, illustrating these as far as possible from cases which have come under my own immediate observation. The three principal phenomena resulting from dropping of the viscera are : a. The formation of adhesions—along the lines of resistance to downward displacement. B. The production of kinks—along the course of the gastro-intestinal tract. c. Gastro-intestinal stasis—with delayed diges- tion, constipation, and auto-intoxication. a. Adhesions. These adhesions are in no sense the result of inflammation, but are in reality conservative struc- tures developed so as to exert the beneficial effect of opposing the natural tendency to dropping of the viscera due to the action of gravity during the long hours from early morning until late at night that the individual is in the erect posture. * “ Operative Treatment of Chronic Constipation,” Clinicaj. Journal, 1901, Nisbet & Co., Ltd., 1909; ” Papers on Adhesions, Kinks, Distension Changes, and Intestinal Stasis,” ‘ Surg., Gyn., and Obstet.,’ Chicago, 1910, vol. xi, and 1911, vols. xii and xiii ; ‘ Lancet,’ April 30th, 1910 ; ‘ Brit. Med. Journ.,’ April 22nd, 1911, p. 913. When a visczts drags upon its mesenteric attach- ment a thickened fibrous band forms along “ the line of drag,” and may be so strong as to merit the name of an acquired or supplementary mesentery. Thus, in the case of the colon, such a mesentery may contract and form a definite suspensory liga- ment, securely fixing the bowel and so preventing its downward displacement into the true pelvis, where its presence would naturally interfere with the functions of the pelvic organs. These acquired mesenteries and adhesions are described by Mr. Lane as being “ the crystallisation of lines of resist- ance to downward displacement of viscera.” In common with many others I was at first extremely sceptical as to the presence and signifi- cance of these adhesions, but six years ago I became a convert as the result of my observation of a particular case of chronic intestinal stasis of many years’ standing. After trying the usual medical and hygienic remedies without permanent benefit, and as the patient was steadily losing weight and appeared to be actually sinking from asthenia, I took her to Mr. Lane, who eventually short-circuited the ileum into the sigmoid colon and resected the remainder of the large bowel. Several thick adhesive bands were clearly demon- strated at the operation such as I had never observed during a long post-mortem experience as a hospital pathologist, and which were certainly abnormal. My later experience of a considerable number of similar post-operative demonstrations preceded by radiographic examinations has only tended to strengthen my belief in the importance of these adhesive structures, and I feel I can with confidence predict that a similar view will sooner or later be universally accepted by both physicians and surgeons. In the case of the stomach, which in the erect posture is apt to be displaced downwards by its contents after a meal, and by the drag of a loaded or over-loaded transverse colon, the natural gastric supports, viz. the oesophageal tube and the weak lesser omentum, are often unequal to the strain, and accordingly a supplementary support in the form of a new adhesive band forms between the pylorus and the under surface of the liver in front of its transverse fissure, extending along the cystic duct and gall-bladder. This anchoring of the pylorus to the liver with the drag downwards of its convex greater curvature