Discussion on the nature of visceroptosis, usually described as Glenard's disease / introduced by Arthur Keith.

  • Keith, Arthur, Sir, 1866-1955.
Date:
1909
Catalogue details

Licence: In copyright

Credit: Discussion on the nature of visceroptosis, usually described as Glenard's disease / introduced by Arthur Keith. 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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    from either the clinician or anatomist, at least so far as I then knew. During the period I was collecting observa- tions on the condition to which I have just alluded, certain points regarding the action of the diaphragm—especially the movements of its central part—occupied my attention. The use of X-rays had just been introduced, and it thus became possible to see and study the movements of the diaphragm, especially of the central part, which at that time was supposecf by many to be an almost fixed platform. The very extensive respiratory movements of the liver, kidneys, stomach, spleen, and of all the upper abdominal viscera, became very apparent, and it was seen that they were loosely fixed and designedly shaped to permit these movements to take place easily. They moved downwards and forwards, as the diaphragm contracted they were replaced at each breath by the contraction of the belly wall muscles—especially the muscles of the epigastric and lumbar region. The diaphragm could not be studied alone, its action became plain when it was studied with its natural antagonists, the muscles of the abdominal wall. When I first observed the condition of visceroptosis I thought the diaphragm had overcome its antagonists—the belly wall muscles—and pushed the viscera down ; in short, the opinion I formed at first—one which I now know to be wrong—was that visceroptosis was the result of a disturbance in the mechanism of respiration. One of the problems I wished to settle then was—What is the normal level of the diaphragm ? In the majority of students examined I found that a line drawn across the chest at the level of the sterno-ensiform joint—usually marked by a sharp depression or notch—was the best indication of the respiratory position of the diaphragm; in extreme inspirations the diaphragm was seen to