The anatomy of Glenard's disease / by Arthur Keith.

Arthur Keith

Date:: [1902?]

Credit: The anatomy of Glenard's disease / by Arthur Keith. Source: Wellcome Collection.

5/14 page 1

$| i THE ANATOMY OF GLENARD’S DISEASE.” AN OPENING LECTURE BY ARTHUR KeituH, M.D., Lecturer on Anatomy. Mr. Keith gave his Opening Lecture in the Anatom- ical Theatre. at mid-day on Monday, October the 6th. Many specially prepared diagrams and two newly designed models were shewn to demonstrate the respiratory movements of the abdominal viscera. The hour fixed for the Lecture made it impossible for many Students working in the Wards to be present, and as the subject is one of value, and perhaps of interest, to them, we report it at some length here. GENTLEMEN, Those of you who have worked in the Dissecting Room must have noticed that in one subject out of, perhaps, every ten or twelve the abdominal viscera do not occupy their normal position, but that all of them are displaced downwards, the liver and stomach usually suffer- ing to a greater extent than the other organs. The condition occurs three or four times more frequently in women than in men. This is a condition which has received a very great deal of attention from clinicians during the last decade; often it is called ‘‘Glenard’s disease,” from the Parisian physician who has spread his verbose studies over a book of 600 closely printed pages. ‘‘ Displacement of the abdominal viscera,” ‘‘ Enteroptosis,” are two of the names given to the condition, but there are many more. Because of its brevity, and because it is clearly recognised by Glenard that ptosis and misshapement of the liver, displacement and elongation of the stomach, displaced and floating kidney and spleen, sinking of the intestines, certain forms of herniz and prolapse of the pelvic viscera, are all part and parcel of one general condition, it is convenient to recognise this general condition by his name. The manner in which the abdominal viscera are fixed and retained in position is one which lies strictly within the province of the anatomist, and I hope, before the hour is up, to shew you not only how they are fixed, but how they become displaced, and give rise to an infinite variety of vague and distressing symptoms. During the autumn, when I intended to pursue an investigation I commenced some years ago into the manner in which the viscera were fixed in other animals besides man, I expected my work to lie mostly within the abdominal cavity itself, and to be directed towards the peritoneal and other ligaments of the viscera. But as the liver and stomach were fixed almost entirely to the diaphragm, I saw that the first matter that required to be settled was ‘‘ How is the diaphragm kept in position, and what movements do the stomach and liver undergo when the diaphragm contracts, for all three must move together ?” Variability in the Position of the Diaphragm. The first point investigated was the common position of the diaphragm after death. I took 50 cases, 35 males and 15 females; 40 of these cases were obtained from very valuable records made by Dr. Addison, Lecturer on Anatomy at Charing Cross Medical School. The position varied enormously, as the Table (Table I.) I give here, which deals with its position in 35 males, will shew :— TABLE I. Shewing the level at which the right dome, the central leaflet, and the left dome of the diaphragm occurred in 35 male subjects. In right In Tn left mammary middle mammary line. line. line. At the level of the 3rd rib ) . I cases. 0 cases. ses. or 3rd intercostal space J goer Y Loss At 4th rib or space U3) asi SAR eee fy oss es tmborepace, =... 18')\,, 930 sn 240%, At 6th rib or space pee eee Smee a ee Thus in 35 bodies the diaphragm varied, as to the level at which it occurs after death, to the extent of three intercostal spaces, or a distance of 34 inches. The three cases in which it occurred at the level of the 6th space were examples of Glenard’s disease. An equal amount of variation was found in the 15 women, as is shewn in Table II. TABLE II. In right In In left mammary middle mammary line. line. line. At the level of the 3rd rib : } O cases. Ocases. O Cases. or 3rd intercostal space Ai 4thibrorspace » ..: 4S 5, Vit ssh Sea oh At 5th rib or space SEARING) ass O00) TOR, , eNivOtumibrowepaces |. Ce 55 cy eae I Two of the cases were examples of Glenard’s disease. The cause of the variability. After death, at any rate by the third day after death, the position assumed by the diaphragm is approximately that of complete expiration; the elasticity of the lungs draws the diaphragm up as far as it will yield. The low or high position of the dia- phragm depends very little on the degree of distension of the abdomen or of the bowel. Does a similiar variation occur in life? The answer is ‘‘yes.” In three young men,$

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The anatomy of Glenard's disease / by Arthur Keith.

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