GLENARD'S DISEASE.
This condition is also known as " Splanchnoptosis," " Enteroptosis," and " Visceroptosis." When only one organ is obviously displaced, such terms as " hepatoptosis," " nephroptosis," gastroptosis," arc employed, but the term " Glenard's Disease " should in strictness only be applied to the condition in which all the organs in the upper zone of the abdomen are displaced.
The treatment is most difficult and often disappointing, a most in veterate neurosis becoming developed which renders the patient's life unbearable, and which may remain with all its neurotic symptoms un relieved even after the displaced organs have been fastened in their normal position by surgical methods.
In recent cases the result of prolonged physical strain accompanied by acute emaciation such as may sometimes be noticed after the tedious nursing of a relative during a fatal illness, the condition may be remedied by a long period of absolute rest in bed with over-feeding and massage and such attention to the general nutrition as will restore the paddings of fat within the abdomen and improve the tone of the abdominal muscles.
Tight lacing and the wearing of heavy garments whose fixed point is at the compressed waist must in all cases be remedied. Skirts and petticoats should be suspended from the shoulders, and constipation, which causes dragging on the colon, should be guarded against by laxatives. The feeding should be liberal, hut regulated by such short intervals as will effectually prevent the stomach being at any time so weighted with food as to facilitate its descent in the abdomen. The patient should sleep with the shoulders depressed and the foot of the bed raised so as to diminish the tendency towards displacement.
During the waking hours an abdominal belt, binder or corset should be worn with suitable padding to keep the viscera supported. The styles or patterns of these are endless. The best support is one which will distribute the pressure in an upward direction in such a manner as the patient instinctively adopts by placing both hands upon the lower part of the abdomen to relieve the dragging sensations experienced whilst standing in the upright posture. If such an appliance be adjusted in the Tren
deleztburg position an amelioration of all the symptoms may be often satisfactorily obtained in mild cases of the affection.
In serious examples of general ptosis, and even when only one organ, as the kidney, is displaced, the neurotic condition may require treatment by the Weir Mitchell method.
When the ptusis of any individual organ is seriously interfering with its functions recourse must be had to surgical procedures.
IEPATOPTOSIS.—This in all its degrees of severity, from slight dis placement downwards to the type known as movable and floating liver, may be the cause of gall-stones with repeated attacks of pain and jaundice, in which case the secondary troubles will require operative relief. Ilepa topexy should also be performed after the removal of the calculi, and sometimes it is clearly indicated where there is no evidence of cholelithiasis when the dragging pain is not relievable by a binder. An incision is made along the lower costal margin on the right side, with the patient in the Trendelenburg position. The lower edge of the right lobe of the liver is then to be stitched with catgut sutures to the upper margin of the wound made in the parietal peritoneum after this has been folded over to the hepatic edge, the patient being kept in bed for 4 or 5 weeks with the shoulders depressed and the feet elevated slightly by tilting the foot of the bed.
GASTROPTOS1S.--Where this fails to yield to a carefully adjusted binder signs of gastric dilatation soon show themselves from kinking at the pylorus, and operative procedure is to be weighed against the relief obtainable by resort to the stomach-tube and lavage at regular intervals. As a rule it is wiser to adhere to the employment of the rubber tube, as the neurotic symptoms are often permanent even when a gastro-enterostomy has been successfully performed. The operation of gastropexy may be carried out by elevating the stomach to its normal position through shortening the gastrohepatic oznentum and the gastrophrenic ligament with sutures.