FIG. 5. Transposition of organs. Heart in the right thorax with apex directed toward the right, markedly elongated stomach on the right side of the abdomen, pylorus directed toward the left. Ascending colon, hepatic flexure and cecum on the left side, marked ptosis of the entire colon.

FIG. 6. Transposition of organs. Heart in the right thorax with apex directed toward the right, markedly elongated stomach on the right side of the abdomen, pylorus directed toward the left. Ascending colon, hepatic flexure and cecum on the left side, marked ptosis of the entire colon.

FIG. 7. Transposition of organs. Heart in the right thorax with apex directed toward the right, markedly elongated stomach on the right side of the abdomen, pylorus directed toward the left. Ascending colon, hepatic flexure and cecum on the left side, marked ptosis of the entire colon.

FIG. 8. A markedly elongated hypotonic stomach still retaining its phrenic attachment.

purely surgical cases and mixed cases. Considering the gravity of the symptoms that may arise from splanchnoptosis, each case should be carefully studied and proper treatment administered. Dr. Rehfuss suggests the following principles for the treatment of visceroptosis:

Glénard states that the essentials for successful treatment of visceroptosis are: an abdominal bandage, laxatives, alkalies and a meat diet.

The treatment of spranchnoptosis may be divided under the following headings:

1. Prophylactic: Frail children with congenital tendencies toward prolapse should have vigilant care. Diseased tonsils. and dental defects should receive proper attention.

2. Psychical: Neurasthenia and other nervous disturbances may be benefited by suggestion. By renewed confidence in ultimate recovery patients may regain appetite and restored muscular

tone.

3. Dietetic: Good nutritious food must be selected according to the digestive power of the stomach.

4. Mechanical: A great number of cases are benefited by a variety of abdominal supports. Rose recommends a piece of moleskin adhesive plaster of zinc oxide about one yard long and eight inches wide. From the middle of the lower edge the plaster is cut obliquely upward on each side to points three inches from the top of both ends, thus forming almost a triangle. The point is applied over the symphysis pubis, the rest is snugly applied to the body, and the ends overlapped on the back. The other two pieces are used to reinforce the lower edge on each side. There are many modifications of the Rose bandage. The chief objection to it is the irritation of the skin and the necessity of renewing the dressing frequently. A great variety of bandages and supporters have been described. Any support is useful if it maintains an upward pressure on the viscera.

5. Postural: Although the postural treatment of viscerop

tosis is only rarely mentioned, I consider it of great importance. It has been given greater prominence in gynecology than in visceroptosis. We are dealing with a relaxed atonic condition of the muscles of the body. Because of a continuous strain on the longitudinal fibers of the muscles and ligaments of an atonic stomach particularly when filled with food they are constantly undergoing strain fatigue which augments the ptosis. It is probable that the rest cure of Weir Mitchell for neurasthenia due to organ prolapse, accomplishes its end more by allowing the muscles and ligaments of the viscera as well as the pelvic organs to regain their tone, than by the psychical effect it has on the nervous condition. I have observed considerable improvement from postural treatment, by directing patients to remain in bed after meals with hips raised.

One of my patients, female, age 56, who suffers from attacks of anorexia, abdominal distress, complete nervous exhaustion, is frequently obliged to go to bed. After remaining in bed from eight to ten weeks she gradually begins to regain her appetite and strength with a general improvement in her physical and nervous condition. On roentgen examination I found the stomach elongated, inclined to the right, ptosis of the pylorus and a six-hour retention of more than half of the meal.

6. Electricity, massage and hydrotherapy have also been suggested in the treatment of visceroptosis.

7. Medicinal: Drugs are of little benefit with the exception of those which tend to improve muscular and nervous tone—such as strychnine, iron and phosphorus. I have noticed some benefit from occasional doses of pituitrin.

8. Surgical operations: These are as varied as the etiology and the symptoms. All the operations aim to raise the stomach. This has been tried by fixing the anterior surface of the stomach to the abdominal wall with a single suture. Rovsing applied three rows of sutures. It seems that the operation of fastening the stomach to the abdominal wall may seriously interfere with its function. A fixed stomach may be worse than a fallen one. The greater omentum has been sutured to the anterior abdominal wall, thus raising the stomach and the colon.