[Reprinted from The Medical News, April 13, 1895.] 
4 CASE OF GA STRO PTOSIS AND MERYCISMUS, 
WITH VOLUNTARY DISLOCATION OF THE 
STOMACH AND KIDNEY.1 
By ALBERT ABRAMS, A.M., M.D. (Heidelberg), 
PROFESSOR OF PATHOLOGY, COOPER MEDICAL COLLEGE, SAN FRANCISCO, 
CAL. 
The case that I have the honor of presenting to you 
this evening is unique in many respects, and I have been 
unable to find anything like it in medical literature. 
The young man is twenty years of age. In June, 1892, 
he fell on his right scapula, without any appreciable 
sequences. About eight months after the accident, in 
consequence of confinement incident to his occupation 
as a chemist, he began to suffer from neurasthenic symp- 
toms, which had become intensified at the time he was 
referred to me by Dr. Jones, of this city. I have never 
regarded neurasthenia as a pathologic entity, but as a 
symptom of varied pathologic conditions; and I can say, 
without exaggeration, that I have never yet examined a 
case of so-called neurasthenia without discovering some 
distinct morbid condition which, when removed, cured 
the affection. The diagnosis of neurasthenia is a mistake 
in diagnosis. It is a conclusion based on subjective 
symptomatology. Subjective symptoms should only be 
employed as accessory evidence in our objective exami- 
nations. 
This patient's chief complaint is and has been the 
1 Presented to the San Francisco Medico-Chirurgical Society, 
February 4, 1895. 2 
rapid accumulation of gas in the stomach, and in his 
efforts to expel the gas he has developed unusual con- 
trol over the diaphragm, to which I attribute some of 
the visceral phenomena that I shall presently show you. 
In general the patient suffers from nervous dyspepsia, 
prolapse of the transverse colon, stomach, and right 
kidney, a symptom-complex described by Glenard as 
enteroptosis, a term which in our case may be substituted 
by a better one, viz., splanchnoptosis. The prolapse 
of the abdominal viscera in this case is acquired, and 
may be attributed to a mechanical origin, superinduced 
by repeated voluntary diaphragmatic contractions of 
the abdominal viscera. The apex-beat of the heart can 
be felt in the fifth intercostal space within the mam- 
mary line, but by diaphragmatic action the patient can 
cause it to descend to the seventh intercostal space, a 
condition, if I may so call it, of voluntary cardioptosis. 
You will observe when I ask him to dislocate his right 
kidney, the latter can be distinctly seen and felt as it 
bulges in a limited area of the right hypochondriac region 
in the mammary line. The kidney recedes on suspen- 
sion of diaphragmatic action. That the kidney resumes 
its normal place is evidenced by the distinct change in 
the percussion-note in the right lumbar region. I will 
now introduce the soft rubber stomach-tube, but before 
it enters the stomach I wish to direct your attention to a 
method of intra-thoracic auscultation recently described 
by Richardson. If I connect the terminal of my stetho-* 
scope with the stomach-tube, with the end of the latter 
distant about ten inches from the incisor teeth I hear 
the two sounds of the heart with unusual distinctness. 
I direct attention to this method of auscultation be- 
cause I believe that, while its use will always be limited, 
it will prove of signal value when ordinary auscultation 
is unsatisfactory. In this case I thought a murmur was 
present, but suspicion was dispelled by intra-throracic 
auscultation. I believe the latter form of auscultation 3 
to subserve another, to my knowledge, hitherto unde- 
scribed purpose in percussion of the stomach. In the 
employment of the gastrodiaphane the clinician is forced 
to admit the uncertainty of conventional methods in 
determining the area of the stomach. This I attribute 
to the fact that when percussion is attempted over the 
stomach, especially in pathologic cases, the transmitted 
percussion-blow causes the stomach to contract, and in 
place of dulness one obtains a tympanitic sound. Now, 
with the rubber tube in the stomach connected with the 
stethoscope, as in Richardson's method of auscultation, 
percussion conducted over the entire area of the stomach 
yields a clear metallic percussion sound. This method 
of intra-gastric auscultation is worthy of development. 
I will now introduce the gastrodiaphane. You will 
observe that I direct the patient to bring his chin forward 
on his chest. This maneuver greatly facilitates the in- 
troduction of the tube by bringing the esophagus in a 
direct line with the throat. You can now see the 
illuminated area. By shifting the lamp I can trace the 
stomach nearly to the cardiac orifice. Illumination 
shows the stomach to be prolapsed {gastroptosis} and 
only slightly dilated. You can also see with what ease 
the patient shifts his stomach about; to the right, left, 
upward, and downward. The greatest voluntary dis- 
location is upward. He first dislocates the stomach 
downward to a point on a level with the crests of the 
ilia, then, by a supreme effort, he draws his stomach 
upward until it can no longer be seen. When the 
patient practises rumination he throws his stomach into 
a vertical position, which you can easily see. The 
phenomenon here noted may explain some cases of 
merycismus and food-regurgitation. A feature readily 
observed in this case is peristaltic unrest of the stomach. 
I will produce it by percussing the stomach-region. 
You note that the muscular waves diminish the extent 
of the illuminated area. 4 
The patient can also develop a phantom-tumor. This 
he does by buccal insufflation of the stomach, and by 
relaxing his recti muscles and forcibly contracting his 
diaphragm; at the same time he arches the vertebral 
column forward. 
As a concluding phenomenon the patient will demon- 
strate his ability to compress the aorta to obliteration, 
causing a disappearance of the femoral pulse. This 
phenomenon I likewise attribute to contraction of the 
diaphragm at a point where the artery passes through 
the muscle.