Ptosis (and ptoses)

There is a range of medical conditions to which the term ‘ptosis’ is applied. The term comes from the Greek πτῶσις, meaning 'dropped, a fall, or a falling'. Typically the term is applied where there is a droopiness or abnormal downward displacement of a body part or organ. On the surface of the body, structures that can be clearly seen to be affected include the eyelid, the breasts and the chin.

The condition may also occur internally. If affecting the stomach, the condition is called gastroptosis; if affecting the kidneys, it is called nephroptosis. The general term for organs that are found lower than expected is ‘visceroptosis’ (although the terms ‘splanchnoptosis’ or ‘abdominal ptosis’ may also be used.) Originally it was called Glénard's disease (after French physician Frantz Glénard (1848–1920)). However, eponymous terminology is now considered somewhat outdated.

However, with regard to the internal organs, whether this constitutes a ‘disease’ is uncertain. Internal organs cannot be seen directly, and when they can be visualised, they can demonstrate considerable variability in their vertical placement. This has led some to doubt the veracity of conditions such as Glénard's disease and even to speak somewhat disparagingly of it. There has been some suggestion by sceptics that visceroptosis was a product of the discovery of X-rays by Wilhelm Röntgen in 1895.

The story has been told of how, in the early days after the discovery of X-rays (a period during which Frantz Glénard was active), patients would present to their doctor with abdominal discomfort for which no obvious cause could be found. Now with the invention of X-ray machines, one could peer inside the body, and so the patients were sent to a hospital so that that could be done. At that time, the patient would typically stand between an X-ray source and a fluorescent screen that would show a shadow of their insides to an examining doctor. Finding their organs lower than described in the textbooks, the cause of their discomfort became immediately obvious: fallen organs. To which the more scientifically sounding names 'ptosis' and 'Glénard's disease' were applied.

It was later pointed out that the descriptions and drawings in textbooks were based on cadavers as seen at autopsy or in the anatomical dissecting room. These were invariably laid out horizontally, whereas the patients being examined by X-ray stood up. The effects of gravity on the organs were not taken into account. They move up when we lie down and move down when we stand up.