Congenital stenosis of the pylorus
Price, Lloyd Turton
The subject of Congenital Stenosis of the Pylorus presents interest alike for the Physician, the Pathologist and the Surgeon. The first recorded ob- servation was made in 1341 by Williamson of Leith. The symptoms described leave no doubt that the patient suffered from Congenital Stenosis of the Pylorus, whic proved fatal when the child was 5 weeks old. The Stomach and Pylorus were removed post mortem and were - exhibited at a meeting of the Edinburgh Anatomical Society, where the condition was considered to be Con - enital Scirrhus of the Pyloric extremity of the Stom- ach. In 1842 Dawoskk reported a case with similar !!symptoms, which proved fatal at the age of 10 weeks. At the post mortem examination a hard Pyloric tumour as found, the lumen of which would hardly admit a robe. Dawosky looked upon the condition as one of h ypertrophy with induration of the submucous tissue. Landerer, in 1879, and Maier, in 1335, again called attention to the subject of Congenital Pyloric Sten- osis by the publication of some observations they had ade, both clinical and anatomical. But their cases were all observed in adults, the two youngest patients being respectively 16 and 12 years of age, and they re now not generally regarded as true cases of Con - genital Stenosis of the Pylorus. In 1888 Hirschsprung recorded two cases of his. Both patients suffered from symptoms similar to those which will be described belo las typical of the condition and both died. From the post mortem examinations Hirschsprung was the first to ' recognise that the hypertrophy of the Pylorus was chie- ly of the muscular tissue. In 1889Peden showed a,spec - imen at a meeting of the Glasgow Pathological and Clines ical Society taken from the body of a child who had died from malnutrition, the result of Congenital Sten- osis of the Pylorus. At a meeting of the Pathological Society of London in 1891 Newton Pitt showed another specimen taken from an infant 7 weeks old at death, 1 and he drew attention to the hypertrophy of the musculi ar coat of the Stomach as well as the Pylorus. In 1891 Henschel published notes of four cases which poss4 iibly were cases of Congenital Stenosis of the Pylorus.; One of them recovered without operation and the others¡ died between the ages of 7 months and 2- years. At the post mortem examinations of the three fatal cases none of them revealed the marked muscular hypertrophy which is usually met with at the Pylorus. Thomson in 1896 published notes of two fatal cases (see below)¡ E nd of another the following year with full descrip- ions of the morbid anatomy. About the same time as homson published his first two cases, Gran recorded otes of three cases. Soon afterwards Finkelstein ublished.a paper on Congenital Stenosis of the Pylorue nd gave notes of a case of his own and three cases from Heubner's private practice. In 1896 De Bruyn op and Schwyzer each reported a case and the following ear Ashby published a paper on the subject with notes of two cases. In his book on "Disorders of Digestion in Infancy and Childhood" in 1897 W.S.Fenwick gave Totes of two cases of Congenital Stenosis of the Pylor- us, which he had treated. In 1898 cases were recorded Meltzer, by EAVElfEreN Batten and Rolleston, and in that year Stern had a case on which he operated. The following year, Still recorded three cases he had had under his charge, and Abel also operated on a case of Kehr's about the same time. Since then the literature on the subject of Congenital Stenosis of the Pylorus has been rapidly increasing, and a considerable number of cases have been recorded. The following have either written on the subject, or recorded cases - Blackadder Cantley and Dent, Dival, Fletcher, Greeff, Kehr, Lark- ins, Lobker, fonnier; Xicoll, Pritchard, Rolleston and Crofton- Atkins, Saunders, Schmidt, Simonson and South - worth. A complete bibliography will be found below.Owing to the kindness of Mr. H. J. Stiles and Dr. John Thomson I am enabled to give notes of their cases. The first three cases recorded have been published by Dr. Thomson and they are copied from the punished notes. Three of the cases were treated at the 'Min- burgh Children's Hospital by Dr. Thomson when I held the position of House Surgeon to the Hospital and I had ample opportunity of seeing the cases. Mr. Stiles operated upon two of these three cases and'i'assisted him at the operations.