Medical versus surgical treatment of pyloric stenosis in infancy / L. Emmett Holt.
- Luther Emmett Holt
- Date:
- 1914
Licence: In copyright
Credit: Medical versus surgical treatment of pyloric stenosis in infancy / L. Emmett Holt. Source: Wellcome Collection.
Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.
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![or even months in cases in which recovery occurs without operation. In two of my patients who recovered, it was noted as late as the sixth month of the child’s life; the patients were seen at A]/2 and 5 years, respectively, and both were well. The tumor is usually more evident just before or during the act of vomiting, and it may not be easily felt at other times. It usually hardens during active peristalsis and may be difficult to feel at other times. It may then rise and meet the hand lightly pressed on the abdomen, some- what as the spleen may do when forced down by full inspiration. It may be displaced from its usual posi- tion and so missed. In my opinion, too much has been made of this symptom nof only in classifying these cases, but also in deciding the treatment to be followed. The presence of a tumor, because so frequent, is an important symptom in diagnosis, but tbe decision as to operation should not rest on finding or not finding it, but rather on how much obstruction is present. While the tumor is naturally more prominent when much hypertrophy exists, in the absence of a palpable tumor we are not justified in deciding that only spasm exists, for operation in these cases has often disclosed a typical tumor. One of the most important means of determining not only the fact of pyloric obstruction, but also its degree, is by measuring the amount of gastric retention. The child is fed a measured quantity and the stomach is emptied by aspiration three hours after this. The ordinary apparatus used for stomach washing will hardly answer the purpose. The little apparatus sug- gested by Hess for aspirating the duodenum is much better. A food not coagulating in the stomach in large masses must be given, that is, boiled milk diluted at least twice with barley water or condensed milk, or simply by a barley gruel. If, for example, three hours after feeding, the stomach is found to contain nearly as much as the quantity taken or more than this, or if, after no food has been given all night, the following morning 4 or 5 ounces can be removed, as in a case I saw recently, one may be sure that obstruc- tion exists. A determination of the amount of reten- tion is of especial value in the rather rare cases in which vomiting occurs only infrequently. Aspiration is also useful during the progress of the case medically](https://iiif.wellcomecollection.org/image/b22447878_0010.jp2/full/800%2C/0/default.jpg)
