A survivor by an accident

Dr Conrad Ramstedt in later life. He discovered a surgical remedy for pyloric stenosis.

A simple surgical technique that was discovered by an accident only a few decades earlier saved my life back in 1945.

Before 1912, babies who started to projectile vomit would most likely die from malnutrition and dehydration. Tragic at any time, terrible for new (often first-time) parents.

Pyloric stenosis is the over-development of the muscle ringing the stomach’s outlet. Weird stuff, but rather serious: it stops the baby’s food going further and the result is dire.

By the early 1900s, several fairly crude techniques were sometimes used to try to correct the problem, but the failure rate was ultra high. The French surgeon Pierre Fredet advocated “pyloroplasty” – cutting and then stitching the pylorus, with the aim of weakening the overgrown muscle to open the passage – but babies rarely survived this procedure. Another “answer” was to open the stomach and stretch the pylorus from its inside – pretty drastic stuff! No wonder babies rarely survived.

Then on 23 August 1911 the German Army surgeon Conrad Ramstedt noticed that splitting the hard and enlarged muscle around the pyloric canal lengthwise (but taking care to leave the inner lining of the passage intact) immediately relieved the obstruction. When his stitches to close the cut muscle (for pyloroplasty this was the accepted technique) immediately ruptured and the passage stayed open, he decided to leave the wound gaping wide – and his baby boy patient (the firstborn and son of a friend) went on to flourish.  Ramstedt tried this technique of splitting and spreading the pylorus muscle (instead of sewing it up) again some months later – with similar results. The gaping little cut in the muscle band clearly healed by itself in good time, and with food able to pass again, the babies recovered.

Would you allow a surgeon like Dr Conrad Ramstedt (seen here perhaps in the 1940s) near your sick baby?

Ramstedt’s procedure is one of the simplest surgical tasks: nothing is removed.  No wonder surgeons regard it as “elegant surgery”.  Pyloric stenosis surgery (and medical treatment when the baby’s condition is not too weakened) is very much based on the principle that medical intervention should ideally aim to help the baby survive long enough to heal itself.

Different studies in the 1910s and ’20s show that up to 70% of babies still died despite the surgery. At post mortems it was noticed that by about two months after surgery and a little longer after medical treatment, the swollen pylorus had returned to its normal size.

Conrad Ramstedt spoke about and published his accidental discovery of this procedure (“pyloromyotomy”) in 1912, and it has become known as “Ramstedt’s operation” and sometimes the “Fredet-Ramstedt operation”.

Whichever, Hallelujah! Praise God! It’s been a lifesaver for millions of babies and their stressed-out parents – and discovered by an accident, some careful observation, and some courage to try an innovation.

I had this stomach issue at just 10 days old (quite early), had the surgery and like lots (almost everyone now) I survived and flourished.  I have had no major physical problems since, unlike the substantial minority who have had trouble with adhesions or gastric issues from the operation.  But I am one of those who has struggled with PTSD issues for much of my life.  It’s becoming increasingly clear that this stress arose from (1) the way the surgery was done until recent decades and (2) my mother being so traumatised by the various effects on her of World War 2 and later by my infant surgery that it affected me.

These are all challenges I plan to discuss on this site.  However, I’m really grateful for medical skills – and sometimes for accidents.

9 thoughts on “A survivor by an accident

  1. Wendy

    Wonderful writing–engaging and humorous. I especially loved the subject, having survived infant surgery for pyloric stenosis as well. I love the story of the accidental success. (This situation is often the case with scientific discoveries.) I was very lucky to have survived and to have had no complications, unlike many who, as Fred stated, suffer from adhesions. I have suffered PTSD from the surgery, however. I only discovered this in the last few years, so I want to make folks aware that many of us who have had early traumatizing medical experiences still suffer psychological effects. Many of us had no anesthesia for those pre-1980 procedures. I am so thankful to this website for discussing issues regarding infant surgery with grace, clarity, and style.

  2. John

    This was a very nice post. I want to put something in writing like this, taking time and precise effort to make a very good article… but what can I say… I procrastinate alot.

  3. Fred Vanderbom Post author

    Give it it go, start with a short and straight-forward story or message about something you feel strongly about. Write and rewrite it over some time. The web has lots of helps.

  4. Jon

    Thank you for this information! I am a survivor of a PS procedure that I had at age 2 months, have a very small scar and no adhesions or lasting effects. I wondered about the history of the surgery and I found your post very helpful and interesting!

    1. Fred Vanderbom Post author

      Thanks for your Comment, Jon. I also found the history interesting enought to make more available, and will write some more about it here sometime. Many are treated for PS like yourself – thankfully without ill effect. But there are also substantial numbers with ongoing challenges of several kinds. That’s the main reason I’m blogging here.

  5. Kathy G

    Thank you Fred! I had PS surgery in 1951 probably hours away from dying.
    I was very dehydrated and was rushed to Duke Univ. Hospital from my NC town.
    I have had five children and in 1984, my last born son was diagnosed with this disorder. He was close to 3 weeks old when the projectile vomiting started, but I noticed right away, he did not seem to be comfortable while suckling from the start… almost like it was a strain in that area. With much pressure on the docs, I got them to perform an ultrasound that showed the problem. I kept saying “But I HAD pyloric stenosis!”
    He was in surgery within an hour and home in 3 days!
    My scar is medial upper abdominal and long, his is a shorter neater scar right over the pylorus muscle.
    We are both anxious; I wonder if this trauma of being cut and having our bowels pulled and cut on without the proper surgical meds have indeed left their mental mark! I would love to hear more from any of your readers or you about this and thank you for the history of our life saving surgery. A wonderful accident saved my life and the life of a beautiful young man, my son.

  6. Fred Vanderbom Post author

    Your Comment is encouraging and your story was valuable and is all too typical in what you wrote about the diagnosis of your son, Kathy. The story of Ramstedt’s discovery of the simplest way to fix PS is wonderful, and this man has restored life and happiness to so many of us and our parents.
    I have written a few posts about some of the long-term effects of the starvation, dehydration and surgery – the latest in September (Is a sick and starving baby affected for life?). Many medical articles stress that only the pylorus should be taken outside the wound, so it’s likely there can be a problem here, and adhesions are the most recognised result. Let’s hope that with increasing use of minimal access surgery the after-effects will be reduced.
    A PS history certainly makes one aware of the wonder of the gift of life!

  7. Pingback: Stories from the Survivors of early Surgery

  8. Pingback: Pyloric stenosis surgery makes a century! (2) « Stories from the Survivors of early Surgery

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