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.
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.