In this fourth post in this series, we look at the decade in which I was born and started my story with the infant form of pyloric stenosis (PS). Each decade during the 20th century saw more professional medical interest in and discussion of this condition, more medical journal reports and studies were published, and the survival rate of PS babies rose further.
It is not surprising that the differences about treatment that we noted in the previous blog continued and even intensified during the 1940s.
- Should medical treatment always be considered, or should PS now be regarded as the scalpel’s territory?
- What are the advantages and disadvantages of local and general anesthesia?
- Which incision should be used to access the overgrown pylorus?
- How can the deathrate be lowered further?
I writing this overview I have been able to read dozens of medical journal articles, and they give a picture that I find tremendously interesting. They show the medical community was quite divided on the above and some other related questions – sometimes sharply and deeply so. These accounts have also given me the key to knowing and understanding much more about my own PS surgery than my parents would ever tell me (or knew), even though it’s now 66 years after the event! The web is wonderful.
The article I found the most valuable by far was included in the July 1947 issue of the Archives of Disease in Childhood. It reviewed the carefully kept records of 112 PS cases treated in a large regional English hospital from 1938 to 1945, seeking especially to discover why there could be such a wide variety of results of both medical and surgical treatment of PS, as well as assessing its own practice.
- In the light of what I wrote about the 1930s, it is interesting that only 8 of the cases were decided on the basis of x-rays; in the other 104 cases a palpable tumour was taken as confirmation.
- Nursing mothers were admitted along with their baby, and separate “pyloric stenosis cubicles” were provided for each infant, both to minimise cross-infection.
- Normally, glucose and salts were given alternately into each armpit and groin until the baby was rehydrated. So that’s why I have those hidden mystery dimples…
- Then medical treatment with eumydrin was usually tried, and the stomach was washed out twice daily, with enemas being given if needed – all to rid the little body of gastric residue.
- It is noted that several studies had found that older babies responded better to medical treatment than the younger ones. Babies went to surgery when it became clear they were not responding to eumydrin after a few days.
- 12 of the 112 PS patients died: all had been admitted with “gross” or “serious” dehydration, and it was believed that these could have been saved after rehydration and prompt surgery; low birth weight was another mortality factor, and one baby died of bronchopneumonia that developed less than 12 hours after the careless use of ether (which was often very chilled).
The article reports that a search of medical literature shows that between 1910 and 1944 there was an average of 11.8% mortality from a large number of PS cases, and that these deaths were very evenly divided among the 4,162 treated medically and the 3,508 surgical cases. It comments that many of the reports giving poor or excellent results for either treatment are not based on comparable techniques and conditions.
The recommendations are not surprising:
1 Use separate cubicles;
2 Breast-feeding greatly reduces gastroenteritis infections;
3 Set clear criteria for the choice of treatment based on (1) the hospital’s and doctor’s experience with the treatment method, (2) the availability of treatment, and (3) the special considerations regarding each patient, including the age of PS onset, the baby’s weight, the duration of vomiting, the degree of dehydration, and the presence of infection.
This hospital also conducted follow-up research which found that the babies’ physical and mental development was unaffected by their illness but that some had continuing gastric problems, including delay in stomach emptying which was most common among those babies who had been in the hospital the longest.
In my next post I will pass on some more of this wealth of material that is so telling about the treatment of PS during the 1940s.