Past Pylorix Pages – Pyloric Stenosis treatment in the 1940s (1)

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.

New dads learning to feed their baby in the 1940s

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.

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8 thoughts on “Past Pylorix Pages – Pyloric Stenosis treatment in the 1940s (1)

  1. wendy williams

    Loved this article. I especially loved the picture of the dads feeding their new babies. It’s fascinating to learn about the ways the English went about trying to perfect the care of infants with PS. Equally interesting is learning that in the forties, an almost equal number of babies were treated medically and surgically. Can’t wait to read about what happened in the fifties.

    Reply
  2. Fred Vanderbom Post author

    Ah, I found that great photo of the dads learning to bottle-feed their babies and just had to slip it in – glad you liked it too.
    Sadly, the English had terrible infant mortality rates for many decades in the 20th century: one report says around 25% when the North American rate was about 2%. The Brits needed to do a lot of work to address this heart-rending statistic. Having spent a few weeks in G B in 1976 and again recently, the improvement in personal cleanliness was rather obvious… and gratifying. The lack of personal care was the biggest single factor in the high infant death rate in public hospitals, and the irrepressible Dr David Levi several times expressed his disgust and frustration about this.

    Reply
  3. Phillip C.

    Fred Vanderbom,
    My name is Phillip and my daughter was born with IPS. The standard Pyloromyotomy was done in 2006 and after this she was 100% better. The operation was done when she was 2 months old, she is now 5 years old. She has a problem gaining weight. I am researching this also, I was curious if you found a lot of post op data about children’s weight gain and eating habits. Her eating habits are irregular, however she eats plenty. Her weight has fluctuated between 4 lbs over the last 2 years and her doctor says it is normal, because the women in both families are petite. She is smart, strong, and a great kid and I am very thankful for the operation. I need to know if there is something more I can do.
    Thank You,
    Phillip

    Reply
  4. Fred Vanderbom Post author

    Phillip, your story is not uncommon, but I also have not been able to find research reports dealing with this frustrating pattern. I will certainly keep your Comment and concern for your daughter on file and get back to you if I find something.
    You probably recognise that you have had the same response other parents also report getting when they consulted a pediatrician about this: the subject of gastric behaviour and eating habits seems to be complex and unless a child is wasting away or otherwise seriously affected, the recommendation is usually, let’s wait and see.
    Two of my sisters, also of petite build but without a PS history, had eating problems until teenage, and one of them at times looked quite unwell, but their weight did not fluctuate. By maintaining a nutritious, balanced diet and with much diligent patience at mealtimes my mother was able to see them grow out of their trouble into strong, healthy and productive adults. Perhaps at times all we can do as parents is our level best.

    Reply
  5. Brandy

    I had pyloric stenosis and underwent surgery for it at 6 weeks old. I have had problems with eating, weight gain since childhood. I am not sure if there’s a correlation, which is why I’m writing. I am almost always hungry and want to eat. I am (thankfully) not obese but can absolutely see how I could, should and would be if I hadn’t had liposuction surgery. I work out and try to eat healthy. I find that I do feel full but it’s like there’s a mental hunger. I don’t know how else to describe it.
    I had an uncle who had Infant P/S and died from obesity. My 1 year old nephew also had it and (thankfully) he has a very healthy appetite. I’m concerned about his future, considering the family history. I’ve battled over-eating, anorexia, bulimia and all sorts of eating disorders since a very young age as I have always fought to avoid the obesity I was told was a possibility as a result of IPS. I find that I battle with this constantly and was curious as to whether or not there were others with this experience? Are there any findings? Are there things that can or should be done in order to not cope but overcome this struggle??

    Thank you!!!

    Reply
    1. Fred Vanderbom Post author

      Brandy, what you write here is not universal after IPS: many have no great complaints and others again cannot gain or lose weight (opposite problems). But sadly your kind of issues are far too common for there not to be a connection. However, there have been only a very few small and shallow research projects on this that I’ve been able to find, and they all say, yes there seems to be a link but it’s not significant. That doesn’t sound like a way forward to me.
      I will email you about this but let me just note a few general possibilities.
      1) It could be that your family’s obesity problems are genetically caused and thus constitutional. Your nephew’s parents will need to teach him good diet and lifestyle attitudes to help him avoid weight issues seriously affecting him in later life.
      2) Your problems could be related to your IPS and its surgery. The minor studies I’ve posted about admit this possibility. Many of us with PS and stomach surgery in our history have gastric issues – but then many others do too. This is probably why most GPSs don’t easily admit there may be a link. By the time we are adults we have all gathered several possible causes of gastric, over- or under-weight problems: genes, diet, life experiences, other health factors, etc. If the gastric issues are effects of the PS or surgery, we cannot do much about the past except to understand and deal with it as best we can.
      3) The bottom line is just that: work through our possible genes/make-up, psychological, emotional, diet, lifestyle and other issues that have made us who we are, and then begin working on the ones most likely to be troubling us. Most of us need a friend or other help to do this effectively.
      Best wishes – and please do let us here know how you get on.

      Reply
  6. Mindy09

    I had pyloric stenosis surgery when I was a month old. I’m now 21 and all my life, I’ve never been able to eat normally. I feel full after eating just a few bites and any more bites cause nausea. Has it anything to do with my past surgery??

    Reply
    1. Fred Vanderbom Post author

      You would need to see a supportive GI specialist and have some tests done to find the cause of your trouble, Mindy. Quite a number of gastro-intestinal problems (from minor to major) are rather common among those of us who had infant PS and its surgical remedy, but many doctors go by the textbook mantra that “there are no lasting side-effects”. There are several medical articles and some enlightened doctors who recognize that there can be a link, and it’s medically explainable. Don’t believe the deniers. You can either live with managing your condition (as you have for 21 years), or persist in finding its cause and if possible a solution. The Facebook “Pyloric Stenosis Support Group” has many stories from people like you and including your problem. So does a “Patient UK” forum and one on Topix. Check them out if you’re interested. Feel free to respond here.

      Reply

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