During the past few months I have thoroughly enjoyed learning and writing about and passing on some of the history of treating pyloric stenosis (PS), the condition that 100 years ago used to starve to death the great majority of babies afflicted by it. Today the deathrate among PS infants in most countries is (or should be) minimal: well under 1%.
What have I learnt and how have I benefitted?
1 I was heartened by the continuous improvement with new treatment techniques and new drugs.
I have been able to trace and inwardly celebrate these advances. 100 years ago, medical treatment (albeit crude) was strongly preferred to surgery; the surgical techniques were terribly harsh on a weakened infant and rarely successful. Today the medical treatment avenue has benefitted from better versions of the basically same drugs, it is usually quite responsible and successful, and the medical world should be much more aware of what can and cannot be done by the medical management of PS.
In many developed countries the health industry has become so sophisticated and costly that for mainly cost/benefit reasons, most pediatricians will send almost all recognised PS babies straight to a surgeon; the medical treatment route is simply and sadly even more expensive.
The improvement of the surgical option has often been held back by surgeons being bogged down in their training and habits, but over a century the progress is still very obvious: I have posted a considerable number of scar illustrations to make this clear.
With the ageing and passing of two or three generations, scars from PS and several other kinds of surgery should become far less obvious.
2 I now understand much of what my traumatised parents did or could not explain to me.
Like I imagine many of us, I could not bear to go through life with a foreign, obvious and ugly scar and not know what caused it. Even as a child I already wanted to know what physically happened to make such marks on my body.
My parents (like many, I have discovered, and quite understandably so) could never bring themselves to answer my questions, let alone take the initiative in raising the subject. I also realise that with the advent of the internet, I can answer my childhood and later questions so much better than they could ever have done.
On this blogsite I have appealed to parents of scarred children to talk. But I also increasingly realise how hard many parents find this. I plan to devote a blog to this area soon.
3 I now understand the essence of some of the issues that divided the pediatric and pediatric surgery community over the past century.
Why did so many surgeons refuse to give babies pain relief, let alone local or general anesthesia?
Why did those who recognised that babies are affected by pain divide over whether to use local or general anesthetic?
Why wasn’t I treated with medicine as many were over this century?
When both avenues of treatment (medicine and surgery) were respected, why were some babies treated with medicine and others sent to the surgeon?
Why were (and are) some babies intubated awake while the majority are “put to sleep” before a tube is inserted into their airway, a terribly traumatic experience because it induces the gag reflex in babies even more so than in adults?
4 I have a much better appreciation of why PS and other life-threatening conditions of infancy are still so partially (and actually poorly) understood.
Despite having been recognised for around 300 years, many studies, and “modern medicine” being (arguably) a century or so old, the causes of PS are still only partially understood and the object of much debate and even argument.
Researching this subject has given me a deeper understanding of the complexity of the causes of PS and the sheer vastness of medical knowledge that needs to be assimilated.
5 I realise that physical and emotional trauma and scarring from PS treatment have been much reduced.
Despite the fact that many areas of ignorance, uncertainty and debate remain, the improvements that have occurred to date are (I am grateful to say) obviously reducing both physical and emotional trauma and scarring. This area is of the greatest interest and concern among people like me whose lives have been long and deeply affected by our infant surgery.
Next time: some of the negative thoughts I had as I worked on the medical journal material on PS.