{"id":{"repo_id":"edinburgh","oai_identifier":"oai:era.ed.ac.uk:1842/31780"},"canonical_url":"https://search.dev.ndltd.org/etd/edinburgh/oai:era.ed.ac.uk:1842/31780","repository":{"repo_id":"edinburgh","name":"University of Edinburgh","base_url":"https://era.ed.ac.uk/server/oai/request"},"display":{"title":"Congenital hypertrophic pyloric stenosis: a historical, anatomical, pathological and clinical study","abstract":"PATHOLOGY: We feel we have shown, by histological sections of the normal pylorus and of the pylorus affected by congenital hypertrophy, that the pyloric sphincter itself is not directly affected by the hypertrophy.","abstract_html":"PATHOLOGY: We feel we have shown, by histological sections of the normal pylorus and of the pylorus affected by congenital hypertrophy, that the pyloric sphincter itself is not directly affected by the hypertrophy.","abstract_has_math":false,"creators":["Douglas, John Alexander"],"institution":"The University of Edinburgh","degree_name":null,"degree_level":null,"degree_discipline":null,"degree_department":null,"school":null,"contributors":[],"advisors":[],"committee_chairs":[],"committee_members":[],"year":1935,"date_issued":"1935","date_published":"1935","updated_at":"2026-07-24T02:14:11Z","subjects":[],"languages":[],"rights":[],"rights_urls":[],"identifier_entries":[]},"links":{"outbound_url":"http://hdl.handle.net/1842/31780","outbound_label":"Handle","outbound_source":"dc:identifier.uri"},"metadata_groups":[{"id":"people","label":"People","entries":[{"key":"dc:creator","label":"Author","values":["Douglas, John Alexander"]}]},{"id":"academic_context","label":"Academic Context","entries":[{"key":"dc:date.accessioned","label":"Dc Date Accessioned","values":["2018-09-13T15:47:30Z"]},{"key":"dc:date.available","label":"Dc Date Available","values":["2018-09-13T15:47:30Z"]},{"key":"dc:date.issued","label":"Date","values":["1935"]},{"key":"dc:publisher","label":"Institution","values":["The University of Edinburgh"]},{"key":"dc:type","label":"Dc Type","values":["Thesis or Dissertation"]},{"key":"dc:type.qualificationlevel","label":"Dc Type Qualificationlevel","values":["Doctoral"]},{"key":"dc:type.qualificationname","label":"Dc Type Qualificationname","values":["PhD Doctor of Philosophy"]}]},{"id":"identifiers","label":"Identifiers","entries":[{"key":"dc:identifier.uri","label":"Identifier URI","values":["http://hdl.handle.net/1842/31780"]}]},{"id":"additional","label":"Additional Metadata","entries":[{"key":"dc:description.abstract","label":"Abstract","values":["PATHOLOGY: We feel we have shown, by histological sections of the normal pylorus and of the pylorus affected by congenital hypertrophy, that the pyloric sphincter itself is not directly affected by the hypertrophy.","The prepyloric portion of the pyloric canal undergoes marked hypertrophy of its circular muscle, and we believe an outgrowth of this circular muscle, forcing its way into the duodenum, compresses the pyloric sphincter, which is only slightly enlarged and is seen to be at the apex of the fornix of the portio vaginalis. The points which occur to us are such questions as, whether the pyloric sphincter and the prepyloric portion of the pylorus have a separate nerve supply.","Is this under the control of the sympathetic parasympathetic nervous system? We know in Hirschsprung's Disease division of the sympathetic fibres leads to remarkable recoveries.","More recent work on cardiospasm shows very encouraging results by removing the sympathetic fibres round the left gastric artery and its oesophageal branch.","In no other condition, however, is there such marked hypertrophy of muscle at the sight of obstruction, and it seems doubtful even if the course of the sympathetic fibres to the pylorus was definitely established, that attempts would be made to divide these nerves in the hope of a satisfactory result. The treatment, by division of this hypertrophied muscle, is so satisfactory in this condition, that little in the way of methods of treatment is being sought after, but more in the nature of methods of prevention. The causation, however, still remains definitely obscure.","CLINICAL: This thesis is based on fourteen cases operated on over a period of nine years. Two of the cases were delivered into this world by the author and these were the only cases operated on at an early date. The average age of these infants when submitted to surgical treatment was 6 weeks and the average weight was 7 lbs. 8 ozs. In all cases a Fredet-Rammstedt operation was performed.","The majority of these infants were discharged from hospital within seven to nine days.","Two of these babies died, one from broncho pneumonia 14 days after the operation, and the other immediately after operation owing to the parents refusing operation when the child was four weeks old, and returning two months later with the marasmic, dying infant, pleading for something to be done. The prognosis in this case was extremely bad as the child was practically moribund and at that time our knowledge of pre-operative treatment was very much less than it is now.","The work of Maizels & McArthur, who stress the value of pre -operative treatment and the recognition of alkalosis so common in neglected pyloric stenosis cases has, we feel, done much to make the course of these little patients much easier after operation and has resulted in a greatly lowered mortality.","Another important factor is the advantages of the private room in hospital and the private nurse. Most of these cases were operated on in the Transvaal Memorial Hospital for Children.","All were in private rooms and many had their own private experienced children's nurses.","Congenital pyloric stenosis has always been looked upon., and we believe rightly, as a medical disease.","The operation is only an incident, albeit an important one, in the malady.","The gradual onset, the change from occasional regurgitation to the characteristic vomiting, the presence of gastric peristalsis and the routine palpation of the abdomen for a tumour must be the duty of the physician.","Similarly, after the operation, the details of feeding are of great importance to secure a successful_ result and entirely beyond the province of the surgeon.","The surgeon may study his operation figures and decide that his failures occur in wasted infants who have been weaned from one patent food to another. That his successes occur in the breast fed children of nearly normal weight and in his private cases which are nearly always diagnosed and operated on at an early age. It is reasonable for him to ask that his aid should be invoked before the patient is in extremis.","We agree most heartily with Wallace & Wevill who show, in a report of 145 pyloric stenosis cases operated on in the Royal Hospital for Children, Edinburgh, that if the mortality rate which in this series was in the region of 20% is to be reduced to a reasonable figure,it is essential that the diagnosis should be made at a much earlier date.","There appears in nearly all cases to be a period of three to four weeks after the commencement of symptoms, during which time these cases are treatrl as digestive disorders and the feeding is changed every few days in the vain hope that the vomiting will cease. Eventually, when the child is more or less in extremis, it is sent to hospital in a state of health which makes any form of treatment a dangerous procedure.","Pyloric $tenosis should be considered as a possibility in every case of forceful vomiting in infancy and it should be recognised that the longer the delay in sending the cap i ld for treatment the less are its chances of survival.","It should be cons idered an abdominal emergency of infants and one feels confident, if the condition . were diagnosed within one week after the commencement of symptoms and sent for operation without delay, the mortality rate would be greatly reduced,","How can this be attained? We feel it is only from the family doctor, more keenly alive to this somewhat rare disease and more aware of the possibili ties of surgery, that further improvement must come."]},{"key":"dc:title","label":"Title","values":["Congenital hypertrophic pyloric stenosis: a historical, anatomical, pathological and clinical study"]}]}],"canonical_facts":{"dc:creator":["Douglas, John Alexander"],"dc:date.accessioned":["2018-09-13T15:47:30Z"],"dc:date.available":["2018-09-13T15:47:30Z"],"dc:date.issued":["1935"],"dc:description.abstract":["PATHOLOGY: We feel we have shown, by histological sections of the normal pylorus and of the pylorus affected by congenital hypertrophy, that the pyloric sphincter itself is not directly affected by the hypertrophy.","The prepyloric portion of the pyloric canal undergoes marked hypertrophy of its circular muscle, and we believe an outgrowth of this circular muscle, forcing its way into the duodenum, compresses the pyloric sphincter, which is only slightly enlarged and is seen to be at the apex of the fornix of the portio vaginalis. The points which occur to us are such questions as, whether the pyloric sphincter and the prepyloric portion of the pylorus have a separate nerve supply.","Is this under the control of the sympathetic parasympathetic nervous system? We know in Hirschsprung's Disease division of the sympathetic fibres leads to remarkable recoveries.","More recent work on cardiospasm shows very encouraging results by removing the sympathetic fibres round the left gastric artery and its oesophageal branch.","In no other condition, however, is there such marked hypertrophy of muscle at the sight of obstruction, and it seems doubtful even if the course of the sympathetic fibres to the pylorus was definitely established, that attempts would be made to divide these nerves in the hope of a satisfactory result. The treatment, by division of this hypertrophied muscle, is so satisfactory in this condition, that little in the way of methods of treatment is being sought after, but more in the nature of methods of prevention. The causation, however, still remains definitely obscure.","CLINICAL: This thesis is based on fourteen cases operated on over a period of nine years. Two of the cases were delivered into this world by the author and these were the only cases operated on at an early date. The average age of these infants when submitted to surgical treatment was 6 weeks and the average weight was 7 lbs. 8 ozs. In all cases a Fredet-Rammstedt operation was performed.","The majority of these infants were discharged from hospital within seven to nine days.","Two of these babies died, one from broncho pneumonia 14 days after the operation, and the other immediately after operation owing to the parents refusing operation when the child was four weeks old, and returning two months later with the marasmic, dying infant, pleading for something to be done. The prognosis in this case was extremely bad as the child was practically moribund and at that time our knowledge of pre-operative treatment was very much less than it is now.","The work of Maizels & McArthur, who stress the value of pre -operative treatment and the recognition of alkalosis so common in neglected pyloric stenosis cases has, we feel, done much to make the course of these little patients much easier after operation and has resulted in a greatly lowered mortality.","Another important factor is the advantages of the private room in hospital and the private nurse. Most of these cases were operated on in the Transvaal Memorial Hospital for Children.","All were in private rooms and many had their own private experienced children's nurses.","Congenital pyloric stenosis has always been looked upon., and we believe rightly, as a medical disease.","The operation is only an incident, albeit an important one, in the malady.","The gradual onset, the change from occasional regurgitation to the characteristic vomiting, the presence of gastric peristalsis and the routine palpation of the abdomen for a tumour must be the duty of the physician.","Similarly, after the operation, the details of feeding are of great importance to secure a successful_ result and entirely beyond the province of the surgeon.","The surgeon may study his operation figures and decide that his failures occur in wasted infants who have been weaned from one patent food to another. That his successes occur in the breast fed children of nearly normal weight and in his private cases which are nearly always diagnosed and operated on at an early age. It is reasonable for him to ask that his aid should be invoked before the patient is in extremis.","We agree most heartily with Wallace & Wevill who show, in a report of 145 pyloric stenosis cases operated on in the Royal Hospital for Children, Edinburgh, that if the mortality rate which in this series was in the region of 20% is to be reduced to a reasonable figure,it is essential that the diagnosis should be made at a much earlier date.","There appears in nearly all cases to be a period of three to four weeks after the commencement of symptoms, during which time these cases are treatrl as digestive disorders and the feeding is changed every few days in the vain hope that the vomiting will cease. Eventually, when the child is more or less in extremis, it is sent to hospital in a state of health which makes any form of treatment a dangerous procedure.","Pyloric $tenosis should be considered as a possibility in every case of forceful vomiting in infancy and it should be recognised that the longer the delay in sending the cap i ld for treatment the less are its chances of survival.","It should be cons idered an abdominal emergency of infants and one feels confident, if the condition . were diagnosed within one week after the commencement of symptoms and sent for operation without delay, the mortality rate would be greatly reduced,","How can this be attained? We feel it is only from the family doctor, more keenly alive to this somewhat rare disease and more aware of the possibili ties of surgery, that further improvement must come."],"dc:identifier.uri":["http://hdl.handle.net/1842/31780"],"dc:publisher":["The University of Edinburgh"],"dc:title":["Congenital hypertrophic pyloric stenosis: a historical, anatomical, pathological and clinical study"],"dc:type":["Thesis or Dissertation"],"dc:type.qualificationlevel":["Doctoral"],"dc:type.qualificationname":["PhD Doctor of Philosophy"]},"updated_at":"2026-07-24T02:14:11Z"}