The medical diseases of children . dilatation of the pelves of the kidneys whichhas been reported. Theoretical Considerations.—Of the theories which have beenadvanced to explain the origin of hypertrophic pyloric stenosis, twoonly need be considered. In the first it is supposed that at the timeof the childs birth the pyloric wall is thicker than normal, and that HYPERTROPHIC PYLORIC STENOSIS 263 from this there arises, either immediately or later, stenosis of the outletto the stomach. This theory, then, assumes the presence of a congenitalanatomical abnormality. The second theory is to the eff
The medical diseases of children . dilatation of the pelves of the kidneys whichhas been reported. Theoretical Considerations.—Of the theories which have beenadvanced to explain the origin of hypertrophic pyloric stenosis, twoonly need be considered. In the first it is supposed that at the timeof the childs birth the pyloric wall is thicker than normal, and that HYPERTROPHIC PYLORIC STENOSIS 263 from this there arises, either immediately or later, stenosis of the outletto the stomach. This theory, then, assumes the presence of a congenitalanatomical abnormality. The second theory is to the effect that thereis no such malformation, but that spasm of the pylorus, set up in theearly days of life, and occasionally before birth, accounts for the hyper-trophy and for the stenosis. In both views the hypertrophy of thestomach is compensatory in order to overcome the stenosis at thepylorus. These two views require some consideration, for various authorities—unfortunately as it seems to me—have very dogmatically laid down. Fig. 51.—Hypertrophic Pyloric Stenosis:Stomach showing hypertrophy ofpyloricand gastric walls, also folding of pyloric mucosa. rules for the treatment of the disease founded upon their speculationsas to its origin. That the disease is due to a congenital malformation is supportedto some extent by its sex-incidence and its frequency in firstbornchildren. It is difficult to see why an acquired disease should showthese two peculiarities, while such might occur in a congenitalmalformation. The view is also supported by the fact that a hyper-trophied pylorus has once been found in a foetus (Dent). Againstthis theory, however, are several important points. That thecircular muscular coat of the pylorus should alone be involved iswithout question peculiar. That the symptoms of stenosis, usually 264 DISEASES OF THE DIGESTIVE SYSTEM absent at birth, should come on later, is difficult to explain by thistheory alone ; for a gradual narrowing of the pyloric open
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
