PYLORIC STENOSIS IN INFANCY Such cases have been ob served as far back as the eighteenth century', but the real historical literature of pyloric stenosis in infancy originates with a lecture held by the Danish pecliatrist Hirschsprung before the German Pediatric Society in Wiesbaden, in 1887. On that occasion Hirschsprung communicated two eases which he believed to belong together. The first case presented the very characteristic features of what has since become known as "hypertrophic pyloric stenosis," type Hirschsprung, while the second case. in all probability belongs to a different group. Thus it is a. remark able fact that -the very first publication on the subject permits of the assmnption that the nature of pyloric stenosis in infancy' may have a different origin and that there is danger of confusing one condition with another.
Hirschsprung's publication gave rise, in the first place, to the com munication of a few isolated further observations. Such observations were, for instance, made in Heubner's clinic, where Finkelstein compiled the same in a valuable work which, from a symptomatic as well as diagnostic point of VieNV, was a considerable advance. General interest, however, was only aroused about ten years after Hirschsprung's dis covery, when the therapeutic indications became the subject of lively controversy. At that time surgery commenced to take these cases in hand, and this was objected to on the ground of newly gained experience on the anatomical basis and the nature of the affection. The question arose whether pyloric stenosis in infancy, which up to then had been exclusively regarded as a congenital organic defect, was not—at least partly—caused by a functional disorder, and, if so, whether it was justifiable to relegate all the observations made to one uniform treat ment or whether at least two entirely distinct groups should not be recognized (Pfaundler, 1S9S).
However, many authors still look upon the nature and clinical features of the affection as uniform, with the exception of a few exceed ingly rare cases which should unquestionably' receive different treatment and which will be specially referred to later on (p. 21S) These "unita rians," however, are divided into two camps, for, while the majority of French physicians, and others, will not acknowledge any organic basis at all, holding a spasm of the pyloric musculature responsible, many German authors believe that every clinically pronounced case of this description is based upon muscular hypertrophy. The dualistic doctrine, which has found more supporters in England and America than in Ger many, is shared by the author, who holds the conviction that in the arrangement of the material due regard should be paid to the needs of the practitioner. At the same tirne it may once more be emphasized that, by following this arrangement, it is not intended to deny the possi bility, or probability, of a close genetic connection between the two types.
There is now an abundant literature on this question. It is dis cussed in nearly every volume of pediatric periodicals and at every pediatric congress, which proves the vast interest aroused in this peculiar pathological picture. Two years ago the number of reported cases and publications on the subject amounted, according to Ibrahim, to more than 400, and has more than doubled since the first edition of his work. A list of the more important puhlications of the last few y-ears has been appended to this chapter.