PYLOROSPASM There is no doubt that there are pathological conditions in infancy, the manifestations and course of which could without constraint be explained by the assumption of a mechanical interference with the physiological evacuation of the stomach, in which organic stenosis is never found and where there is no clinical or anatomical probability for its presence. The most important of these signs probably is constantly recurring vomiting, or hyperemesis lactentium. This in itself no doubt admits of totally different interpretations than (functional) pyloric occlusion. It might be occasioned by hyperwsthesia of the gastric mucosa, and it must unquestionably be conceded that cases of hyper emesis occur on this basis. But this assumption no longer holds good if vomiting occurs at a later digestive period, and especially if it is associated with retention of the chyme. In that case, however, there .might still be hypotonic conditions of the gastric musculature (motor insufficiency consequent upon atony). Furthermore, the occurrence of this group of affections, which is well known in the pathology- of adults, in infants shall not be denied, especially in older rachitic infants. In early infaney, however, manifestations in other motor areas and the behavior of the patients in regard to their nervous functions will not, as a rule, admit of the assumption of primary atony; on the contrary, they rather show a pronounced tendency to hypertonic and spastic conditions. These early cases very closely suggest the assumption of pylorospasm being at the bottom of the gastric manifestations.
This assumption considerably gains in probability on consideration of the fact that the above described hypertrophic pyloric stenosis (type Ifirschsprung) develops, in the opinion of the majority of authors, on the basis of a primary pylorospasrn; that in demonstrably hypertrophic conditions spastic factors continuously participate; and that even the cardinal symptoms of that affection are not caused by the hypertrophy, but by atypical motor conditions. It can further be supported by the
proof of the presence of etiological factors for the spasm, by the effect of certain therapeutic measures, by the positive occurrence of such conditions in older children and adults, and filially by negative findings in operations and autopsies. That the latter are not frequently estab lished is easily explained by the relatively favorable course of pyloro spasm, and other factors, such as psychology.
It is only natural that the pathological picture of pylorospasm is less sharply and precisely demarcated than that of hypertrophie stenosis, the entire pathology of which is still attributed to it to-day by French authors, while other unitarians are of the opposite opinion: that the pure disturbance of innervation may be absolutely eliminated and that the interpretation of all these cases as hypertrophie stenosis is sufficient.
tinder these circumstances it is, of course, difficult to draw a com plete picture of the affection. The attempt, however, to do so in the following sketch, will be justified, the more so as it may serve to furnish a desirable fortification of the doctrine.
Occurrence.—Pylorospasm seems geographically widely prevalent. It occurs as a family affection. The author is inclined to attribute great importance to the factor of general (congenital?) neuropathy. The patients arc mostly restless, cry for hours without any apparent cause, have twitching, spasmotic contraetures, as if from fright, and enjoy but short and light sleep. They exhibit a changeable temper and disposi tion, overexeitability of the vasornotors, general myotony, tense abdom inal walls, nystagmus, laryngospasm, tetany, and spastic cough Weiser).
The illness commences without any assignable cause, or perhaps in the course of a slight digestive disturbance in the first month of life and certainly even beyond the eighth week. tip to that period a predis position of the male sex and of breast-fed infants is not yet recognizable.