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Moore, Beveridge Harshaw, Miller, Jos. L. Discussion.....343
Chicago

..200 Miller, S. M. Paper.... . 100
Legislation, Medical, Supplemen-

Murray, Warren Garfield, Discussion. (Paper 214) ..116
tary Report of the Commit-

Kankakee

254 Minutes, House of Delegates.... 27
tee on. (E)..

66

Parr, Samuel E., Ottawa.....137 Minutes, Official, of 63rd Annual
Lespinasse, V. D. Discussion. .175

Meeting

22
Pearce, Warren Frederick,
Leucorrhea and Cervical Ero-

Quincy

...137 Minutes of Sections One and
sions, Dry Treatment of.

Two

23
John A. Koch, Quincy.... .330 Pratt, John Abraham, Aurora. 200

Minutes of Section on Eye,
Lewis, Henry F. Letter. .307

Quillin, Lawrence Jacobs, Ear, Nose and Throat...... 25
Lewis, Henry F. Paper.. 307

Streator

.317

Minutes of Section on Public
Lilienstein, S. Paper..
9 Savage, Robert Garfield, Oak

Health and Hygiene

26
Lillie, C. W. Discussion.. .107

Park

.137 Mitral Stenosis,

Stenosis, Complicating

Pregnancy.
Lind, Dr., a Pioneer.
Sawyer, Alvah Lewis, Chi-

S. E. Munson,
.124
...200

.114

Springfield
cago

364
Litany for Doctors..

Slinde, Arthur Christian, Chi-

Mix, Chas. L. Discussion.. .341
Lydston, G. Frank. Letter.. ..372

cago
.317 Mundt, G. H. Discussion......

.346
Lydston, G. Frank. Paper.....321

Tanquary, Reuel James, St. Munson, S. E. Paper ..... 114
Louis

..200 Murphy, John B. Discussion. .344
M

Thomas, Russell V., Manteno.317 Mycoses—New Enemies of Man-
Timmons, Clifton Kersey, Chi- kind. (E)....

65
Maclay, Otis H. Paper ........129

cago

137
Marriages :

N
Trace, Isidore Michael, Chi-
Baer, Joseph Louis, Chicago..200

cago

..386 Nasal Deflection, Odd Cases of,
Brown, Elvin Otis, Kellerville.317
Walker, Sydney, Jr., Chicago.317 with Suggestion as to Treat-

ment
Wolfer, John Adams, Chicago. 137
Burgess, Charles D., Mon-

of Nasal Adhesions.
mouth

Otis H. Maclay, Chicago.....129
386

Wood, Bert Leslie Taylor, Chi-
cago

137

New and Non-Official Remedies. 84
Cepelka, Jan Jaroslav, Chi-

Wynekoop, Gilbert H., Chi- News of the State....
cago

.317
cago

386

..78, 133, 196, 252, 314
Camp, Harold M., Monmouth.386

..308

Noble, Wm. L. Paper.....
Magnuson, P. B. Paper...

.357
Chilcott, Israel Henry, Chi-
Mann, William A. Paper..

Norbury, Frank P. Discussion.330
cago
137

73
Nose: Adhesions....

.129
Cleff, Oscar, Chicago..... 386 Mason, Mrs. F. M. Toast. 195

Nose: Deflection of Septum...129
Cornell, Edward Lyman, Chi-
Mayo Clinics. (E)...... 239

Nystagmus, Clinical Vestibular.
cago
.317 Medical Charity Commonly

John R. Fletcher, Chicago....188
Cunningham, William Henry, Abused. (E).

.236
Rockford
.200 Medical Economics. (E).... 178

O
Dew, Walter A., Belleville...317 Medical Economics, Letter of

323

Ochsner, A. J. Paper....
Dolan, John Edward, Chicago.386

Benjamin H. Breakstone......179

Officers of Societies. (See So-
Duey, Delmer R., Belleville...317 Medical Education Committee,

cieties.)

42
Farley, William K., Fulton...254

Report of
Medical Legislation, Report of

Ophthalmology, Hexamathyla-
Gollobith. Edward Frank,

min in ..

...290
Hanover

.200
Committee

48

Organization in the Antipodes,
Gould, Lyman, Chicago.......200
Medical Organization in the An- Medical. (E).....

.306
tipodes.
Graham, Ralph, Monmouth...137

(E)

.306

Osler, William. Modern Medi-
Hensler, L. J., Carrollton....137

Medicines, New, etc.

84

cine, Its Theory and Prac-
Medicine and Surgery. How Old

tice
Irwin, Millard Holloway, No-

..388
komis

137
the New in. James Walsh, Ostrum, L. Paper..

.347
New York City

153
Jerijian, Nazareth A., Chicago.254

Otrich, G. C. Paper.

295
Johnson, T. Arthur, DeKalb.. 83

Medico-Legal Defense Commit-
tee Report ...

.185
Kuhn, LeRoy Philip, Chicago. 137

P
Membership Records, Notice to
Lagorio, Frank Ambrose, Chi- Secretaries

.....370 Pfeiffenberger, Mather. Paper. 76
cago

83
Lehman,

Parks, Charles H. “Who's Who
Douglas Archer,

Membership Requirement, Pro-
posed. (E)...

305
in Delegates"

123
Harrisburg
..200

Phlebostasis; a New Treatment
Linder, Louis J., E. St. Louis. 83 Mental Abnormalities Resulting

for Broken-Heart Compensa-
from Erroneous Educational
Lischer, Robert Franklin, Mas-

tion. S. Lilienstein, Bad Nau-
Methods.
coutah

.119
..137
(E)......
heim, Germany

9
Logé, Edward S., Milwaukee.200 Metatarsalgia, The Relief of. Phthisis, Diagnosis of Incipient;

Weller Van Hook, Chicago... 11
Lowry, Nelson Horatio, Chi-

the Points Demanding Empha-
cago

83 Mettler, L. Harrison. Address. 225 sis. B. G. R. Williams, Paris.208
McPherson, Warren Gordon, Microscope, Corneal. H. S.

Physician and the Defective.
Bement
200 Gradle

71

C. J. Caldwell, Lincoln, Ill....326
Meixner, Frederick M. F., Pe-

Pierce, Norval H. Discussion.. 190
Milk Supply of Smaller Cities
oria
and Towns. W. W. Greaves,

Pierce, Norval H. Paper .......332
Montezuma, Carlos, Chicago..317 La Salle

85 Pierce, Norval H. Discussion..350

386

....136

..194

Plummer, S. C. Discussion....360 Rhinitis, Hypertrophic, Etiology Englewood Branch, Chicago
Pituitrin. Ed. Summers, Mat-

of. J. A. Pratt, Aurora......345 Medical Society, June 3,
toon

1913
127 Ritter, John, Chicago. Discus-

.131
Pneumothorax, Artificial, in sion

.208, 217
October 7, 1913

.312
Treatment of Pulmonary Tu-

Crawford County, September
berculosis. Ethan A. Gray,
Roads, Discussion on Good.....193

11, 1913

...250
Chicago

..201

Roads, Governor Dunne En- Douglas County, July 18, 1913.193
Poetry, An Appreciation. Letter dorses Good.

.177

Edgar County, July 30, 1913..193
of. G. W. Johnson. .309 Rukke, G. V. Paper....

.221 Fulton County, Oct. 7; Hen-
Pratt, J. A. Paper.
.345

derson County, Nov. 4......379
President, Report of..

37
S

Gallatin County, May Meeting. 194
Printers' Style. (E)... .122 Sachs, T. B. Paper ..

97 Hamilton County, May 6, July
Profession, Business Side of the.
Sanitation, Country School.

8, 1913

. 131
Mather Pfeiffenberger, Alton, 76
Francis G. Blair, Springfield. 95

Iroquois-Ford County, Sep-
Profession, Economic condition

tember 2, 1913

..250
of the. Charles J. Whalen,
Sawyer, Carl W. Discussion....147

Jersey County, June 10, 1913..131
Chicago
20 Schmidt, Miss Clara. Discus-

Kane County and Aux Plaines
Psychologic Clinic as a Eugenic sion

.149

Branch, August 7, 1913.....194
Agency. Clara Harrison Town,

School Sanitation,
Lincoln

Kankakee County, June 12,
150

Country.
Francis G. Blair, Springfield.. 95

1913

75
Pterygium, Case of. J. E. Col-
burn

Lake County, June 26, 1913.. 131
70

School Ventilation, Method of
Obtaining Proper. Louis Beck-

September 5, 1913... ..251
Public Health:

er, Knoxville..

94 Macoupin County, Oct. 28;
Baby's Life, Plea for....... 80
Scientific Medicine

Madison County, Oct. 3;

Call for
Baby Welfare in Chicago..
Change of Specialism. A. A.

McHenry County, Sept. 17,
199
Bondurant, Cairo

.247
Oct. 19.

.380
Cancer, American Society for

Scudder, Charles L. Paper. 1
Control of........

McHenry County, May 27,

1913
Secretary's Report ....

.27, 183
Chicago Tuberculosis Institute 82

132

August 9, 1913.
Secretaries of County Medical
Chicago Waste Disposal......317

Madison County, August 1,
Societies, to the....... ..370

1913
Eugenics .....
..317

.251
Serum and Vaccine Therapy...331
Friedmann, New York City Shambaugh, George E. Discus- Montgomery County-
Health Department. Report sion ....

..190
May 27, 1913

. 132
82 Sinus Disease, Ventilation Rather

June Meeting

.194
Income Tax Law...
.384 Than Drainage Essential for

July 29, 1913.

.194
Johns Hopkins Medical School
the Cure of. L. Ostrum, Rock

August 22, 1913

..252
Island
Bequest
..316

..347

Morgan County, Oct. 9; Rock
Lead Poison Prevention... .257
Society Proceedings:

Island County, Oct. 21;
Alexander County, June 19,

Tazewell County, Oct. 14;
Leper Cured ...

256
1913

.247

Wabash County, Oct. 28...381
Medical Fakers Leave San An-

Christian County,
tonio

Morgan and Cass Counties,
198

July 17,
1913
.127 August 14

.252
Missouri Housing Law .255

Clark County, June 12, 1913... 69 Morgan County, September 11,
Mortality in Chicago, Infant. .199

1913
Clark County, August 14, 1913.187

....313
Public Health School ........254
Radioactive Mineral Waters..254
Clinton County, August 12,

Ogle County, July 16, 1913...132
1913

.187

Pike County, July 31, 1913....194
Radium

..316

Coles County, July 1, 1913. .127 Randolph County, July 24,
Royal League, Report of Medi-

1913
cal Department of..........137
Cook County-Chicago Med-

195
ical Soc., Oct. 1, 8, 15, 22,

October 4, 1913

..313
School Hygiene, Fourth Inter-

29, Nov. 5, 12; Crawford

Rock Island County, August
national Congress on.......136
County, Nov. 14....... 1.378 12, 1913

.252
Tuberculosis Fakers

82
Cook County Alienists and

Tazewell County, July 15,
Tuberculous Milk in Manches-

Neurologists' Meeting, June

1913

.133
ter ...

.....136
23-25, 1913

.248

Vermilion County, August 8,
Public Health Instruction; Sup- Chicago Laryngological and

1913

.195
ply and Demand (E).........367

Otological Society, Febru- Whiteside County, June 12,
Public Policy Committee, Report

ary 18, 1913
.129 1913

133
38

Chicago Laryngological and Winnebago County, June 10,
Pyloris, Stenosis of, in Infancy. Otological Society, March

1913

77
Charles L. Scudder, Boston..

18, 1913

.188

September 9, 1913. 252
Chicago Medical Society, May

October 14, 1913..

.314
R
28, June 4..

70

Woodford County, May 6,
Red Cross Seals......

385
June 11, June 18, 1913.... 70 1913

78
Red Cross Misused. Letter of.

June 25, 1913.... .248 Sonnenschein, Robert. Discus-
A. L. Brittin.....

..309
Chicago Ophthalmological So-

sion

..190
Refrigeration, Modern.. .239 ciety, May 19, 1913.........131 Specialism, Change of.. ..247
Rheumatism, A New Specific. Chicago Ophthalmological So- State University School Commit-
Letter of N. 0. Sucker.......239 ciety, April 21, 1913.... 70 tee, Report of...

39

on

on

1

Sterilization Destined to Be a Tuberculosis Act, The Illinois Vaccine and Serum Therapy,
Social Menace? G. Frank County. E. Mammen, Bloom-

Observations on. Philip H.
Lydston, Chicago.... ..321 ington

.158 Kreuscher, Chicago... 331
Sterilization, Compulsory, and Tuberculosis Act, The Illinois Vail, D. T. Case Report. 70
Segregation of the Mental De- City. T. B. Sachs, Chicago.. 97 Vail, D. T. Paper

74
fective. H. M. Carey, Odessa,
Del.

Tuberculosis County Law. (E).178 Van Hook, Weller. Paper..... 11
.287

Tuberculosis, Methods of Con- Ventilation, School, Method of
Stricture, Urethral. L. W. Brem-

trol of. S. M. Miller, Peoria. .100 Obtaining Proper. Louis
merman, Chicago

...131
Tuberculosis of the Kidney. R.

Becker, Knoxville....

94
Style of the Journal, Change in. E. Barrows, Cairo..... .217 Vital Statistics and Water Sup-
(E)
63 Tuberculosis, Pulmonary, Arti-

plies. Paul Hansen, Urbana.. 92
Sucker, N. O. Letter.... .239

ficial Pneumothorax, in Treat- Vital Statistics Bill, The. (E). 63
ment of.

Ethan A. Gray,
Sucker, George F. Discussion..294 Chicago

In
Vital Statistics, Status of.
..201

Illinois and our Obligations.
Summers, Ed. Paper ..........127 Tuberculosis, Pulmonary, Early T. H. D. Griffitts, Springfield. 104
Surgery Before Christ (E)....368

Identification of. Sumner M.
Carroll County, Oct. 14; Clark

Miller, Peoria
.....214

W
County, Oct. 9.. .377 Tuberculosis, Pulmonary. (See Wassermann Test, Concerning
also Phthisis).

the. Frederick Baumann,
Surgeons of North America,

Chicago
Tuberculosis Sanatoria. (E)...119

...117
Clinical Congress of.........309

Tydings, Oliver. Case Report.. 71 Water, Rural Supplies. Edward
Surgeon, The Modern and His

Bartow, Urbana...
Work (E).

89
Tympanic Cavity, Topography

...303
Sutures, Intestinal, Experimen-

of the. John A. Cavanaugh, Water Supplies and Vital Sta-
Chicago

12
tal Study of. Gordon T.

tistics. Paul Hansen, Urbana. 92
Courtenay, Chicago

166 Typhoid. (See Anti-Typhoid). 187 Weisenburg, Berthold. Letter to
Typhoid (Anti), Vaccination..221

Public Relations Committee.. 122
T

U

Whalen, Charles J. Paper..... 20
Temporal Bone, Diagnosis and

Treatment of Meningeal Com- Urethra, Stricture of.. .131 Wilgus, S. D. Discussion......149
plications of Suppurative Dis- U. S. Army Medical Corps Ex- Williams, B. G. R. Paper......208
ease of. Norval H. Pierce, amination, Notice of.........370
Chicago
.352 Uterus, Cervical Erosions, Treat-

Wilson, J. Gordan. Discussion. 192
Tice Frederick. Paper
.261 ment

.330

Woodruff, H. W. Paper.......291

Wounds, Accidental, Cleansing
Tomlinson, H. A., Resolutions
on Death of...

...127

V

and Dressing of. (E)........120
Town, Clara Harrison. Paper.150 Vaccination, Anti-Typhoid. G.

X
Trachoma, The Role of the Tar- V. Rukke, St. Louis, Mo......221 X-Ray Manifestation of Gastro-

in. H. E. Woodruff, Vaccine, Personal Experience Intestinal Motility. Charles A.
Joliet

....291
with. William A. Mann...... 73 Elliott, Chicago

..282
Trachoma, Treatment by Glass

Vaccine Therapy, Indications
Rod. C. G. Darling, Chicago.362

Y
and Contra-indications.
Treasurer's Report
184 Adolph Gehrmann

72 Young Doctors. Poem...... ..382

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15 FEB 1 - 1915

ILLINOIS MEDICAL JOURNAL

THE OFFICIAL ORGAN OF

THE ILLINOIS STATE MEDICAL SOCIETY

ENTERED AT the Chicago PostOFFICE AS SECOND-CLASS MATTER

Vol. XXIV

Chicago, ILL., July, 1913

No. 1

Original Articles

muscle fibers of the pylorus. The tumor is a muscle tumor; it represents an overgrowth of

muscle tissue. STENOSIS OF THE PYLORUS IN The tumor is as evident at autopsy as on the INFANCY *

living. It exists in the living, whether gastric

peristalsis is present or not. It is no more eviCHARLES L. SCUDDER, M.D.

dent to direct touch when gastric peristalsis is Surgeon to the Massachusetts General Hospital, Associate present than when there is no gastric peristalsis. in Surgery, Harvard Medical School

It is a passive tumor. Muscle contraction is not BOSTON

necessary to its existence. Mr. President, Ladies and Gentlemen, Members

That the pyloric tumor encroaches on the of the Illinois State Medical Society: -I thank lumen of the pyloric canal is proven not only by you for this invitation to address the annual

the clinical signs in these cases, but by direct meeting of the Illinois State Medical Society.

examination of the stomach at autopsy and at With the approval of your committee I have

the operating table. The tumor itself is sufficient chosen for the subject of my address, "Stenosis of

cause for the obstruction to the pyloric canal. the Pylorus in Infancy.” The very great interest

The obstruction is an anatomic one, and is not that we have all taken in gastric and duodenal necessarily dependent on physiologic causes. The surgery in the past few years makes me bold to significance of this fact will appear later. ask your consideration to-day of this rather All other pathologic changes are secondary to special disease of infancy.

the obstruction caused by the tumor, viz., the I shall divide my address into four parts: thickened or stretched gastric wall, the dilated First, a systematic statement of the facts of the esophagus, the empty intestine, the emaciated and disease; second, reasons why the treatment should

wizened body of the baby. be surgical; third, a consideration of two prob

The Etiology.-- What is the cause of this tumor lems which have arisen in connection with the found at the pylorus in these new-born babies? study of these cases; fourth, a report of my own

This has been the subject of much speculation. experience with these cases; and in conclusion, a The most likely hypothesis is, I think, the one demonstration by lantern slides of the easily that considers it a congenital anomaly. The demonstrable facts concerning pyloric stenosis in tumor represents a congenital overgrowth of babies.

muscle tissue. In support of this view are the 1. First then, a systematic statement of the following considerations: facts of the disease: The pathology. A pyloric a. The earliest indications of the presence of tumor is always present. It is about the size of a pylorus is in the third month of fetal life. the terminal phalanx of a finger or thumb, oval There is, therefore, ample time for the growth in shape, smooth of surface, firm or hard, like of muscle tissue to take place. cartilage. There are never adhesions about it. b. There is one case recorded in literature by The lumen of the pylorus is narrowed. The Dent of a pyloric tumor in a seven-months old longitudinal folds of mucous membrane are fetus. The tumor shows the same structure that enormously hypertrophied, adding to the narrow- is found in the stenosis cases examined after ness of the lumen. This tumor is caused by an

birth. overgrowth and an hypertrophy of the circular c. The symptoms in these cases appear so near between birth and the onset of symptoms. My baby is taking water from the bottle, there will be youngest case was only 14 days old. The tumor noticed rather vigorous peristaltic waves passing in this case was fully developed and as definite as across the upper half of the abdomen from left to those seen in cases 3 months old.

to birth that it is impossible to conceive of the Address delivered at the Annual Meeting of the Illinois State Medical Society, Peoria, Illinois, May 22, 1913. overgrowth of muscle as having taken place

right. This visible peristalsis is very marked in d. The tumor is associated occasionally with many cases. The stomach is contracting violently other congenital defects, such as imperforate anus in the attempt to overcome the obstruction. If and clubfoot.

the abdomen is palpated from the side and from e. Aberrant Brunner's glands that normally before backward, in about from 60 to 80 per cent. belong only in the duodenum have been found of the cases it will be possible to feel the tumor in the tumor at the pylorus. It seems to me

between the thumb and finger. This will be therefore that the evidence at hand favors a pre

noticed more readily just after the peristaltic natal or congenital overgrowth of muscle tissue wave passes the pyloric portion of the stomach. as the best explanation for the tumor present in

The tumor may be obscured by an enlarged liver, these cases of infantile pyloric stenosis.

by enlarged lymphatic glands, or even by the Why talk of or consider the etiology? Because lower pole of the right kidney. The stomach it is important to determine the significance of itself will be dilated, particularly if the baby has spasm of the pylorus which is said to occur in lived some time after the obstructive symptoms certain of these cases. If it is likely that a con

have been present. genital overgrowth of muscle is the cause of the

The obstructive vomiting, the palpable tumor, tumor, then spasm, which has never yet been

the visible peristalsis, the meconium-like stool, known to have caused an hyperplasia, is removed

the epigastric fullness, the continual loss of still further from the field of symptomatology in weight, these are the symptoms of pyloric

, these cases. I think it will appear as the facts obstruction in infancy. Despite experiments with concerning this disease are unfolded that spasm feeding and the use of drugs of various sorts, the has little, if anything, to do with these cases of baby gradually wastes away and dies of starvatumor obstruction.

tion; dies of a pyloric obstruction. The Symptoms.The symptoms are those of

This is the typical picture of an unrelieved obstruction. The patient is usually a healthy pyloric stenosis in infancy, and it is the usual appearing, breast-fed boy. There is at first, often termination. The death certificate in cases of overlooked, loss of appetite. The baby does not

.

this kind in the past, and also to-day, is often care to nurse. Vomiting appears soon after birth signed by the attending physician: Inanition, or within the first two or three weeks. This acute gastritis, infantile atrophy, gastro-intestivomiting is characterized by its persistence and nal catarrh, marasmus, dyspepsia or pyloric its projectile character. It is the vomiting of spasm. obstruction. The quality of the food seems to Diagnosis.-The diagnosis in typical cases is make no difference with the vomiting, the vomit- comparatively easy. However, there are many ing depending rather on the quantity taken. The

cases of babies difficult to feed who may be susamount of the vomitus depends largely on the pected of having a pyloric tumor. Pediatricians amount of the feeding. The material vomited

have employed the term "spasm of the pylorus” is the food taken. The vomitus never contains

in order to explain the obstructive symptoms seen bile, an excess of HCl, blood, mucus or lactic acid.

in little babies who suffer from persistent vomitBecause of the little material passing through the pylorus into the duodenum the baby is consti- ing, and in whom there is a demonstrable tumor. pated. The dejections are consequently small in

This idea of a spasm of the pylorus is a purely amount; there being very little milk residue, the hypothetical notion introduced by clinicians to stool, consisting almost entirely of bile, pancre

account for symptoms which they are otherwise atic juice and cast-off epithelium, is meconium- unable to explain. There is little doubt that like.

there is a group of cases difficult to feed which There is a progressive loss of weight. The

are fairly easily explained by the idea of pyloric child has not been receiving sufficient nourish- spasm without the tumor.

These supposedly ment to keep the weight up to the normal gain. pure spasm cases occur in bottle-fed, excitable, Instead of the normal gain there is an actual loss. irritable, neurotic babies. The onset of sympThere may be erratic gains in weight which sub- toms is several weeks after birth. The stools consequently are lost. If the baby's abdomen is un- tain fecal material. A pyloric tumor, if felt, is covered while the baby is feeding, or while the felt only when the gastric contraction occurs. 1. Boston Med. & Surg. Jour., Dec. 14, 1905.

The vomiting lacks the characteristics of the

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