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

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

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


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


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


Pearce, Warren Frederick,
Leucorrhea and Cervical Ero-


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


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



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

Health and Hygiene

Lillie, C. W. Discussion.. .107


.137 Mitral Stenosis,

Stenosis, Complicating

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

S. E. Munson,



Litany for Doctors..

Slinde, Arthur Christian, Chi-

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

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

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

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

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

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

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


Marriages :

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


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

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

of Nasal Adhesions.

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

Wood, Bert Leslie Taylor, Chi-


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

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



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


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

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

Norbury, Frank P. Discussion.330

Nose: Adhesions....

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.
.317 Medical Charity Commonly

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

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

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


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,


Farley, William K., Fulton...254

Report of
Medical Legislation, Report of

Ophthalmology, Hexamathyla-
Gollobith. Edward Frank,

min in ..




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

Graham, Ralph, Monmouth...137



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

Medicines, New, etc.


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

Irwin, Millard Holloway, No-


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

New York City

Jerijian, Nazareth A., Chicago.254

Otrich, G. C. Paper.

Johnson, T. Arthur, DeKalb.. 83

Medico-Legal Defense Commit-
tee Report ...

Kuhn, LeRoy Philip, Chicago. 137

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

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


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

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

in Delegates"


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-

heim, Germany

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-

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

Physician and the Defective.
200 Gradle


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

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

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

85 Pierce, Norval H. Discussion..350




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,

127 Ritter, John, Chicago. Discus-

Pneumothorax, Artificial, in sion

.208, 217
October 7, 1913

Treatment of Pulmonary Tu-

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

11, 1913



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


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.

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


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

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

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

Kane County and Aux Plaines
Psychologic Clinic as a Eugenic sion


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

School Sanitation,

Kankakee County, June 12,

Francis G. Blair, Springfield.. 95


Pterygium, Case of. J. E. Col-

Lake County, June 26, 1913.. 131

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,
Bondurant, Cairo

Oct. 19.

Cancer, American Society for

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

McHenry County, May 27,

Secretary's Report ....

.27, 183
Chicago Tuberculosis Institute 82


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

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

Eugenics .....

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

May 27, 1913

. 132
82 Sinus Disease, Ventilation Rather

June Meeting

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

July 29, 1913.

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

August 22, 1913



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 ...



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

Christian County,

Morgan and Cass Counties,

July 17,
.127 August 14

Missouri Housing Law .255

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

Clark County, August 14, 1913.187

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

Ogle County, July 16, 1913...132


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


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

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

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

October 4, 1913

School Hygiene, Fourth Inter-

29, Nov. 5, 12; Crawford

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

Tuberculosis Fakers

Cook County Alienists and

Tazewell County, July 15,
Tuberculous Milk in Manches-

Neurologists' Meeting, June


ter ...

23-25, 1913


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


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

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

ary 18, 1913
.129 1913


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


Charles L. Scudder, Boston..

18, 1913


September 9, 1913. 252
Chicago Medical Society, May

October 14, 1913..

28, June 4..


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

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

Red Cross Misused. Letter of.

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

Chicago Ophthalmological So-


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...





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

fective. H. M. Carey, Odessa,

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

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

Tuberculosis of the Kidney. R.

Becker, Knoxville....

Style of the Journal, Change in. E. Barrows, Cairo..... .217 Vital Statistics and Water Sup-
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

Vital Statistics, Status of.

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

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

the. Frederick Baumann,
Surgeons of North America,

Tuberculosis Sanatoria. (E)...119

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

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

Bartow, Urbana...
Work (E).

Tympanic Cavity, Topography

Sutures, Intestinal, Experimen-

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

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


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
.352 Uterus, Cervical Erosions, Treat-

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


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

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



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

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.

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

Trachoma, Treatment by Glass

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

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

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


[merged small][ocr errors]

15 FEB 1 - 1915






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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