In the eumydrin series, abnormalities were
found in only 4 cases in these investigations. In
only one of these cases was delay in gastric emptying
still present. This child was 1 year and 7 months,
which shows that the pyloric canal may take a long
time to return to normal.Finally these radiological investigations confirm the conclusions arrived at by the clinical
investigations, that after successful treatment of a
case of congenital hypertrophic pyloric stenosis,
the outlook is as good as that of a healthy infant.ADVANTAGES AND DISADVANTAGES OF SURGICAL
AND MEDICAL TREATMENT:
Certain factors, which will now be discussed,
must influence one in deciding upon the method of
treatment to be employed.LENGTH OF TIME IN HOSPITAL:
The comparatively long period of hospitalisation
found necessary in the treatment by eumydrin therapy,
has been considered to be the chief disadvantage of
this method. Swensgaard's cases had an average
period of 77 days, while in my series, although it
had been reduced to 41 days, this was 13 days longer
than that of the surgical cases.The considerable difference in the period of
hospitalisation has led to an increase in the liability
to intercurrent infection in the medical series,
especially acute gastro-enteritis.EXPENSE OF TREATMENT:
The long period of hospitalisation of those
treated by eumydrin increases the expense of treatment
of each patient. Also the necessity for
isolation of these cases in cubicles, raises the cost
considerably.FEEDING DIFFICULTIES:
I have attempted to show previously, that
breast feeding plays an important part in reducing
the mortality of these cases. If the baby is left
in hospital for only a few days, the risk of causing
cessation of breast feeding is small. It is very
difficult indeed, however, to retain the supply of
breast milk over several weeks, if most of the milk
has to be drawn off by a breast pump.SURGICAL SKILL REQUIRED:
The one formidable disadvantage of surgical
treatment is the high degree of technical skill required to perform the Fredet-Rammstedt operation.
This is easily obtained in the large cities where
surgeons specialise in child surgery, but in the
smaller provincial towns the expert skill is often
lacking. Thus the geographical situation of a practise
is apt to play a part in influencing a physician
as to the method of treatment to be employed.
However the greater nursing skill required in eumydrin
therapy must be kept in mind when considering the type
of hospital available.EUMYDRIN FAILURES:
Surgery to-day offers a fairly low mortality
rate. Parsons considers that the mortality rate,
with good post operative treatment, should not exceed
5. Eumydrin, although in some cases produces an
equally low mortality rate, does fail completely to
effect a cure in a number of cases, 12% in the series
investigated by me. The possibility of this failure
of eumydrin therapy, must be always kept in mind by
its adherants.CONCLUSIONS AS TO THE IDEAL FORM
OF TREATMENT:
The chief disadvantage of eumydrin therapy
has been the prolonged stay in hospital. Dobbs and
Vertue have treated cases as out-patients with considerable success. If this continues to be found
satisfactory, the chief disadvantage of eumydrin
therapy will be removed.In my opinion, eumydrin therapy should be tried
in all cases for from one week to ten days, according
to the degree of dehydration on admission. If improvement is not obtained by that time, a Fredet-
Rammstedt operation should be performed v :ithout delay.
The decision of changing the treatment should be based
on three factors: -
1. The extent of the vomiting and constipation.
2. The extent of the gastric residue.
3. Whether the patient has gained weight or
not.The most difficult decision to make is exactly
how long to continue the eumydrin therapy, only a
slight guide has been offered, as each case must be
gauged separately on the physician's judgement.
However, if surgery is employed, the post operative
treatment of the patient should be carried out under
the physician primarily, although of course, full co-
:operation with the surgeon is essential for success
