Idiopathic muscular hypertrophy of oesophagus, pylorus, duodenum and jejunum in a young girl.

The patient, J. McH., a girl aged eleven years, the first-born in the family, who had previously been healthy, was admitted on 11.2.42 with a history of illness of a few days' duration beginning abruptly with bilious vomiting and green diarrhoea, followed by severe abdominal pain and after a short interval by a convulsion. The child lapsed into coma and was unconscious on admission, with intermittent spasticity of the limbs and rotary nystagmus. The urine contained albumin with a trace of acetone. The blood non-protein nitrogen was 125 mgm. per 100 c.cm. There was no oedema. Death occurred about twelve hours after admission. An autopsy was performed some nine hours later. The girl was well-grown and of normal build with no excessive muscular development or other external feature of note. Acute nephritis was the cause of death and there was an early broncho-pneumonia. The left ventricle was slightly hypertrophied. Apart from the renal lesion no morbid change was observed in the solid abdominal organs which were all of normal size. On opening the abdomen, a striking feature was the condition of the alimentary tract. The distended stomach had a rather thin wall, except in the pyloric canal which showed massive muscular hypertrophy. The calibre of the