On the incidence of congenital hypertrophic pyloric stenosis in the 17th and 18th centuries.

The clinical picture presented by hypertrophic pyloric stenosis in the child is so distinctive that it seems improbable that such a condition, had it been as common as it is now, should have failed to attract attention before Hirschsprung's' presentation of two cases in 1888. There has been, therefore, on the one hand, a tendency, initiated by Osler2 in 1903 with his reprint of the case reported by Beardsley' in 1788, to search the literature for earlier descriptions of the condition; and on the other hand room, possibly, for speculation whether any change in the modern mode of life could have favoured the development of this condition, the Ttiology of which is unknown. During the past six years three isolated and earlier examples of this condition have been recovered; Foote4 has called attention to the case described by Armstrong" in 1771, Still6 to that by Weber7 in 1758, and Caulfield8 to that described by Blair' in 1717. Recorded by Patrick Blair9 (1717). A male infant who at ' a month old was seized wi'th a violent vomiting and a stoppage of urine and stool. Some time after both these became more regular, but the vomiting still continued.' He died at 5 months, very emaciated and weighing no more than 5 lb. Post mortem ' the ventriculus was more like to an intestine than a stomach, its length being 5 inches and its breadth but one inch . . . The pylorus and almost half the duodenum were cartilaginous and something inclined to an ossification.' Recorded by Christopher Weber7 (1758). Female, newly born infant. ' Sucked milk without difficulty but soon after she had filled her stomach with this infant nourishment she returned it by vomiting.' She died on the 6th day. Post mortem ' the pylorus was hard to touch like cartilage, and contracted. On incision its substance was seen to be thick, and the tightness of its contraction made the lumen similar.' Recorded by George Armstrong5 (1771). An infant, sex not stated, suffered from 'watery gripes,' and died at about 3 weeks old. Post mortem ' I found most of the stomach . . . in the same tender state, but towards the pylorus the structure was firm enough as likewise that of the intestine . . . the stomach was quite distended with curdled milk and victuals . . . but the whole intestines were remarkably empty . . . it looked as if the disease had been chiefly owing to a spasm in the pylorus.' Recorded by Hezekiah Beardsley' (1788). A male infant showed from the first week ' puking . . . of the milk and of every other substance almost instantaneously . . . The feces were small in quantity . . . yet seemed otherwise pretty well . . . yet more lean.' He died at the age of about 5 years. The account of the necropsy contains the following:-' The esophagus was found greatly distended . . . from one end to the other of this tube, between the circular fibres which compose the middle