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A horrible case, with similar results, happened in France, and was reported by Tardieu. A brutal peasant, whose wife was pregnant, dragged out a fetus of seven months, together with the uterus and the whole intestinal canal, from within 50 cm. of the pylorus to within 8 cm. of the ileocecal valve.
There is a possibility that some of these cases of Hippocrates were instances of pyloric carcinoma or of stenosis of the pylorus. In the older writings there are instances reported in which the period of abstinence has varied from a short time to endurance beyond the bounds of credulity.
The pike, eels, and carp eat greedily always, as everybody knows well, they feast on the vulture. Now suppose that next day, one of these eels, or pike, or carp, poisoned at the fourth remove, is served up at your table. Well, then, your guest will be poisoned at the fifth remove, and die, at the end of eight or ten days, of pains in the intestines, sickness, or abscess of the pylorus.
Gastroenterostomy and pylorectomy are operations devised for the relief of malignant disease of the pylorus, the diseased portions being removed and the parts resected. Gastrectomy or extirpation of the stomach is considered by most surgeons entirely unjustifiable, as there is seldom hope of cure or prospect of amelioration.
If this state continues it deranges, at first insensibly, the digestive functions; the secretions change, the appetite is impaired, and the digestion becomes capricious; sharp pains are felt; they grow worse day by day, and more frequent; then the disorder comes to a crisis, as if a slow poison were passing the alimentary canal; the mucous membrane thickens, the valve of the pylorus becomes indurated and forms a scirrhus, of which the patient dies.
Sometimes when the stomach is dilated the pylorus becomes insufficient, and bile regurgitates into the stomach, and is a cause of the profound nausea and vomiting arid the subsequent collapse. In these cases Henderson: Am. Jour.
Occasional manifestations of its presence had been exhibited for some years, but his usual health always returned after every attack, and its fatal nature was not suspected, although Napoleon himself had several times said that he should die of a scirrhus in the pylorus, the disease which killed his father, and which the physicians of Montpelier declared would be hereditary in his family.
He was pointing at the lungs. "A single peristaltic contraction takes place normally in a very few seconds. Here it takes minutes. And the stomach. Notice what the bismuth mixture shows. There is a very slow series of regular wave-contractions from the fundus to the pylorus. Ordinarily one wave takes ten seconds to traverse it; here it is so slow as almost to be unnoticed."
Another lame officer is affected by rupture of a main nerve in the leg. Salik Sidki, judge of Mecca, entrusted us with a letter of thanks to the English authorities, in recognition of the care which he received at the hospital where he underwent a severe operation for a chronic affection of the pylorus. Prisoners' Wishes.
To describe in technical detail the examination we made would not interest the general reader of this strange narrative. The average man or woman knows nothing or cares less for the duodenum or the pylorus; therefore it is not my intention to go into long and wearying detail.
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