Symptoms
The symptoms begin to appear during the first or second week of life. Up to this time the child may have been gaining and showing all signs of perfect health. Vomiting is usually the first symptom to appear and this may be at irregular times but without apparent cause. It soon becomes very forcible and later projectile. The symptoms of indigestion are absent; there is no eructations of gas; the breath is sweet and the appetite is good. There is no evidence of pain and there is no fever, yet the child steadily wastes and loses in weight.
The contests of the stomach are sometimes expelled with such force that the food will be thrown a distance of two or three feet. The food sometimes comes through the nose. The vomiting takes place immediately after feeding and sometimes while the child is nursing. The fact that the child will nurse after vomiting and sometimes will leave the breast only while the food contents of the stomach are being ejected shows that the vomiting is not the result of indigestion; the fact that the food is all expelled at one time and not regurgitated at intervals is further proof. The food seldom remains in the stomach long enough for gastric digestion to take place, therefore the vomited food is not digested but it is just about in the same stage as it was when taken into the stomach. In some cases, however, the vomiting may not take place immediately; in some cases the food may even be retained for two or three feedings, although this is unusual.
The constipation is very obstinate from the fact that the food is vomited and does not pass into the intestinal tract. In the severe cases the stools resemble meconium. There is very little fecal matter in the stool. In the severe cases there is persistent loss of weight which may amount to two or three ounces per day. The constipation is very marked and the urine is scanty.
In the mild cases the symptoms are all less marked. The vomiting may be only occasional, the loss of weight is not so great, fecal matter is passed in the stools and there may even be a gain in weight at times.
Due to the character of the vomiting which is projectile the symptoms are sometimes mistaken for cerebral symptoms. The scanty urine and the vomiting confuse the condition with renal dis-ease. It is not difficult to distinguish stenosis of the pylorus from gastric indigestion. The latter rarely develops suddenly, but is very common in infants. The vomiting usually occurs shortly after feeding.