Neuro-muscular Incoordination at the Cardia in the Newborn.

Hurst (1915) coined the word achalasia, i.e. absence of relaxation, to describe a neuro-muscular incoordination in the alimentary tract. Previously, Rolleston (1896) had suggested such an incoordination to explain some cases of dilatation of the oesophagus. The condition was then known as cardiospasm, a word introduced in 1882 by Mikulicz (1904). Earlier it was known as simple or idiopathic dilatation of the oesophagus and had been described by Hannay (1833). While most of the writings on the subject refer to later childhood and maturity, the presence of the condition in infancy has long been recognized. Rotch (1896) described simple dilatation of the oesophagus in a girl who died aged ten weeks. Luschka (1868) recorded what he considered to be congenital dilatation of the oesophagus, and Zenker (1878) reported the appearance of dilatation of the oesophagus above the cardia in a premature infant of seven months gestation, who died at the age of seven days as a result of haemorrhage from the umbilicus. Recognition of the condition in the neonatal period has been rare, though many of the cases diagnosed at a later age gave a history of vomiting from birth or soon after (Langmead, 1919; Morgan, 1911). Tyson (1926) was the first to record a case of achalasia in the neonatal period. He called it phrenospasm. Birnberg (1929) published three cases of cardiospasm. Segar and Stoeffler (1930) recorded two cases. Olmsted (1931), Bogert (1933), and Vinson (1945) reported one case each. Aikman (1933) recorded four cases. The main features of these cases, all of which were diagnosed radiologically, are given in Table 1. A case of uncontrollable vomiting from the second day of life onwards and recorded by Garrahan and Muzio (1932) has not been included in this table. There is some doubt about the diagnosis of this case and no supporting radiological evidence appears to have been obtained at the time of the illness. In an extensive search of the literature no cases other than these were found. This relative infrequency with which the condition in the newborn infant has been recorded, is justification for recording the following three cases of neuro-muscular incoordination. The first two cases appear to be typical of achalasia of the cardia, but the third case is different and requires separate discussion.