484 FREDERIC T. LEWIS 



When a peristaltic wave remains fixed after death, the stomach 

 may appear as "two joined together" (Riolan 1618), in which 

 case the subdivisions need not correspond with the anatomical 

 parts already described. Usually the constriction is near the mid- 

 dle of the stomach, and falls within the cardiac portion. Mor- 

 gagni (1761) observed five cases, all in women. One of the stom- 

 achs was from a patient who had been troubled with excessive 

 vomiting since birth, but none of the stomachs showed any sign 

 of disease. Since several cases had been reported in men, Mor- 

 gagni concluded that the double stomach was not a deformity 

 due to stays, but had existed from the first formation of the organ. 

 Sandifort (1777-1781), as quoted by Bettman, described a typical 

 case in a fetus, the age of which is not stated in the citation. Del- 

 amare and Dieulafe (1906) reported a case in a new-born syphilitic 

 infant, in which they describe an hypertrophy of the circular 

 muscle at the place of constriction. The thickened muscle-layer 

 may, however, be due to contraction, as indicated by the folded 

 and thickened overlying layers shown in their figures. Cunning- 

 ham (1906) holds that there is not an atom of evidence that the 

 hour-glass stomach ever arises as a congenital deformity, but he 

 is not prepared to state that the strictures which separate the two 

 sacs of the bilocular stomach are always temporary and fleeting. 



The change in the direction of the lesser curvature is more 

 dependable as a boundary between the pars pylorica and pars 

 cardiaca, than the constriction which is present in certain cases 

 but "not as a rule" (Huschke). The lesser curvature, which is 

 concave along the cardiac portion, becomes convex along the 

 pars pylorica (Meckel 1820; Huschke 1844). Retzius (1857) 

 figured a deep stricture in the lesser curvature at the beginning of 

 the bulbous pars pylorica, where Luschka (1869) frequently 

 found an acute angle directed toward the gastric cavity. This 

 notch has been named by His (1903) the 'incisura angularis,' 

 and it occurs between the two parts of the stomach. Along the 

 greater curvature the boundary is less clearly marked. It is 

 indicated by the change in direction already described as the elbow 

 of the stomach, and referred to by Home as "an angle formed at 

 the part where the temporary contraction takes place." Some- 



