1002 THE DIGESTIVE SYSTEM. 
Natural Form of the Stomach.—<As seen in male bodies the viscera of which have been 
hardened by the intravascular injection of formalin, the empty stomach, as already stated, presents 
an attenuated or slender pear-shaped appearance, and is sharply bent on itself, particularly at 
the junction of the cardiae and pyloric portions. As a rule it is somewhat flattened from above 
downwards in its cardiac portion, but preserves in its whole length, more or less, an irregularly 
rounded or eylindrical form. Its long axis is directed, in the cardiae portion, from behind 
forwards and to the right with a slight inclination downwards; then it bends almost at a right 
angle, and in the pyloric portion runs to the right towards the pylorus. 
Even in the empty condition, the cardiac portion retains, as a rule, an appearance of 
rotundity, and never assumes a completely collapsed and flattened form ; although it sometimes 
is very much contracted, and approaches the tubular form of the pyloric portion. 
The collapsed, flat-walled, and flaccid bag, often pictured as the empty stomach, does not 
represent its true condition during life, but is rather the result of post-mortem softening, re~- 
laxation, and pressure. The stomach, like the bladder, and like other hollow viscera with 
muscular walls, is not an inert bag, but an extensile living organ capable of expansion and 
contraction, which adapts the size of its cavity to the amount of its contents. When food enters, 
it expands, the expansion being proportionate to the amount of food that enters; and when the 
food passes away or is absorbed, it contracts, until its cavity is reduced to little more than a 
stellate lumen. 
In the gradual passage of the stomach from the empty to the distended condition we may 
recognise three stages. First stage-—This commences with an enlargement of the fundus, and 1s 
followed by an expansion of the whole cardiac portion, which passes upwards and also to the 
left towards the diaphragm, displacing the coils of the transverse colon, which lie here when 
the stomach is empty. The pyloric portion for 3 or 4 inches still remains contracted and 
cylindrical. In this condition the stomach is frequently found after death. Second stage—As 
distension goes on the lesser curvature opens out, the pyloric portion (with the exception of its 
last inch)-expands, but its junction with the cardiac portion usually remains distinct, until disten- 
sion is almost complete. Third stage. —A further general expansion of the whole stomach takes 
place ; the diameters of both cardiac and pyloric portions, as well as the length of the organ, are 
increased ; and the great curvature presses forwards against the anterior abdominal wall in front, 
where the restraining influence of the ribs is absent. The pyloric end for about 1 ich (2°5 em.) 
from the pylorus remains narrow (constituting the pyloric canal of Jonnesco), but to the left of 
this it bulges forward, forming the antrum pylori, which is most distinct at the great curvature. 
By the increase of the organ in length the antrum is carried a considerable distance to the right 
beneath the liver—even further than the pylorus itself—so that the terminal part of the stomach 
is bent backwards and to the left, in order to reach the pylorus, which latter very rarely passes 
more than one and a half or two inches to the right of its normal position, namely, in the empty 
condition, within half-an-inch (12 mm.) of the middle line. Finally, as it fills, the stomach 
becomes gradually more oblique, so that in the distended state the long axis of the posterior 
two-thirds of the organ is directed forwards, downwards, and to the right, and forms an angle 
of about 40° to 45° with both the horizontal and sagittal planes (Fig. 674), whilst its anterior 
third is still more oblique. 
There is, however (as pointed out by Jonnesco), no distinct rotation of the organ on its long 
axis—no turning of the great curvature more forwards, nor of the so-called anterior surface more 
upwards. 
In the change from the distended to the empty state these stages are reversed ; the whole 
stomach is contracted, or drawn in, from all directions towards the lesser curvature ; this latter 
is bent upon itself to an acute angle, and the long axis of the organ, becoming less oblique, 
approaches the horizontal. 
Although this description of the shape and direction of the stomach is at variance with the 
generally accepted accounts, it is based upon the examination of a considerable number of 
specially-hardened bodies, and has been found to apply so generally, that it is advanced here as 
the condition most frequently found in the male immediately after death, and as, in all probability, 
giving a near approximation to the conditions present during life. It must, however, be 
admitted that, in the female, as a result of tight lacing, the stomach is often found to assume 
an abnormal vertical position; but this condition is associated with displacement of other 
abdominal organs in the neighbourhood, and cannot be looked upon as normal (see page 1007). 
Size and Capacity of the Stomach.—Probably no organ in the body varies more 
in size within the limits of health than the stomach. Moreover, as its tissues change so 
‘apidly after death, measurements made on softened and relaxed organs are not only 
worthless but quite misleading. Consequently it is difficult, perhaps impossible, to arrive 
at a correct estimate of its size and capacity. 
The length of the stomach in the fully distended condition is about 10 or 11 inches 
(25 to 27°5 em.), and its greatest diameter not more than 4 or 44 inches (10 to 11:2 em.) ; 
whilst its capacity in the average state rarely exceeds 40 ounces, or 1 quart. 
The length has been estimated by different authorities at from 10 to 1385 inches (26 to 34 
em.) ; its diameter, from 3} to 6 inches (8 to 15 em.) ; and its capacity from 15 to 5 pints. The 
measurements of the capacity given by Dr. Sidney Martin are probably the most accurate: he 
states that the capacity varies between 9 and 59 oz., with an average of from 35 to 40, or a little 
over a litre. 
