STRUCTURE OF THE STOMACH. © 1007 
anterior layer of the small sac. From the lesser curvature the lesser omentum 
extends to the liver, whilst from the great curvature the great omentum passes 
down to the transverse colon. Higher up still, on the left, the continuation of the 
great omentum, namely, the gastro-splenic omentum, passes off (from the inferior 
surtace, a little below the great curvature) to the spleen. Finally, a small peri- 
toneal fold, known as the gastro-phrenie ligament, is found running from the 
stomach up to the diaphragm along the left side of the cesophagus. 
A small, irregularly triangular, area (Fig. 674), about 2 inches wide and 14 inches from above 
downwards, during moderate distension of the stomach, on the inferior surface below and to the 
left of the cardia, is uncovered by peritoneum, and over it the organ is in direct contact with 
the diaphragm, occasionally also with the top of the left kidney and suprarenal. From the left 
angle of this “ uncovered area” the attachment of the great omentum (gastro-splenic part) starts ; 
and at the right angle the coronary artery passes on to the stomach. 
In the child at birth the stomach is scarcely as large as a small hen-egg, and its 
capacity is about one ounce (28°3 grammes). In shape it corresponds pretty closely to 
that of the adult, and the fundus is well developed, although the contrary is often 
stated. , 
In the female (Fig. 678), as a result of tight lacing, the stomach is often displaced 
in position and distorted in shape, so that instead of running obliquely forwards, downwards, 
and to the right, it is placed nearly vertically along the left side of the vertebral 
column, in which direction it has a very considerable length. Its lower part bends rather 
suddenly, and runs upwards and to the right to join the pylorus, which is often placed 
quite superficially below the liver. Asa result of the displacement, the left extremity of the 
pancreas is pushed downwards from the horizontal until it almost assumes a vertical position. 
The narrowing and inversion of the lower margin of the thoracic framework at the same 
time constricts the stomach about its middle, and often leads to a bilocular condition. 
Hour-glass or Bilocular Stomach.—This is a condition of the organ, by no means rare, 
in which the stomach is more or less completely separated into two divisions—a cardiac and 
a pyloric—the normal arrangement in certain rodents and other animals. As a rule the former 
division is the larger, but occasionally the two are nearly equal, or the pyloric portion may 
exceed the cardiac in size. Sometimes the condition is temporary, and the result of a vigorous 
contraction of the circular muscular fibres at the seat of 
constriction. In other cases it is permanent, and may 
be due to pressure of the lower ribs, as from tight lacing, 
to cicatricial contraction after gastric ulcer, or possibly 
to a congenital or acquired thickening of the muscular is euuaau 
fibres corresponding to the constriction. The condition 
is much more frequent in the female than the male, 
and is rarely found in the child. Muscularis 
mucosee; —¥ 
Gland mouths 
STRUCTURE OF THE STOMACH. 
The stomach wall is composed of four coats— Submucosa 
namely, from without inwards: (1) peritoneal, (2) 
muscular, (3) submucous, and (4) mucous (Fig. 679). 
Peritoneal or Serous Coat (tunica serosa).— 
This coat is formed of the peritoneum, the relations Oblique 
of which to the stomach have already been described. St" Pres 
It is closely attached to the subjacent muscular 
coat, except near the curvatures, where the con- 
nexion is more lax ; and it confers on the stomach Oienien 
its smooth and glistening appearance. muscular fibres 
The muscular coat, which is composed of un- 
striped muscle, is thinnest in the fundus and body, ne 
much thicker in the pyloric portion, and very highly deere cing 
developed at the pylorus. It is made up of three Peritoneum — 
incomplete layers —an external of longitudinale a Ta) 629. SkonoNy. waROUGHa WATE Cee 
middle of circular, and an internal of oblique SromacH, Carpiac Portion (slightly 
muscular fibres. modified from Stohr). 
The external layer (stratum longitudinale) con- 
sists of longitudinal fibres, continuous with those of the cesophagus, on the one hand, 
and those of the duodenum on the other (Fig. 680, A). They are most easily demonstrated 
on the lesser curvature, where they can be traced down from the right side of the aso- 
