42 PROFESSOK A. BIKMINGHAM. 



The distended stomach. — In the gradual passage of the 

 stomach from the empty to the distended condition, we may 

 recognise three stages. First stat/c. — This commences with an 

 enlargement of the fundus in a backward direction, and is 

 followed by an expansion of the cardiac portion, which passes 

 upwards towards the left cupola of the diaphragm and also to 

 the left, displacing the coils of the transverse colon which lie 

 over the stomach and to its left when the organ is empty. The 

 pyloric portion for 3 or 4 inches remains contracted and 

 cylindrical, the whole organ bearing some resemblance to a 

 Florence flask, sharply bent at the junction of the neck with 

 the body, and 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) becomes distended, but its junction with the 

 cardiac portion is, as a rule, still marked by a faint constriction, 

 most evident at the curvatures, which persists until distension 

 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 ; 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 inch (2-5 cm.) 

 from the pylorus remains narrow (constituting the pyloric canal 

 of Jonnesco), but to the left of this it is dilated, forming the 

 antrum pylori, which is most distinct at the great curvature. By 

 the increase in length of the organ 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 directed backwards in order to reach the pylorus, 

 which latter rarely passes more than 2 inches to the right from 

 its normal position, namely, in the empty condition, within half 

 an inch (12 mm.) of the middle line. And finally, as the 

 stomach becomes distended, it gradually becomes more oblique, 

 80 that in the distended condition the long axis of the posterior 

 two-thirds of the organ is directed forwards, downwards, and to 

 the right, and it forms an angle of about 40 to 45 with both 

 the horizontal and sagittal planes. This obliquity is due to 

 the ascent of the fundus and adjacent parts of the upper sur- 



