46 PROFESSOR A. BIRMINGHAM. 



retracts, and finally comes to lie both above and in front of 

 that organ and immediately beneath the diaphragm — a fact of 

 some importance in clinical examination of this region. Possibly 

 one of the reasons why the transverse colon is so tortuous and 

 its mesentery so long is to permit of its doubling up in the 

 manner described in order to fill the space vacated by the 

 contracted stomach. Sometimes part of the small intestine, too, 

 may be found in the chamber. 



The pyloric portion of the stomach and the antruvfi pylori. — 

 When the stomach is empty the pyloric portion for a distance of 

 3 or 4 inches is contracted and cylindrical ; it resembles in 

 appearance a bit of thick-walled small intestine, and runs trans- 

 versely to the right, lying, as a rule, beneath the left lobe of the 

 liver. When the stomach is distended, this part is carried to 

 the right beneath the quadrate lobe, and its terminal part is 

 directed backwards, or even backwards and to the left, to reach 

 the duodenum ; at the same time it becomes curved like an 

 italic >S' placed horizontally. This /S-shaped curve (which is 

 maintained by the hgamenta pylori) gives rise to two grooves, 

 one at the upper, the other at the lower border and nearer to 

 the pylorus. The first curve of the S — i.e. that nearest to the 

 cardiac end — is convex downwards and forwards, and this 

 becoming more prominent with distension, forms the antrum 

 pylori. The terminal curve of the S extends up to the pylorus ; 

 it is nearly one inch in length, and it appears never to become 

 dilated to any noticeable extent. This is the part described by 

 Jonnesco as the pyloric canal. 



When examined iwst-mortem, in the ordinary way, the pyloric 

 aperture, viewed from the duodenal side, is somewhat oval in 

 form, and closely resembles the external os uteri, as pointed out 

 by Cunningham. From the opposite side it presents an irregular 

 or stellate appearance, owing to the rugse of the gastric mucous 

 membrane being continued up to the orifice. In formalin- 

 hardened bodies with empty and contracted stomach and duo- 

 den vmi, the aperture is closed, and presents a stellate or purse- 

 mouth appearance when viewed from either side, the appearance 

 of firm closure being much more marked on the gastric than the 

 duodenal aspect. In hardened bodies with distended stomach 

 and duodenum, the aperture, which is somewhat oval, is practi- 



