PRACTICAL CONSIDERATIONS: THE STOMACH. 



1629 



nations of the nerve-fibres within the mucosa, especially their relations with the 

 gland-cells, are still uncertain. 



Growth. At birth the capacity of the stomach is 25 cc. The organ, although 

 sometimes rather tubular, does not differ very much in shape from that of the adult. 

 The oesophagus enters it less obliquely than later, so that regurgitation occurs more 

 readily. The sphincter of the pylorus is already developed. We do not remem- 

 ber ever to have seen at birth a well-marked antrum pylori. An important pecu- 

 liarity of the growth of the stomach is the unequal development of the two sides at 

 the fundus. At an early period the top of the original left side, which becomes the 

 anterior one, grows 



upward, so that the FIG. 1382. 



line of attachment of m tmim 



the greater omentum 

 is along the posterior 

 surface. This unequal 

 growth is quite analo- 

 gous to that of the 

 caecum. According to 

 Keith and Jones, this 

 asymmetry is most 

 marked in the third 

 and fourth months of 

 foetal life. We have 

 examined no younger 

 foetuses than these, 

 and cannot state how 

 early the process be- 



J , ,-, r , , Surface view of fragment of muscular coat of stomach, showing groups of gan- 



gms. r rom the end glion-cells and nerve-fibres of plexus of Auerbach. X 70. 



of the first week after 



birth the growth of the stomach is very rapid during the first three months. It is 

 slow in the fourth month, and in the two months following it is almost quiescent. 2 

 We have seen it at a few weeks relatively broader than in the adult. While it is 

 probable that individual variations show themselves early, the shape and size of the 

 stomach depend, beyond question, to a great extent on the nature and quantity of 

 the food. With advancing years the stomach often becomes dilated, and, apart 

 from dilatation, is likely to descend lower in the abdomen. The female stomach, 

 except for its greater tendency to subdivision, differs less than the male from the 

 fcetal form. 



Variations. Apart from those of size and shape, already alluded to, the important ones 

 are those of subdivision. There may be a constriction at the middle dividing the organ into 

 two chambers connected by a narrow passage : the " hour-glass stomach." There may also be 

 a reduplication of the antrum, or, indeed, there may be three, or, on the other hand, the place of 

 the antrum may be taken by a tube with thick walls. It is probable that these changes are 

 sometimes caused by a local contraction becoming fixed. 



PRACTICAL CONSIDERATIONS : THE STOMACH. 



Congenital malformations are rare. Perhaps the most common is a constriction 

 dividing it into two unequal compartments, " hour-glass constriction, " a condi- 

 tion somewhat similar to that found normally in the kangaroo. 



The position of the stomach varies with its degree of distention. When it is 

 empty the pyloric end descends and the long axis of the stomach is oblique from 

 left to right, approximating the vertical (i.e., the fcetal) position or that which pre- 

 ceded functional use. This falling of the pyloric end is due to gravity, the nearest 

 firmly fixed point of the alimentary canal below being the lower portion of the duo- 



1 Priority of publication of this peculiarity of development belongs to Mr. Arthur Keith and 

 to Mr. F. Wood Jones : Proceedings of the Anatomical Society of Great Britain and Ireland. 

 Journal of Anatomy and Physiology, vol. xxxvi., 1902. 



2 Rotch's Pediatrics. 



