Stomach. 211 



tilages of the left side; (2) that a small portion, only, of 

 the stomach is in contact with the abdominal walls, and 

 ( 3 ) that the lowest limit of the greater curvature is a lit- 

 tle below a point midway between the tip of the ensiform 

 cartilage and the umbilicus, i.e., that it corresponds to the 

 breadth of two fingers above the umbilicus. That portion 

 of the anterior surface of the stomach in contact with the 

 abdominal parietes is somewhat triangular in shape and 

 corresponds to the area exposed below the inferior border 

 of the liver, and is bounded by the following lines : Above, 

 by the inferior line of the liver, i.e., a line drawn from the 

 ninth right to the tip of the eighth left cartilage ; below, 

 by the line joining the tips of the tenth cartilages, and, 

 laterally, by the margins of the eighth and ninth left costal 

 cartilages. It is over this triangular-shaped portion, there- 

 fore, that the normal stomach may be palpated, and, in it, 

 incisions should be made for the purpose of exposing the 

 organ in operative work on the stomach. 



Morbid Conditions affecting the Stomach. 

 In diaphragmatic hernia the stomach is the abdominal or- 

 gan most frequently involved, since it has been found, that 

 in this form of rupture, the stomach formed the protrusion 

 in 65% of the cases reported. 



Ulcer of the Stomach. Ulcer involves, most fre- 

 quently, the posterior surface of the stomach, towards 

 the pyloric end and near the lesser curvature. Welch's 

 statistics show, that out of seven hundred and ninety-three 

 cases, the ulcer occupied the lesser curvature in 36% ; the 

 posterior wall in 29% ; the pylorus in 12% ; the anterior 

 wall in 8% and the fundus in 3%. 



As the ulcer extends, it becomes funnel-shaped, with 

 its apex towards the peritoneum, and, when the latter is 

 destroyed, perforation occurs, unless the inflammatory 

 action excited in the peritoneum covering the ulcer has re- 



