Chap xvii.] ABDOMINAL VISCERA. 329 



tenth cartilage has a distinct tip and plays over the 

 cartilage of the ninth rib, producing under the finger 

 a special crepitus. Thefundus of the stomach reaches 

 on the left side as high as the level of the sixth sterno- 

 chondral articulation, being a little above and behind 

 the heart apex. The close relations of the stomach 

 to the diaphragm and thoracic viscera serve in part to 

 explain the shortness of breath and possible palpita- 

 tion of the heart, etc., that may follow upon distension 

 of the organ (Fig. 33). The near proximity of the 

 heart to the stomach is illustrated by a case where a 

 thorn (of the Pi'unus spinosa), half an inch long, had 

 been swallowed, and had then found its way through 

 the diaphragm and pericardium into the wall and 

 cavity of the right ventricle. 



On reference to the development of the stomach, it 

 will be seen that it is originally placed vertically in 

 the abdomen. This position may be to a great extent 

 maintained in adult life. The feats of an acrobat who 

 styles himself " the sword swallower " can hardly be 

 explained on any other supposition than that his 

 stomach is vertical ; but whether such condition is 

 congenital, or has been produced by the manoeuvre 

 he practises, must be an open question. 



Although the mobility of the stomach is not con- 

 siderable, yet it is frequently found to occupy both 

 diaphragmatic and epigastric hernise. 



The viscus is susceptible of enormous dilatation 

 when the pylorus is obstructed. The distended organ 

 may reach as low as Poupart's ligament. 



The stomach has been frequently wounded. In 

 most cases a fatal result rapidly follows upon these 

 injuries, for the contents of the stomach escape 

 into the peritoneal cavity and set up an acute peri- 

 tonitis. The most certainly and rapidly fatal cases, 

 therefore, are those in which the stomach was full of 

 food at the time of the accident. The empty stomach, 



