28 PROFESSOR D. J. CUNNINGHAM 



to preserve in every detail the proper shape of the organ, the ful] significance of the 

 condition was not appreciated. 



Under the heading of ' ausgepragte Schniirmagen,' His (22) describes in his 

 recent paper (p. 365) the stomach of a female which bears a striking resemblance to 

 that under discussion. He has also published three photographs (PL XVIII.) and 

 two casts of this specimen. Copies of the latter are in the Anatomical Museum of 

 the Edinburgh University. One of these exhibits the organ after its removal 

 from the abdominal cavity, whilst the other represents it from behind in its relation to 

 the abdominal wall. The only essential points of difference between this stomach and 

 the one I have described consist in : (l) its more perpendicular position ; (2) its slightly 

 smaller pouch-like cardiac sac ; and (3) the more pronounced incisura angularis, and 

 the more acute manner in which the gastric tube is bent on itself at this point. The 

 subject from which this specimen was obtained showed a marked constriction of the 

 waist, and His points out that this constriction of the body wall as seen from the 

 interior corresponds with the constriction of the stomach. The words he uses are the 

 following : " Die Abbildung zeigt links den Magen von der Riickseite her gesehen in 

 Verbindung mit der vorderen Bauchwand, und sie lasst leicht die Beziehungen der 

 Schniirfurche der Bauchwand zur Gestaltung des Magens verfolgen " ; and then again : 

 " An beiden Schenkeln des Magenschlauches bedingt die Schniirfurche eine Einbuchtung 

 der Wand, sehr viel starker allerdings am linken Schenkel." The two limbs of the 

 stomach, to which he refers, are the two parts of the organ which are marked off from 

 each other by the sharp bend in the gastric tube, and the deeper of the two constrictions 

 is the deep notch in the greater curvature which indicates the separation of the cardiac 

 sac from the gastric tube. From this description I think we may conclude that His was 

 under the impression that the stomach-form to which he alludes is the result of tight-lacing 

 or some other kind of compression applied to the lower costal arches. The view that 

 the stomach may be divided into two parts or chambers by a localised contraction of 

 its wall caused by compression of the lower portion of the thorax is not new. Indeed, 

 it is of considerable antiquity, and some forms of hour-glass stomach have been accounted 

 for in this way. Meckel (32) and Soemmerring (60) were exponents of this theory, 

 and the former, in his work upon pathological anatomy, points out that many cases which 

 had been considered to be congenital hour-glass stomachs were in reality due to mechanical 

 causes operating from without. He adds : "So fand Reinmann den so abweichend 

 gebildeten Magen bei einem Frauenzimmer, die bestiindig ein festes Schniirleib getragen 

 hatte" (quoted from Kern (28)). Recently Rasmussen (43) and Chabrie (8) have 

 strenuously supported this view. Most frequently, according to the latter writer, the 

 biloculation is excited by costal pressure, but it may also be caused by the pressure of 

 the liver or of its suspensory ligament. 



The question before us, however, is not whether costal or other compression may 

 provoke a response in the stomach by a localised contraction and constriction of its 

 wall, but whether the stomach-form described by His can be explained in this way. 



