38 PROFESSOR D. J. CUNNINGHAM 



The different degrees of contraction exhibited by different portions of the muscular coat 

 of this stomach were demonstrated in a striking manner by removing the mucous and 

 submucous coats (fig. 40), and the part which the oblique fibres played in determining 

 this stomach-form was rendered evident. The thick band of oblique fibres which forms 

 a loop around the left side of the oesophagus, at the bottom of the incisura cardiaca, 

 and which is carried on both aspects of the stomach to a point a little below and beyond 

 the incisura angularis, was strongly contracted, and was clearly concerned in producing 

 the doubling of the stomach upon itself. 



It is manifest that the three aberrant forms which we have described not only 

 present features in common with each other, but also with other stomach-forms which 

 may be regarded as exhibiting a normal degree of motor activity : they are evidently 

 in what Kussmaul (29) has termed a state of "peristaltic unrest." The conditions 

 they represent are no doubt more or less temporary, but I am inclined to look upon 

 them as abnormal, and in all probability caused by spasmodic contraction of the muscular 

 coat. In cases of infantile pyloric stenosis exaggerated peristaltic constrictions with 

 intervening bulging wave-like eminences can in certain cases be seen following each 

 other over the surface of the abdomen in the region of the stomach. Several beautiful 

 photographs of this are given by Ibrahim (26). Specimen V. B (fig. 35) is suggestive 

 of such appearances. 



Hour-Glass Stomach. 



From the forms which we have had under discussion to the form known as hour- 

 glass stomach is but a step. This is too large a question to enter upon at any length 

 in the present communication ; still, it is one which is so intimately connected with 

 much that goes before that it is impossible to pass it over without touching upon 

 certain points concerning it which are suggested by this investigation. 



Although it is generally admitted that Morgagni (37) was the first who properly 

 described the condition, the earlier anatomists were acquainted with the fact that it was 

 not uncommon to meet with cases in which the stomach was divided more or less 

 completely into two chambers. It has been customary to classify such stomachs into 

 two groups, viz. (1) the acquired or pathological, and (2) the congenital. 



The pathological group does not come within the range of this investigation. 

 Every museum contains specimens which would seem to indicate that certain morbid 

 conditions may, by adhesions, cicatrices, or otherwise, produce permanent localised 

 contractions of the circular muscular fibres of the stomach, and thus a permanent 

 division of the organ into two chambers which communicate with each other by a more 

 or less narrow intervening passage. 



In this country, the late Sir John Struthers (50) may be regarded as the leading 

 exponent and advocate of the view that hour-glass stomach may occur as a congenital 

 deformity, but recently the accuracy of this supposition has been strenuously called in 

 question. Moynihan (38 and 39), who has had a large experience from the pathological 



