40 PROFESSOR D. J. CUNNINGHAM 



glass stomach, the subdivision takes place by a tueking-in of the greater curvature ; # 

 in no specimen belonging to this variety have I ever seen any indentation of the 

 lesser curvature. When stomachs of this kind are opened up (PI. IV. fig. 39), the 

 mucous membrane at the place of constriction is seen to be thrown into closely set 

 longitudinal folds, which may more or less completely occlude the passage from the one 

 chamber into the other (see also His's PI. XVIII. ). 



In all cases of hour-glass stomach included in this class the condition is due to a 

 localised spasmodic contraction of the muscular coat. Most frequently this occurs at 

 the site of the physiological subdivision of the stomach (i.e. about the middle of the 

 body of the stomach), but it may also take place at any point between this and the 

 pylorus. Moynihan gives a graphic account of the motor capabilities of the human 

 stomach from this point of view. He says : " On several occasions during the last few 

 years, when operating for chronic ulcer, I have watched the stomach intently for 

 several minutes, and have seen the onset, the acme, and the gradual relaxation of 

 a spasmodic muscular contraction of its walls. Quite gradually the stomach narrows 

 and the wall becomes thicker and almost white in colour ; when taken between the 

 fingers the contracted area feels like a solid tumour. The spasm may be so marked 

 as to prevent a finger being invaginated through the segment affected. The appearance 

 presented is very striking. I have seen it in the body of the stomach and at the 

 pylorus, but never at the fundus. As slowly as it comes on, the spasm quietly relaxes 

 and the stomach assumes its natural form.'' 



Every anatomist is familiar with corresponding spasmodic conditions of the 

 intestine (PI. IV. fig. 37). It is no infrequent occurrence to find two expanded pieces 

 of intestine (either large or small) separated by a short piece of the gut so tightly 

 contracted that it is reduced to the diameter of the little finger, and gives a hard and 

 solid sensation when grasped between the finger and thumb. These are passing con- 

 ditions in the intestine, and the question naturally suggests itself : Are the spasmodic 

 local contractions of the stomach wall which separate the two relaxed chambers of 

 an hour-glass stomach of the same kind ? in other words, are these gastric states 

 temporary and fleeting ? Upon this point we have no proof, and I am not prepared 

 to hazard an opinion on the subject. It is a problem which must be left to the 

 clinician to determine. 



Topography of the Stomach. 



In the article by His (22) to which reference has been so frequently made, the 

 topography of the stomach is very fully dealt with, and, as I find myself in general 

 agreement with most of his results, it is unnecessary to dwell at any length on this 

 aspect of the subject. A few observations supplementary to those of His are all that 

 need be referred to. 



* In this connection the diagrams given by Koux and Balthazard, showing the constriction-waves travelling 

 along the greater curvature of the human stomach after the introduction of 15 to 20 grammes of subnitrate of bismuth 

 suspended in 100 grammes of water, are very instructive (47). 



