42 PROFESSOR D. J. CUNNINGHAM 



upper surface has lost to a great extent its downward slope to the right. Only that 

 portion of the upper surface which remains in contact with the liver is oblique. For the 

 most part both surfaces of the stomach are horizontal, and the greater curvature 

 projects forward so as to press against the anterior wall of the abdomen (see PI. I. 

 figs. 9, 10, 11, and 12). 



It is obvious, therefore, that His takes too limited a view of the possibilities of 

 changes in the position and form of the full stomach. He does not sufficiently allow 

 for altered conditions of surrounding viscera. In all cases the state of the movable, and 

 as a rule yielding, floor of the stomach chamber has to be taken into account. It is 

 possible that the easiest and most natural way for the stomach to expand, under 

 ordinary circumstances, is in a downward direction by intestinal displacement, and 

 when this occurs the oblique position of the organ described by His is the result. But 

 when the intestines are distended the stomach cannot acquire the necessary space 

 in this manner, and the liver, which forms so large a part of the roof of the stomach 

 chamber, has to give way before it. Symington (52), several years ago, gave a 

 convincing demonstration of the changes produced on the liver by the pressure of 

 the stomach. The obvious result of such a condition of the intestine is that the full 

 stomach retains the horizontal position. Although I do not possess specimens which 

 exhibit intermediate conditions between the perfectly horizontal position and the oblique 

 position of the full stomach, I have no doubt that such occur. 



In the chimpanzee which was examined in connection with this investigation 

 the stomach was well filled and had a horizontal position in every respect in close 

 accord with the similar cases found in the human subject (PL I. fig. 13). In 

 the second orang the stomach was slightly over-filled. It was oblique or almost 

 vertical in position, and it was placed entirely to the left of the mesial plane (PL I. 

 fig. 14). In this specimen, therefore, the stomach presented a condition in accord with 

 that usually ascribed to the human foetus. 



LITERATURE REFERRED TO IN THE TEXT. 



(1) Beaumont, Experiments and Observations on the Gastric Juice and the Physiology of Digestion (Combe 



edition), 1828. 



(2) Birmingham, Text-book of Anatomy ; edited by Cunningham, 1902. 



(3) Bbaune, TopograpJiisch-anatomischer Atlas, 3 Aufl., 1888. 



(4) Brinton, Diseases of the Stomach, 1864. 



(5) Broca, Bulletin de la Societe Anat., vol. xxvi., 1851, p. 30. 



(6) Cannon, "The Movements of the Stomach studied by means of the Rontgen Bays," American Journal 



of Physiology, vol. i., 1898, p. 359. 



(7) Cautley (with Dent), " Congenital Hypertrophic Stenosis of the Pylorus and its treatment by 



Poroplasty," Lancet, 1902. 



(8) Chabrie, These de Toulouse, 1894. 



