1. Original Arrest Of Development Of The Stomach

Original Arrest Of Development Of The Stomach involving at the same time a large portion of the intestinal canal is found in very imperfect monstrosities, and more particularly in acephalous foetuses, - the stomach is occasionally absent in individuals otherwise normally built and provided with a well-developed intestinal tube, or it may only be indicated by a small saccular dilatation of the oesophagus.

2. Deviations Of Size

Congenital malformations belonging to this class, are either unusual enlargement, or unusual diminution of size; the latter peculiarly affecting the female sex.

Either of these conditions, but chiefly the abnormal increase in size, occur likewise as acquired diseases.

Dilatation of the stomach is either spontaneous, or it is caused by stenosis. The former variety presents a uniform increase of size, and sometimes acquires such a surprising extent, as to fill the entire abdominal cavity. Repeated repletion, in consequence of a morbid appetite, may give rise to this development, or it may occur as a result of paralysis from concussion, traction, or dislocation produced by large scrotal herniae, and it kills slowly with vomiting, with or without gangrene of the mucous membrane, under symptoms of complete paralysis.

Dilatation from stenosis varies according to the seat of the latter. In common stenosis of the pylorus, it is mainly developed at the splenic portion; it equally reaches an enormous degree, and proves at last fatal by paralysis. When stenosis occurs at a different spot, more or less considerable saccular dilatations take place in other sections of the stomach, and in different directions.

A diminution of the stomach is sometimes produced as a permanent condition in consequence of an insufficient supply of nutriment; in other cases it is the consequence of textural disease, especially that produced by cicatrization of extensive ulcers. Contractions or stenoses are the result of hypertrophy of the gastric membranes, of carcinoma, particularly when occurring at the pylorus, and of cicatrization after ulcerative destruction of the tissue at this and at other points.

In reference to the thickness of the parietes of the stomach, we may observe, that extreme thickness, not connected with degeneration of the tissues, is the immediate consequence of the hypertrophy of one, or more commonly of both of the internal coats. The pyloric region is chiefly liable to the affection, which is sometimes limited to the annular portion; it is developed to a greater extent when resulting from stenosis of the pylorus, accompanied by the above-described dilatation, and it then affects mainly the muscular fibres. Hypertrophic disease of the pylorus must be carefully distinguished from carcinomatous thickening.

Attenuation of the gastric coats not unfrequently occurs at the fundus in consequence of extreme dilatation of the stomach resulting from stenosis of the pylorus. The thinning which occurs as spontaneous atrophy, or tabes, with or without an accompanying change in the capacity of the stomach, is of greater importance; it is a very rare and tedious disease, but one which we have invariably seen associated with universal tabes, and with atrophy of the lungs (emphysema senile) and the heart.

3. Deviations Of Form

Among these we reckon, first of all, those rare congenital malformations of the human stomach, in which an annular contraction divides it into a cardiac and pyloric stomach, or in which two or three such contractions form three or four sacculated divisions, and thus cause a resemblance to the stomach of ruminants. We distinguish these from the contractions produced during the agony of death, by the fact that the latter may be removed by inflating the stomach.

Similar and various other malformations are observed as acquired conditions; they have their origin mainly in loss of substance and in cicatrization of the so-called perforating gastric ulcer, and we shall recur to the subject when we discuss the latter.

4. Deviations Of Position. Congenital

Position of the stomach external to the abdominal cavity in eventration, and in umbilical hernia; in the left side of the thorax, the diaphragm being wholly or partially absent on this side; vertical (foetal) position, with the pylorus downwards; the position of the fundus, in the right hypochondrium, corresponding to the reversion of the formative type in lateral translocation. Acquired. - Protrusion of the stomach, externally, in consequence of extensive penetrating wounds, or into the thorax, after injuries to or rupture of the diaphragm; the position of the stomach in large hernial sacs, especially of umbilical and scrotal hernia; the dislocation of the stomach from its natural position by enlargement of the organs in its vicinity, by morbid products, by effusion into the peritoneal cavity, by traction of the omentum and transverse colon: lastly, the spontaneous sinking of the entire stomach into a lower abdominal region from increase of volume or weight, as in the case of a scirrhous pylorus.

5. Solutions Of Continuity

We merely allude here to those rare occurrences of wounds of the stomach produced by penetrating instruments, and by firearms, occasionally healing up with a fistulous opening, and to those circumscribed separations of the membranes of the stomach from one another, accompanied by extravasation of blood, which occasionally result from concussion.