1907 Boston Medical and Surgical Journal  
The lower border of tympany was now 17 cm. below costal margin on left, C cm. below the xiphoid and had disappeared beneath costal margin on right as previously described. The tympany on the right did not reappear. Inflation with air lowered the line of tympany 4£ cm. The patient was placed on his back, but no more fluid could be expressed. Inflation in this position showed lower border of stomach visible at umbilicus and extending up to costal margin on both sides well outside of mamillary
more » ... de of mamillary lines. From these clinical facts ¡t probable diagnosis of hourglass stomach or dilated duodenum and stomach with pyloric relaxation was made. Dr. Cunningham saw the patient" and determined t-o make a gastro-enterostomy. On April 21,1905, this operation was done. At that time the stomach was seen to be enormously dilated, with no obstruction at the pylorus. The patient stood the operation poorly, and without completely regaining consciousness, died the next evening.
doi:10.1056/nejm190705091561907 fatcat:sqr2t5ohyfaz7fuuhvuj4o77oa