Tom's Stomach

A shy, proud, slight (105 lb.) man, known professionally as Tom, is the owner of one of the strangest stomachs in existence. This stomach was the subject last week of a book (Human Gastric Function; Oxford University Press; $4.75), by Drs. Stewart Wolf and Harold G. Wolff of Manhattan's New York Hospital. Says famed Physiologist Walter B. Cannon in his foreword: "The functions of the stomach have never been investigated with the detailed care, the skill and ingenuity" that Drs. Wolf & Wolff display in their researches on Tom's stomach.

Abdominal Mouth. One day when Tom was nine years old his father brought home some hot chowder in a beer bucket. Thinking it was beer, Tom took a swig, burned his esophagus so badly that the doctors could not keep it open as it healed. So for 47 years Tom has fed himself through an opening surgeons made in his abdominal wall. He chews his food, then spits it into a funnel attached to a rubber tube which runs through the opening to his stomach. A sensitive, self-respecting little man, with a peppery Irish temper, Tom has kept "the way I feed" a secret from all but his closest friends.

Tom used to be shy even with doctors because, when he went to have the opening (medical name: stoma) treated, doctors appeared more interested in the stoma than in Tom. Once when a doctor left him for a moment to call in colleagues, Tom disappeared from the examining table. After that he would let doctors listen to his chest and look down his throat, but he would not let them look at his stoma nor peer through it at his stomach.

Reluctant Guinea Pig. Some of Tom's stomach lining protruded in a rosette around the stoma. To absorb this membrane's secretions and the occasional leakage from inside, Tom wore a gauze bandage between meals. Sometimes the bandage irritated the rosette and it bled a little. When Tom worked as a sewer laborer during the depression, the bleeding got so bad that he had to let a surgeon remove some of the bleeding tissue. The convalescence was long and Tom had to go on relief. This hurt his pride--he had always managed to support his family. So Drs. Wolf & Wolff asked Tom to better his lot and do medicine a service by taking a job as clean-up man in their laboratory and serving as an experimental subject. Tom was worried and broke, but it took four months to persuade him.

Once Tom took the job (in 1941), he uncomplainingly let the doctors do almost anything to him. His was a peculiar schedule: with or without breakfast, as the doctors prescribed, he lay all morning on the examining table, sometimes napped; in the afternoons he tidied up the laboratory and ran errands. Human Gastric Function reports what happened when Drs. Wolf & Wolff plied and prodded Tom's stomach with whiskey, glass rods, hot & cold water, mustard, drugs, air pumps. The book is a minute record of his stomach's color, secretion and activity when Tom felt relaxed and secure, when he was full, hungry, worried or angry. Some of Wolf & Wolff's findings:

> Whether he was asleep or awake, Tom's stomach usually had a ten-to 30-minute spell of vigorous contractions every three hours or so. (Unless there was something inside, the stomach walls touched each other.) Between times, contractions were rare, slow and gentle. The stomach could be made to start work in the midst of a rest period by feeding it solids (e.g., a bouillon cube); it could be made to relax in the middle of work by feeding it liquids. > Tom's stomach secreted juice continuously, about 8 to 15 cc. an hour even while resting. (This contradicts a conclusion William Beaumont drew in 1833 from his famous experiments on Alexis St. Martin.)

> When Tom was frightened both his face and his stomach lining turned pale. When Tom was depressed, his stomach lining, which usually reddened and increased its secretion of acid after a dose of beef bouillon, hardly responded at all to such feeding. When Tom got mad, his face got red and so did his stomach. (This happened when an officious clinic secretary angered him.) More than any other emotion, anxiety increased the amount of blood in the stomach membrane and the amount of acid secretion. When Tom was anxious (e.g., worry about his stepdaughter's illness and death), he had diarrhea and no appetite, and he was wakened in the night by acid juices escaping from his stomach. Though Tom did not want food when he was worried, the doctors found that, if he ate, his digestion rate was faster than normal. Hence they conclude that not the stomach, but the emotions determine appetite. They write: "What is known about the length of time food remains in the stomach must be re-evaluated in the light of the profound alterations which accompany altered emotional states."

> Unusually vigorous stomach contractions caused Tom to suffer cramping "hunger" pains. Pinches and pricking and electric shocks sufficient to cause intense pain to a man's skin had no effect on Tom's gastric mucosa. But when a spot on his stomach lining was stripped of its protecting mucus and sprinkled with mustard, it became very sensitive. Strong pressure with a glass rod or from a balloon inflated in his stomach to 1,500 cc. gave Tom a stomachache.

> The doctors found out some new things about ulcers by producing a small ulcer on a bit of exposed stomach membrane. Mucus protects healthy stomach walls from being digested by their own juices, but this area did not have much mucus, and an ulcer developed when the doctors merely dropped gastric juice on it. The spot bled and grew for four days. Meanwhile the whole stomach lining became inflamed and produced more gastric juice than before. The doctors found "a vicious cycle is set up [by stomach ulcers], since the acid gastric juice in contact with a denuded region induces further acid secretion." The doctors healed the ulcer in three days by bandaging it with a petrolatum poultice. Atropine, which is often given to soothe ulcer sufferers, cut down Tom's mucus secretion. Therefore the doctors believe atropine should not be generally used for ulcers (except occasionally as a sedative), because the drug reduces the very protection the stomach most needs. Proper ulcer treatment, Wolf & Wolff conclude, "would involve the management of the personality disorder" causing the excited, ulcerated stomach.

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