Triumphs of Surgery

From Illinois and Georgia last week came case histories of surgery's triumph over one of nature's malign quirks that was once invariably fatal, then permanently crippling. The anomaly: a baby, healthy-looking at birth, may prove to have no gullet (esophagus) to carry food from mouth to stomach. Sometimes there is a short, dead-end stretch of gullet at both top and bottom, but the middle section is missing. Often there is an opening between the defective gullet and the windpipe, so that air goes into the stomach and food into the lungs. Exact incidence of these defects is unknown: the best estimate is once in every 5,000 births.

Until the turn of the century, such infants always died. Then came operations to allow feeding (usually by tube) through the abdominal wall into the stomach. Many victims struggled along for years with these makeshifts. About 20 years ago, surgeons got bolder, devised several operations to supply a missing stretch of gullet by stitching a piece of the child's gut in its place. Appallingly complex, these techniques often needed a series of operations spread over a period of years. They could be done only in major medical centers.

For some types of cases the operations have now been simplified, and they are being done in more and more hospitals, many in smaller cities. Example: Karen Lee Gordon, from Pana, Ill., went to St. Mary's Hospital in nearby Decatur (est. pop. 75,000) for five operations to correct a complicated no-gullet anomaly. Last week, out of the hospital in time for her fifth birthday, she was eating normally, tasting and swallowing food, for the first time in her life. She even had sausage for breakfast.

Two-day-old Tommy Boston Jr. of Cartersville, Ga., was taken to St. Joseph's Infirmary in Atlanta, where Surgeon William A. Hopkins found that he had a short stub of gullet extending one-third the normal length down from his throat, then nothing. Dr. Hopkins led this stump out through a hole in the neck, so Tommy could get rid of saliva. For feeding, he ran a tube into the stomach. This worked well for six years, until Tommy was big enough to undergo the operation. Then Dr. Hopkins pushed the gullet stump back into place, stretched a piece of Tommy's large bowel up into his throat to meet it, and stitched them together. At the lower end, this piece of gut was joined to the stomach. The small bowel was joined to the remainder of the large bowel. Tommy's revamped digestive tract worked fine. His one problem: learning to use a knife, fork and spoon.

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