Tom's Stoma & Stomach

In the annual riot of trading and boozing at the fur company store on Mackinac Island on a June afternoon in 1822, a gun went off accidentally and blasted a gaping hole in the belly of Alexis St. Martin, ig, a French Canadian voyageur. For the rest of his days he had a hole in his abdominal wall leading directly into his stomach. The blast that let the daylight into St. Martin's stomach enabled U.S. Army Surgeon William Beaumont, in years of experiments, to shed the first light on the mysteries of human digestion.

In 1895 the father of an Irish family on Staten Island carried home a beer bucket. His son Tom, 9, tried to sneak a quick swig, soon collapsed, unconscious. The bucket held scalding, near-boiling chowder, and the burn closed young Tom's gullet with scar tissue. Not a particle of food or a drop of liquid could pass through it into his stomach. So surgeons cut into his abdomen, made a hole in his stomach where they attached it to the muscle wall. For the rest of his life, Tom had to feed himself by chewing his food and spitting it into a funnel from which it passed through a rubber tube inserted in the hole in his stomach.

Red Rosette. This opening (technically a "stoma," or mouth) was surrounded by a rosette of mucous membrane--part of the stomach lining. Because gastric juice tended to leak from the stoma, Tom had to keep it covered with a piece of absorbent gauze. Proud and sensitive, Tom managed to keep the secret of his feeding difficulty from all but his closest friends, got through six grades of parochial school, even played backyard football. He went to work first as a plumber's helper, married and had a daughter.

When Tom was swinging a pick as a sewer laborer during the Depression, the gauze pad so irritated the delicate membrane of his rosette that he had to have an operation. Recovery was slow, and Tom had to go on relief. Up to that time he had not let doctors study him, because of his sensitive feelings. Doctors were callously more interested in his stoma and stomach than in him. He refused to be a human guinea pig. But in 1941 at New York Hospital, Drs. Harold G. Wolff and Stewart Wolf made a deal: on their payroll, Tom would spend his mornings as a subject of medical study, his afternoons as a handyman around the laboratory. Peppery about his right of privacy, Tom made the doctors promise not to publish his last name anywhere, or a recognizable picture outside a medical journal.

Pink & Relaxed. So fruitful was this association that m 1943 Wolf and Wolff published the most momentous study of digestion since Beaumont's: Human Gastric Function (updated in 1947). They had investigated not only the stoma and stomach but, by the psychosomatic approach, the whole man. They showed that Tom's stomach, when he was at ease, was pale pink and relaxed, with many convoluted folds, but bright red, smooth and tense when he became angry. Fright turned both Tom's face and his stomach pale. By shutting off the flow of gastric juices, depression made his stomach almost incapable of digesting food. Anxiety was the most stomach-damaging emotion, clearly linked with the formation of ulcers.

After 1952 when Dr. Wolf went to the University of Oklahoma, Tom commuted twice yearly to Oklahoma City so the work could go on. His worst upset came in 1953, when, by impersonal administrative routine, Tom was summarily notified that he had been retired. But he still had many productive years. With improved microscopy. Dr. Wolf was able to learn in detail the effect of emotional changes in minute blood vessels.

Dead End for Saliva. Finally, Tom's stomach yielded confirmation of a notable discovery. The Oklahoma team isolated a potent, protein-digesting enzyme called gastricsin. and a second substance that blocks the secretion of hydrochloric acid. Question was whether this inhibitor was secreted by the stomach or reached the stomach with the saliva. But Tom's saliva was trapped in his dead-end gullet (he spat out half a glassful three or four times a day), never reached his stomach except when he ate. And in his fasting stomach the investigators found the inhibitor. There was their proof.

Two years ago Tom developed a cancer of the stomach. (The researchers are confident that their myriad tests had nothing to do with causing it.) Prompt removal of part of the stomach saved him, but increased the leakage from his stoma to almost three quarts a day. Dehydrated and starved of protein, Tom's 5-ft. 4-in. frame wasted to 90 lbs. Before he could be built up for another operation, an old kidney ailment complicated the fluid loss. Last week, aged 73, Tom died in New York Hospital.

The name of Tom is already quoted in scores of books and hundreds of technical papers on subjects ranging from physiology to psychoanalysis. The name that he consented only in his last days to have disclosed, along with his picture, was Tom Little.

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