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DIGESTION: STOMACH
The esophagus, or gullet, is a short tube from the mouth to the stomach. This latter thick-walled churn mixes up the food with the pepsin mentioned above, and with hydrochloric acid.
Pepsin will not work without it. If analysis of the stomach contents shows it to be absent, then look out. Two bad diseases, cancer of the stomach and pernicious anemia, are each associated with lack of hydrochloric acid.
I have called the stomach a churn. William Hunter said: “Some physiologists will have it that the stomach is a mill, others that it is a fermenting vat, others again that it is a stew pan; but in my view of the matter, it’s neither a mill, a fermenting vat nor a stew pan; but a stomach, gentleman, is a stomach.” It has become more and more evident in the two centuries since then that there is nothing like a stomach. Its mysteries are not unfolded yet, though we have a great deal of firsthand knowledge of what goes on in the stomach, obtained by direct observation.
Some years ago a group of us stopped at Mackinac Island where Lakes Huron and Michigan join. At that idyllic period of no autos, as we rode along behind a team of horses, I told the story of William Beaumont for which the island is famous. At the end of my tale, the driver turned with a grin, saying, “When there is a doctor in the group, my work is half done for me. I hold the reins; he gives the talk.”
The first time in history that a man could look into the stomach of a living person was a dramatic stepping stone in medicine. William Beaumont, born in Connecticut, was an army surgeon at the frontier fort of Mackinac Island in the first quarter of the nineteenth century. One summer’s day, a young trapper, Alexis St. Martin, was struck in the chest and abdomen by the discharge from a shotgun two feet away. It tore away some of his ribs, part of his diaphragm, and a portion of his stomach. His case, of course, was “hopeless”; but Dr. Beaumont did not proceed on that assumption and St. Martin survived the hardships of life in the wilderness, and got drunk at every opportunity until he was about eighty, when Beaumont had been dead thirty years.
The hole in the stomach never closed, so a contract was made. Dr. Beaumont gave St. Martin surgical care and supported him, and in return was allowed to make physiological studies. Thus he was able to describe the chemistry of the gastric juice, the movements of the stomach, and the appearance of its lining when the patient ate “pig’s feet, wild goose, and venison.” What is more, he noted the profound influence of the emotions. Even to this day most of our knowledge of stomach pathology comes from the studies of Beaumont. One of his pieces of wisdom is pertinent today. “The system requires much less than is generally supplied to it. . . . Dyspepsia is oftener the effect of overeating and overdrinking than of any other cause.”
At the lower end of the stomach is the pylorus, a sphincter muscle, that is, a sort of puckering string. Every little while it relaxes, and lets some of the contents of the stomach into the duodenum. In this neighborhood occur most “stomach ulcers,” to use the popular phrase. Physicians, when grouping them all together, speak of “peptic ulcers.” Nearly all of them are duodenal. When a surgeon operates for a perforated ulcer, he locates the pyloric sphincter, a firm narrow raised band of tissue; and nine times out of ten, he will find the hole, if present, practically touching this, but on the duodenal side.
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