Major discoveries in medicine can occur for different reasons. Some, the result of slow, careful work; aggregate studies and experiments done over time with methodical precision. Some advances however are made as a result of purely circumstantial occurrences. The most dramatic example of this is perhaps the tale of a young Quebecian frontiersman, who as a result of a particularly gruesome accident came to have a hole in his stomach, and the dubiously enterprising surgeon who studied this peculiar condition.
Alexis St. Martin, the unfortunate victim whose primary vocation was destined to be that of a surgeon’s pet, was in 1822 working in the employ of the American Fur Company as a voyageur, a transporter of goods and people along the waterways of Michigan. No doubt enjoying a rare day off at Fort Mackinac on Mackinac Island on June 6th 1822, he was accidentally shot in the stomach by a musket at the range of a single yard. Not a good start to his day.
Fortunately, William Beaumont, a U.S. Army surgeon stationed at the fort, was present and rushed to his assistance. Neither could have known that it was the beginning of a specialized and singularly strange working relationship.
The musket wound was brutal. Described as the ‘size of a man’s fist’, the blast had punctured the stomach, smashing his fifth and sixth rib and causing major lacerations to the diaphragm and lungs, not to mention burying the shot, powder and clothing remnants deep into his chest cavity. The situation looked extremely grim for the young man and it seemed unlikely he would survive.
Beaumont, in his published study of the experiments later performed on Alexis St. Martin, entitled Experiments and Observations on the Gastric Juice and the Physiology of Digestion, describes in rather unappetizing terms the nature of the injury:
“…on examination, found a portion of the lung… protruding through the external wound, lacerated and burnt… below this another protrusion which […] proved to be a portion of the stomach, lacerated through all its coats, and pouring out the food he had taken for breakfast…”
After repair of the lungs, removal of the sharp sections of fractured rib, and several days of inflammation, fever and a smell that we can only try not to imagine, the young man began to recover. For seventeen days he was unable to hold any food, literally; anything he ate ultimately passed through the hole in his stomach, and so was kept alive ‘by means of nutritious injections’. Eventually despite Beaumont’s attempts, the hole remained open and healed, whilst leaving the stomach in an exposed state, described by the surgeon as ‘resembling, in all but a sphincter, the natural anus, with a slight prolapsus.” Delightful. (1)
With the use of compresses and bandages (unsanitized, I might remind you – it is the 1820’s) to enable food and drink to remain within the confines of his stomach, Alexis St. Martin returned to almost normal health, a remarkable result given the severity of his wound. However, hardly a man to shun any proverbially granted lemons, Beaumont commenced a series of extensive gastric experiments. Never before had the process of digestion been studied in real-time, and for ten years Beaumont took full advantage of this anomalous and unique opportunity.
And when I say take advantage, I really mean it. Unable to work in any other capacity, Alexis St. Martin was nigh-on forced to work as his contractually retained servant and suffer the painful ministrations of the army surgeon and his lengthy experiments. Yet such experiments they were, culminating in the 1833 publication of his findings to major acclaim.
As well as studying the effects of temperament, satiation and emotion on the gastric system, most dramatic were his studies in 1825 that tested the time-frame of chemical digestion upon different types of food.
Taking various ‘articles of diet’ and securing them with sections of silk string, he inserted into the new aperture everything from à la mode beef, stale bread to raw sliced cabbage, instructing the undoubtedly weary St. Martin to continue his daily duties; chopping wood, collecting water, etc. – all while presumably trying to pretend he wasn’t Beaumont’s human sized guinea-pig.
At hourly intervals during the investigation, the string was pulled and the attached items removed to study the effects of digestion by the gastric fluids. In one note:
“At 1 o’clock, P.M. – withdrew and examined them – found the cabbage and bread about half digested; the pieces of meat unchanged. Returned them into the stomach.”
The surgeon was a true scientist in his testing. He mentions (and I draw your attention to the method of examination):
“2 o’clock, P.M. – … the raw beef was slightly macerated on the surface… the smell and taste of the fluids were slightly rancid – the boy complained of some pain…”
Yes, you read correctly: taste. That said, at the end of a second round of these experiments, the young man had grown understandably weary of being poked and prodded, and returned to Quebec. Beaumont states, with a detectable petulant affrontery towards his test subject who had the audacity to go wandering off: “…the experiments were consequently suspended.”
St. Martin did eventually return (for reasons best known to himself), the condition of his unique and superfluous orifice remaining the same. Resuming his experiments, Beaumont took to measuring those foods that St. Martin consumed by normal means and removing them via his stomach sphincter to test the effect of saliva and mastication (chewing), from which he concluded that although saliva had no effect on digestion, chewing was vital. The components of a hearty breakfast, milk, sausage and other culinary items, the effect of a warm day and vigorous exercise, all these and more were examined and studied.
As unpleasant as it might seem, Beaumont’s work was actually useful and proved beyond a doubt that chemical disintegration by means of bile and other fluids was the primary means of digestion and not vigorous convulsions of the stomach itself. Additionally, he was the first Colonial – ahem, I mean American (forgive my manners), to be recognized internationally for physiological research.
And Alexis St. Martin? Following the conclusion of the experiments, he moved back to Quebec in Canada with his family, and with all the vigor of any man his age eventually resumed his job as a voyageur, eventually becoming a farmer, his strange wound providing no impediment.
He died at a ripe 78 years old, a seasoned age for the time, as ever the medical Pandora’s Box to various physicians. (2). To prevent curious medical professionals from performing an autopsy upon his death, the cautious family let his body fully decompose before burying him. It’s hard to imagine that such actions weren’t taken as a result of extremely precise instructions from the tough old patient himself, unwilling to be prodded a moment longer by another damnable doctor, even in the sweet and gentle repose of death.
1. Accounts from the doctor’s studies are replete with descriptions of how wide the wound was, the measuring implement being described (without any hesitation) as his own finger. I worry if the good doctor Beaumont took rather too much enjoyment in repeatedly inserting his finger into the poor boys wound. Who can say.
2. Notably, St. Martin outlived the intrusive army surgeon by 27 years, Beaumont perishing in 1853 as a result of falling down some icy steps. Had St. Martin known of this, I feel he may have seen it as a fair demise, given their history.