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Mackinac Island. June, 1822. The American Fur Company store bustles with voyageurs and clerks. Suddenly a thunderous crack breaks the buzz of commerce. A voyageur falls. He is Alexis St. Martin, and he’s been blasted in the belly from the accidental discharge of a shotgun, a load of duck-shot from less than three feet away.
“Chercher le docteur!” you can almost hear his friends calling. The doctor is William Beaumont, the Army surgeon stationed at Fort Mackinac, and he comes quickly. Beaumont examines the hand-sized wound with the edge of a burnt lung protruding from it, discovers also a hole in the man’s stomach and sees the man’s breakfast spilling out. He decides that treatment is nearly futile.
But it is not in Beaumont’s character to give up. At age 37, the New England farm boy has already proven his tenacity by obtaining a one-year medical apprenticeship (his only medical training) and serving through the horrors of the war of 1812. So he cleanses the wound as best he can, clips off a bit of a rib with his penknife to ease the lung back inside, then applies a poultice.
A day later, the voyageur is struggling for his life, pneumonia and fever have set in. Beaumont bleeds the voyageur, then administers a cathartic, which spills out the hole in his stomach. Since attempts to feed the patient have the same result, St. Martin is fed through anal injections for two weeks, until the wound is healed enough for the hole to be bandaged. At least the voyageur can eat.
By December, St. Martin is, miraculously, on the mend, with one exception. The hole in the stomach has not closed—and defies all Beaumont’s attempts to seal it. Instead, the tissue around the opening attaches itself to the tissue in St. Martin’s side, creating a gastric fistula, a permanent opening. A disturbing development for St. Martin, because unless the hole is covered, his last meal leaks out. But for Beaumont, the hole presents an opportunity for his curious medical mind: He can look through the shilling-sized cavity, into a living human stomach. Fascinated, Beaumont spoons in food, then siphons it out again. He attaches meat to a string, dangles it through the hole and pulls it out for observation.
While St. Martin’s gastric fistula was not the first recorded in history, it was the first time one was exploited for scientific research. With encouragement through letters from his friend, Army Surgeon General Joseph Lovell, Beaumont begins experimenting on St. Martin’s stomach on Mackinac Island in 1823 and 1824. He continues the experiments intermittently for the next 10 years, at his posts in New York, Wisconsin and Washington D.C.
Beaumont’s experiments settled a scientific debate waged on both sides of the Atlantic over the nature of digestion. Until Beaumont published his observations in his book, Experiments and Observations on the Gastric Juice and the Physiology of Digestion, most scientists believed digestion was either mechanical or chemical. The first attributed digestion to a grinding in the stomach, the latter to the solvent properties of gastric juice.
Beaumont proved once and for all that digestion in the stomach was chemical—a product (mostly) of the gastric juice itself which Beaumont surmised, correctly, was composed largely of hydrochloric acid. The discovery lifted the doctor from obscurity, and he became seen as the father of American physiology. The fact that Beaumont made these findings with the barest nuts-and-bolts medical background, in frontier conditions, and with no scientific training is a testament to his keen mind. But his biographer, Reginald Horsman, believes that Beaumont’s humble background, so unattached to an elite school or theory, also provided the foundation for his genius. Ultimately Beaumont’s discoveries “convinced most of those who read his work that here was an honest reporter,” writes Horsman.
Beaumont remains a star in the realm of scientific history. But there is also a more humanistic piece to the story, and it has everything to do with the man with the hole in his stomach, Alexis St. Martin.