Medicine: Through a Stomach Hole

The summer of 1822 Fort Mackinac, Michigan Army and fur-trading post, was a rough, brawling, drunken community of about 5,000 Indians, French-Canadians and half-breeds spending the proceeds of their winter fur catches. Only doctor within a 300-mi. radius was William Beaumont, an Army surgeon who meticulously recorded in a diary every medical tittle and jot he performed. For June 6, 1822, the entry, now a precious incunabulum in the history of U. S. Medicine, reads:

“St. Martin, a Canadian lad, about 19 yrs. old, hardy, robust and healthy, was accidentally shot by the unlucky discharge of a gun. . . . The whole charge, consisting of powder and duck shot, was received in the left side at not more than two or three feet distance from the muzzle of the piece, . . . carrying away by its force the integuments more than the size of the palm of a man’s hand; blowing off and fracturing the sixth rib . . . , fracturing the fifth, rupturing the lower portion of the left lobe of the lung and lacerating the stomach by a spicule of the rib that was blown through its coat; landing the charge, wadding, fire in among the fractured ribs and lacerated muscles and integuments and burning the clothing and flesh to a crisp. I was called to him immediately after the accident. Found a portion of the lung as large as a turkey’s egg protruding through the external wound, lacerated and burnt, and below this another protrusion resembling a portion of the stomach, what at first view I could not believe possible to be that organ in that situation with the subject surviving, but on closer observation, I found it to be actually the stomach with a puncture in the protruding portion large enough to receive my forefinger, and through which a portion of the food he had taken for breakfast had come out and lodged among his apparel.

“In this dilemma I considered any attempt to save his life entirely useless. But as I had ever considered it a duty to use every means in my power to preserve life when called to administer relief, I proceeded to cleanse the wound, give it a superficial dressing, not believing it possible for him to survive 20 minutes. On attempting to reduce the protruding portions, I found that the lung was prevented from returning by the sharp point of the fractured rib, over which its membrane had caught fast, but by raising up the lung with the forefinger of my left hand I clipped off, with my penknife in my right hand, the sharp point of the rib, which enabled me to return the lung into the cavity of the thorax, but could not retain it there on the least effort of the patient to cough, which was frequent.”

This was before germs, antisepsis and chloroform anesthesia were discovered. Doctors were often obliged to steal or buy corpses for anatomical studies. They had very little precise knowledge of what goes on within the body of the living man. Organic chemistry was just blossoming out of alchemy, with only 49 of the 92 elements recognized. Surgeon Beaumont had little beyond simple Nature to help him treat Alexis St. Martin.

For three years Dr. Beaumont tried to close the hole in the boy’s stomach. Ultimately a flap grew over the hole and retained food in the stomach. But any time he wished Dr. Beaumont could push the flap away and see what was going on within the stomach. This inquisitiveness made him think of starting a research within the processes of digestion, concerning which knowledge was hypothetical. Alexis St. Martin grew impatient with the experiments, ran away to his Canadian home, married, and fathered two children before Beaumont could find him, through fur trappers.

Experiments on St. Martin’s digestion continued. When Dr. Beaumont had made and recorded 238 protocols, he published at his own expense 1,000 poorly printed copies of Experiments & Observations on the Gastric Juice and the Physiology of Digestion. It was the first thoroughgoing, precise study of its subject matter, and was the first significant U.S. contribution to Medicine. Copies of the book in good condition are now worth $50.

Beaumont published his book in 1833. Earlier this centennial year the Philadelphia College of Physicians, the University of California Medical School and the Wayne County (Detroit) Medical Society (among others) conducted memorial meetings and exhibits. This week the New York Academy of Medicine begins an elaborate commemoration with some 300 Beaumont items on display—photostats of private papers (from Washington University, St. Louis, whose medical school Beaumont helped found ), photographic reproductions of every Beaumont portrait known, and two photographs of Alexis St. Martin.

Dr. Beaumont was unable to do everything he wished with St. Martin’s stomach. Shortly after the book’s publication the French Canadian returned home for good. Dr. Beaumont ultimately resigned from the Army medical corps, established himself in St. Louis. There his reputation as a peerer into organs threw him into court. He had trephined a broken skull. Hostile doctors testified that he had done so to see what was going on in the dying man’s brain. The court acquitted Dr. Beaumont. In 1853, aged 67, he slipped on an icy flight of steps, developed a carbuncle on his neck, died within a month.

Tough Alexis St. Martin lived on at St. Thomas de Jolliette, Ont. to be 83. His family buried him eight feet deep “to make difficult attempts at resurrection.”

Last week at Evanston, Ill. died another hero in stomach annals: Ajax, 9, a dog whose stomach Physiologist Andrew Conway Ivy cut out six years ago to demonstrate that in necessity a person could thrive without that apparatus.