Alexis St Martin was a dead man: of that everyone was certain. When the young Canadian trapper entered the general store of the American Fur Company in the northern frontiertown of Mackinacon the morning of 6June1822, he had no booze-fuelled fights to pick, no slights to avenge, no pelt deals to dispute. He was simply in the wrong place at the wrongtime – directly in front of a trapper’s shotgun when it accidentally went off. “The whole charge entered his body,” a witness reported. “The muzzle was not overthree feet from him-I think not overtwo. The wadding entered, as well as pieces of his clothing; his shirttookfire; hefell, as wesupposed, a dead man.” Butthe shooting of Alexis St Martin was to take a bizarre turn, one that would help to unravel the mysteries of digestion.
THERE was a terrific blast, a groan and then a thud as Alexis St Martin’s body slid to the floor. No one who witnessed the accident really believed a doctor could help, but they sent for one anyway. William Beaumont, an army surgeon based at the local fort, arrived some 20 minutes later to examine a dreadful wound under the victim’s left breast; the shot had blown off “integuments and muscles the size of a man’s hand…materials forced from the musket, together with fragments of clothing and pieces of fractured ribs, were driven into the muscles and cavity of the chest”. Beaumont cleaned the gaping wound as best he could, but with the trapper’s breakfast running out from a hole in his stomach, the end seemed certain. “The man can’t live 36 hours,” he remarked as he left.
Beaumont’s prognosis was based on hard-won experience. As assistant army surgeon during the war of 1812, he had treated soldiers with appalling injuries. After one engagement, he spent two days amputating limbs and trepanning broken skulls. By the time he examined St Martin, Beaumont had seen every sort of wound imaginable, and their typically fatal results.
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Yet the stubborn trapper survived the loss of blood, 10 days of fever, and weeks during which shattered bone and cartilage oozed out of his wound. Eating and drinking were impossible; the contents of his stomach simply spilled out from the hole. For weeks, the only way to sustain St Martin was by injecting fluids into his rectum. But he rallied, clinging to life so long that Beaumont was forced to take the penniless patient into his own home. A few weeks later, the hole had stabilised sufficiently for the surgeon to cover it with bandages, allowing the trapper to eat.
Three years passed under Beaumont’s care, and St Martin could live and work much as before. There was just one problem: although the wound had healed, there was a still a hole, or fistula, leading straight into his stomach. With the bandages off, St Martin’s gastric fistula allowed Beaumont to view inside the stomach “to a depth of five or six inches” and watch food and drink entering it. The gunshot wound had healed into a window on the workings of the stomach – and offered Beaumont an extraordinary scientific opportunity.
Digestion was still poorly understood in the 1820s. For centuries, anatomists assumed food was broken down by a process of fermentation or “putrefaction” by some hazily defined “vital spirit” in the stomach. By the 1790s, the idea of chemical breakdown was becoming better accepted. In one experiment, French scientist René Réaumur fed sponges to his pet bird; after the bird obligingly vomited these back up, Réaumur squeezed the gastric fluids out onto litmus paper, showing it was acidic. Another researcher, French physician Antoine Montègre, had an extraordinary patient who could apparently vomit at will, and he declared in 1812 that the resulting liquid was not acid, but nothing more than swallowed saliva.
In 1825, Beaumont moved to a new post in Niagara, New York. He took St Martin with him and began a ground-breaking series of experiments. He tied food – including a piece of bread, some cabbage, and a lump of salted beef – onto a silk string and lowered it down the hole into St Martin’s stomach. He left the morsels for carefully measured intervals before reeling them back up to examine the results. Beaumont also inserted a thermometer to determine the stomach’s temperature, which was 100 degrees Fahrenheit (38 °C), and used a tube to draw out “gastric juice” for further study. He quickly discovered two key facts: first, gastric juices were acidic, and second that they were not present when the stomach was empty. Food stimulated their production, although they also sloshed about when St Martin got angry.
Beaumont found that while certain foods, such as boiled rice, broke down after an hour in the stomach, salted pork could take 4 or 5 hours. Neither broke down in tubes of gastric juice outside the body unless they were warmed up. Larger pieces took longer to digest than smaller ones, and a little shaking – just as he’d seen the stomach do with its squirming – also worked wonders. So food was broken down by rendering, heating and shaking: it was, in other words, a typical reaction with a solvent. There was no need to invoke some vague “vital spirit”.
In July 1825 Beaumont received two months’ army leave, allowing doctor and patient to visit medical friends in New York and Vermont. But for St Martin, a hard-drinking, illiterate labourer, gastroenterology held no charms. He wearied of people gawping at his guts. The nearby Canadian border beckoned, and one day he slipped away.
Nothing more was heard of him until three years later, when Beaumont received a letter from an agent of the American Fur Company: “While in Canada last winter I succeeded in finding your ungrateful boy, Alexis St Martin. He is married…poor and miserable beyond description, and his wound is worse than when he left you.” Beaumont was thrilled, and paid for St Martin and his family to come to live with him at his new posting in the Michigan Territory. St Martin was to serve as Beaumont’s test subject for the next four years. Beaumont even drew up a legal agreement, possibly the first patient consent form in history. St Martin agreed to “submit to, assist and promote by all means in his power such Physiological or Medical experiments as the said William shall direct or cause to be made in or on the Stomach of him, the said Alexis”. In return, Beaumont agreed to pay $150 a year, and to stop any time his patient fell ill or wished to end the arrangement.
Beaumont threw himself into his work. He sent out bottles of gastric fluid for analysis, determining that a key ingredient was hydrochloric acid. He made hundreds of trials dangling food into St Martin’s stomach, carefully examining the texture and weight of the semi-digested foods he fished out. His scientific fortitude knew no bounds: he even examined the stages of digestion by sampling St Martin’s gastric fluids in his own mouth.
The result of these labours was Beaumont’s Experiments and Observations on the Gastric Juice and The Physiology of Digestion, published in 1833. The first great work of physiology from the US, it established the modern understanding of digestion.
St Martin eventually returned to Canada, where he was courted by doctors as a test subject, to no avail. He drank and made erratic demands for more money and employment for his family. Even Beaumont failed to persuade him to submit to more experiments, although he kept on trying right up until his death in 1853.
Despite alcoholism, poverty and a hole in his stomach, St Martin outlived his doctor by 27 years, and outlasted 12 of his own 17 children as well. When he died near Montreal in 1880, his family kept his body rotting in the June heat for four days, so that nosy doctors would not attempt one last examination. As an extra precaution, they then buried a very ripe Alexis St Martin in an unusually deep grave. And at long last, his stomach stayed covered up for good.