The history of medicine is anything but pleasant. It is brimming with frightful and gruesome mischances, ambiguous ethics and inhuman behaviour. The chronicle of Alexis St. Martin and Dr. William Beaumont hits those low focal points to their nadir.

Irrespective of all the deplorable demerits, it radically altered the manner in which medicine is practised in modern times. A man whose gunfire wound created an opening into his stomach empowered scientists to comprehend the process of digestion.

On June 6, 1822, Alexis St. Martin, a healthy and strong 19-year-old who worked for the American Fur Company was shot in the stomach by accident. This incident happened on Mackinac Island, which is in present-day Michigan. In 1822, a stomach wound was virtually a death sentence. However, Alexis St. Martin did not die, yet his life was irrevocably changed.

The subsequent story of Alexis St. Martin, the youthful trapper and William Beaumont, a surgeon and physiologist, who was posted at the Fort Niagara in New York, represents a standout amongst the most exceptional episodes in the historical backdrop of American medicine.

The grisly wound

Martin was injured grievously in his ribs and stomach, by a sudden discharge from a shotgun. Dr Beaumont, who was treating his wound, expected Martin to succumb to his injuries.

Quite amazingly, Beaumont executed numerous surgeries, sometimes, even without the administration of antiseptics and anaesthesia over several months on St. Martin who eventually recovered. In spite of Beaumont’s woeful prediction, Martin survived with a tearing hole or fistula, right inside his stomach.

The stomach’s bizarre window

By then, St. Martin was completely exasperated with the series of surgeries inflicted on him. The bizarre window that formed in his digestive system never fully healed. Alexis Martin could also not continue with his job for the American Fur Company because of his permanent disability.

When Martin lost his job, he urged for community support. However, as Martin was not a Mackinac Island local, he was adjudged a pauper and commanded to return to his home province Quebec which was around 2000 miles away.

1825: Beaumont’s chain of experiments

Apprehending the possibility that St. Martin would not be able to survive the venture, Beaumont predicted an unusual scientific opportunity to study and observe his digestive processes.

Beaumont relocated to Fort Niagara in New York, by August 1825, and Martin came along with him. He took St. Martin to his home and hired him as his handyman. He was made to work as a house servant during the day and a guinea pig for Beaumont’s experiments at night.

Dr. Beaumont started using the stomach of Martin to perform experiments related to digestion. His experiments focused on a piece of food, tied to a string that was inserted through the fistular window of the stomach.

At regular intervals, Beaumont used to remove the food from the stomach and examine the level of digestion. He also extricated samples of gastric acid from Martin’s stomach for analysis purpose. The two, thus, got engaged in an extensive and peculiar relationship as the “medicine’s oddest couple”.

In September, the same year, Alexis St. Martin fled from the clutches of Dr. Beaumont and shifted to Canada. Beaumont, who was left in the lurch, started focusing on his obligations as an armed force specialist.

But he caught hold of St. Martin again and resumed his experiments on him. Beaumont utilized the samples of gastric secretions which prompted a significant discovery.

Next nine years

Amid 1826 and 1827, Dr Beaumont was posted at Fort Howard in Wisconsin’s Green Bay. In 1828, he was issued a transfer order to St. Louis in Missouri. Beaumont, during his service tenures at three different forts, relentlessly pursued the fur companies trying to know the whereabouts of St. Martin.

Eventually, in 1829, he could locate the truant in Canada. While on the way to St. Louis, Beaumont met Alexis St. Martin. As luck would have it, Martin was ordered to put the stopper on at Fort Crawford, Wisconsin, to fill in as Dr Beaumont’s proverbial “jack of all trades” once again

In mid-1831, Dr Beaumont performed another series of experiments on Martin’s stomach. These included monitoring the basic perceptible impacts which temperature, exercise and emotions have on the digestive process.

By that time, St. Martin was already married and father of two children. Beaumont transferred the entire family at his own expenses to Fort Crawford. Thus, after a gap of a few years, another round of experiments followed. This continued until the spring of 1831.

Martin and his family returned to Canada, assuring Beaumont of his availability in future whenever necessary. St. Martin came back, a year and a half later, on Beaumont’s request for the umpteenth time.

Beaumont was stationed at Washington, DC, at that time. Early in 1834, St. Martin, much to Beaumont’s dismay, asked for an exorbitant sum of money from Beaumont for another bout of experiment and the duo parted ways. He went back home to Quebec for the last time, where he lived till the age of 83.

William Beaumont’s observations on the human digestive system

Beaumont asserted that the stomach performs squashing, pounding and squeezing with the help of its inherent juice. He also discovered how the gastric fluids could also digest the food and disintegrate it into minute pieces of nutrients suitable for the stomach to help the body assimilate.

In this way, Beaumont proved that digestion was basically a chemical process rather than being a mechanical one. Besides, he was a pioneer in observing the digestive system and its processes in real time.

Beaumont was also the first one to profess the striking link between the digestive processes and the presence of a resident disease in the body. He noticed a marked slowdown in St. Martin’s assimilation process when he was particularly sick or feverish.

The draconian approach to medical science

Led over a 9-year time span, with these intermittent experiments and investigations, Beaumont created the most crucial contributions at any point made in the field of gastric physiology.

Worth mentioning, at this juncture, is the fact that Beaumont was bereft of any formal education in medicine or the strategies for experimentation. The discoveries through his apprenticeship made ready for modern physiology, where perceptions directed the conclusions and not the other way round.

The investigations likewise ushered in a few controlled animal experiments and tests by physiologists who registered that they could make quicker headway by conducting several fistula operations in animals.

For example, Beaumont’s tests roused the well-known Russian physiologist Ivan Pavlov to perform fistula operations in dogs. The window into assimilation inspired Pavlov to proclaim his widely acclaimed conclusion that classical conditioning could lead to dogs salivating on cues.

In December 1833 Beaumont officially published his observations in a book titled Experiments and Observations on the Gastric Juice and the Physiology of Digestion. The book primarily covered areas related to the physiology of digestion and a comprehensive portrayal of the experiments. Although Beaumont’s book could never become a best-seller, it earned him a great deal of prominence, which interpreted into a busy practice.

The origin of the Holey Cow

The experiments on St. Martin’s fistula led to the occurrence of a large-scale practice of observing the digestive methods in living animals. This has continued over the past century. One such articulation led to the genesis of the cannulated cow or the fistulated cow, also colloquially called the “Holey Cow”.

The fistulated cows bear a permanent surgically created hole in their rumen (the biggest part of the stomach). The hole allows the insertion of the hand of a person to access the cow’s stomach and understand the extent of digestion of the food.

The fistulation procedure involves desensitisation of the animal with local anaesthesia and surgical creation of the fistula. Once the surgery is completed, the cow can resume normal activity. The artificial hole does not affect the day-to-day living or the lifespan of the cow.

The Holey Cow plays a crucial part in the aspects of research and regular herd management. They enable researchers and scientists to examine the edibility of the different feeds and find out sustenance for cattle that diminish environmental effects. They additionally come to the aid of other sick animals through a procedure known as “rumen transfaunation.”

Rumen transfaunation allows the scientists to directly extricate the healthy gut bacteria and microorganisms from the rumen of the cow. The microbes are then transferred to the sick cows to kick-start their digestive tract and revive normal digestion.

The moral standpoint

There have been numerous debates centering on the ethical viability of this two-man relationship. Although Beaumont promised to seal the man’s stomach in due course, he actually never did it. How much diligent and conscientious was he and how painstakingly he worked to close the gastric fistula?

It was quite evident that although his experiments and findings led to an unmatched scientific opportunity, it also adversely affected Martin’s quality of life. Was the doctor really pretending a propaganda of mere intentions of philanthropy? Could he not simply have arranged for the man’s return back home once his condition normalized?

Notwithstanding, all the pain and discomforts associated with the experiments, for what reason did St. Martin sacrifice his stomach? Actually, he was extremely impoverished and the constant cash inflow helped him.

This was despite the fact that his mandatory presence for Beaumont’s experiments shielded him from seeking his vocation as a voyager or farmer. But more fundamentally, Martin most likely might have felt an obligation towards the doctor who saved his life.

Death of William Beaumont and Alexis St. Martin

In 1853, Beaumont died in St. Louis, Missouri, after an accidental slip while stepping on ice-covered steps. He was interred at the Bellefontaine Cemetery.

Alexis St-Martin died in 1880 at Saint-Thomas in Quebec. His family had to defer his internment in order to prevent the realization of the theory of his probable “resurrection” by doctors. Some of them even went to the extent of suggesting at autopsy. Martin was finally consigned to the grave at the Saint Thomas Parish Cemetery.

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Life and Letters of Dr. William Beaumont: Including Hitherto Unpublished Data Concerning the Case of Alexis St. Martin | By Jesse S. Myer

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