Alexis St. Martin: The Man With A Hole In His Stomach

By the early 19th century, physicians had a clear understanding of the human anatomy (from dissecting cadavers) but knowledge about the role of each internal organ and how they worked in a living and breathing individual was hazy. Doctors had a couple of diagnostic tools at their disposal, such as the stethoscope and the laryngoscope, to poke and prod their patients with, but the scope of these devices were limited. Nobody had ever seen the insides of a living person, save during hastily carried out surgeries, until William Beaumont landed with a gunshot victim.

William Beaumont and Alexis St. Martin. Oil on canvas by Dean Cornwell.

William Beaumont was a surgeon in the U.S. Army stationed on Mackinac Island in Lake Huron, in the summer of 1822, when he was urgently called to attend to a young voyageur and trapper who had received a fatal gunshot wound to his stomach. Alexis St. Martin, the 28-year-old Canadian voyageur of the American Fur Company, got wounded in the stomach when a shotgun loaded for hunting ducks went off accidentally. The muzzle was not more than a yard away. The full charge of the buckshot entered the left side of his abdomen fracturing two ribs, damaging his left lung and tearing a hole though the stomach.

When Beaumont arrived at the scene, he found a crowd had gathered around the injured man. The doctor elbowed his way through, and at once, began attending to the man.

“I found a portion of the lung as large as a turkey’s egg, protruding through the external wound, lacerated and burnt,” Beaumont later wrote, “and immediately below this, another protrusion, which, on further examination, proved to be a portion of the stomach, lacerated through all its coats, and pouring out the food he had taken for his breakfast, through an orifice big enough to admit the forefinger.”

William Beaumont was the only surgeon on the island and he did as best as he could. He cleansed the wound, removed pieces of clothing and bone and other foreign matter from the cavity of the chest, and applied a poultice. Beaumont did not expect St. Martin to live. But to everyone’s surprise, St. Martin pulled through and began a slow but remarkable recovery.

For some reason, the hole in the stomach refused to heal. Everything that St. Martin ate passed out through the hole. During this time, Beaumont sustained him “by means of nutritious enemas.”

Alexis St. Martin’s gastric fistula.

Initially, Beaumont tried to close the hole in the stomach by drawing the edges together with adhesive straps. To retain food and drinks, he applied a compress using lint and more adhesive straps. Beaumont wanted to close the wound by using sutures, but St. Martin wouldn't stand the sight of the needle, and refused. Eventually, after nearly a year of suffering, the hole healed, but the walls of the stomach didn’t bind to themselves. Instead, it merged to the skin of the abdomen creating a permanent hole beneath the ribs that led directly into the organ. Eighteen months after the accident, the hole in the stomach also grew a sphincter, a natural valve, that prevented food from escaping, but easily yielded to the pressure of the finger, allowing Beaumont access to what was inside.

As time passed, Beaumont came to realize the hole, or “gastric fistula”, presented him with a unique means of observing what went on inside. Recognizing the immense scientific opportunity, Beaumont offered St. Martin, who had lost his job as a voyageur because of the accident, employment in his household. During the day, St. Martin, who had mostly recovered from his ordeal, performed all the duties of a common servant, such as chopping wood, carrying burthens, and so on. Between work, whenever he found time, St. Martin submitted himself to Beaumont’s fingering.

Alexis St. Martin

“I can look directly into the cavity of the stomach, observe its motion, and almost see the process of digestion,” Beaumont wrote. “I can pour in water with a funnel and put in food with a spoon, and draw them out again with a siphon. I have frequently suspended flesh, raw and wasted, and other substances into the perforation to ascertain the length of time required to digest each; and at one time used a tent of raw beef, instead of lint, to stop the orifice, and found that in less than five hours it was completely digested off, as smooth and even as if it had been cut with a knife.”

Beaumont tried the effect of gastric juice, both inside and outside the stomach, on different kinds of food, which he would withdraw and inspect at intervals. He examined the action of bile on the digestive process and measured temperature and acidity. Beaumont also sent vials of gastric juice to the leading chemists of America and Europe, and proved that digestion required hydrochloric acid. Beaumont also demonstrated that gastric juice is secreted only in response to food, and it did not accumulate between meals as previously thought. He disproved the idea that hunger is caused by the walls of the empty stomach rubbing against each other.

St. Martin felt helpless and humiliated by Beaumont’s intrusive experiments. He yearned to go back to fur trade, and several times ran back to Canada, where he got married and had several kids. But each time, poverty brought him back to Beaumont. Once Beaumont sent agents to track St. Martin down and bring him to America for another round of experiments.

All in all, Beaumont performed some 200 experiments on St. Martin over a period of 10 years. His treatise on the subject, Experiments and Observations of the Gastric Juice and Physiology of Digestion, published in 1833, laid the foundation for modern gastric physiology and dietetics.

William Beaumont

Beaumont drew no less than 51 conclusions about digestion based on his observations of Alexis St. Martin. He determined that vegetables digested more slowly than meat, that milk coagulated early in the digestive process, and that digestion is aided by a churning motion within the stomach. Beaumont's research into gastric juices was cutting edge. His work confirmed William Prout's theory that gastric juices contained hydrochloric acid, and that the corrosive acid was secreted by the stomach lining.

Alexis St. Martin died in 1880, outliving Beaumont by about 28 years. Several researchers hoped to preserve his stomach in the Army Medical Museum, but his family refused.

Beaumont’s ethics regarding his experiments with St. Martin have been questioned by many. His biographer Reginald Horsman explains that the doctor's attitude was average for the times in which they occurred:

There were no concerned thoughts about the psychological effects of a permanent gastric fistula on this Canadian voyageur, no concerns about the mental effects of repeated tampering with his normal process of digestion, nor even any particular concern about the destitute condition of his family... Beaumont's attitude toward St. Martin was probably as good as most. He had no concern about the ethics of his experiments, but no one else did either. He was not an unkind man, but as a physician he was a man of his age.

 

References:
# Science History Institute, https://www.sciencehistory.org/distillations/magazine/probing-the-mysteries-of-human-digestion
# http://earth.callutheran.edu/Academic_Programs/Departments/Biology/Anatomy/hole_in_stomach.html
# https://jamanetwork.com/journals/jama/article-abstract/1388300
# Guinea Pig Zero, https://www.guineapigzero.com/alexis-st-martin-1794-1880.html
# William Beaumont, https://archive.org/details/experimentsando00beaugoog/page/n8/mode/2up