Urology pearls: A man with a hole in his stomach

Shahar Madjar, MD

It was June 6, 1822, a spring day in Michillimackinac (Mackinac island), Michigan. Alexis St. Martin, a young healthy man, a Canadian of French descent who was working as a voyageur for the American Fur Company, was accidentally wounded by a discharge of a musket. The bullet tore several muscles in Alexis’ abdomen and chest, fractured several ribs, and punctured his stomach.

Dr. William Beaumont, an army surgeon, arrived at the scene and attended the wounded man. Seeing the severity of his injury, Beaumont must have thought that Alexis would die. And still, he used every tool a 19th century doctor had at his disposal: he cleaned the wound. He pushed the lung that was protruding through the wound back into its proper position. He applied poultice and lotion of ammonia and vinegar to the wound. He bled Alexis and gave him cathartic. Later, he used adhesive straps in an attempt to gradually draw the edges of the wound together and close the gap in Alexis’ stomach. After ten months of futile attempts, Dr. Beaumont offered Alexis an operation to surgically close the opening in his stomach. Alexis declined the operation. He didn’t die. Not on June 6, 1822, and not for years later. The hole in his abdomen–a window into his stomach–remained open. 

Beaumont saw an opportunity for “the examination of the interior of the stomach, and its secretions, which has never before been so fully offered to any one … opportunity afforded by circumstances which probably can never again occur …” He later described his findings in his book “Experiments and Observations on the Gastric Juice and the Physiology of Digestion.” 

In experiment number one, he introduced a piece of highly seasoned a la mode beef; then a piece of stale bread; and later a bunch of raw, sliced cabbage, suspended by a string, through the hole in Alexis’ stomach. Later he pulled these items out and carefully examined them, assessing the degree of digestion that took place. He repeated the process with different articles of food, for varying periods of time. In different experiments, he measured the temperature inside the stomach using a thermometer. He obtained some gastric juice and proved that it can digest food articles outside of the stomach. And he observed gastric juice and digested food particles under the microscope. Beaumont was observing, experimenting, and meticulously recording the results, for years. 

The real drama in this story isn’t in the medical marvels that were revealed to Dr. Beaumont, but in the relationship between the two men. When I was reading Dr. Beaumont’s book, I found the relationship between Beaumont and Alexis to be puzzling, almost impossible. All of this experimentation must not have been a sheer pleasure for Alexis. Beaumont’s own description of Alexis response during one of the experiments reads: “the lad (was) complaining of considerable distress and uneasiness at the stomach … with some pain in his head.” 

I asked myself, Why was Alexis willing to undergo these uncomfortable, and, at times painful experiments? 

As an army surgeon, Beaumont was moving from one post to another. He writes: “I took (Alexis) St Martin with me to Burlington, Vermont, and from thence to Plattsburgh, New York … he returned to Canada, his native place without obtaining my consent … After considerable difficulty, and at great expense to me, they [agents procuring voyageurs] succeeded in engaging him and transported him from lower Canada, with his wife and two children, to me, at Fort Crawford … a distance of two thousands miles … He now entered my service, and I commenced other series of experiments …”

And I asked myself, Why was Alexis willing to join the doctor at the different posts he took as an army surgeon? Was it a sense of obligation toward the man who saved his life that motivated Alexis to submit to the experimentation? Was it the doctor’s self-reported ‘zeal and perseverance,’ or his position of power that drove Alexis into participation? 

Altogether, Dr. Beaumont conducted some 200 experiments on Alexis. Before these experiments, the nature of the digestive process was a complete mystery. In his experiments, Beaumont proved, among many other findings, that the human gastric juice is produced by the lining of the stomach and that it contains hydrochloric acid. This discovery was a stepping stone in the understanding of the digestion.

Science advances in leaps and bounds. Sometimes as planned. Often serendipitously. And at times, an opportunity knocks on a scientist’s door. “Open your mind,” it asks of the scientist, “and peer through the window into a world of wonder.” Such was the hole in Alexis’ stomach–a window into the mystery of the digestive system.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.


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