The Man with a Hole in His Stomach

From Ken Saladin's "Anatomy and Physiology" as posted on the HAPS listserv.

Perhaps the most famous episode in the history of digestive physiology began in 1822 on Mackinac Island in the strait between Lake Michigan and Lake Huron. Alexis St. Martin, a 19-year-old fur trapper, was standing outside a trading post when he was accidentally hit by a shotgun blast from 3 feet away. An Army doctor stationed at Fort Mackinac, William Beaumont (1785-1853), was summoned to examine St. Martin. As Beaumont later wrote, "a portion of the lung as large as a turkey's egg" protruded through St. Martin's lacerated and burnt flesh. Below that was a portion of the stomach with a puncture in it "large enough to receive my forefinger." Beaumont did his best to pick out bone fragments and dress the wound, though he did not expect St. Martin to survive.

Surprisingly, St. Martin lived. Over a period of months the wound extruded pieces of bone, cartilage, gunshot, and gun wadding. As the wound healed, a fistula (hole) remained in the stomach, so large that Beaumont had to cover it with a compress to prevent food from coming out. A fold of tissue later grew over the fistula, but it was easily opened. A year later, St. Martin was still feeble. Town authorities decided they could no longer support him on public funds and wanted to ship him 2,000 miles to his home in Canada. Beaumont, however, was imbued with a passionate sense of destiny. Very little was known about digestion, and he saw the accident as a unique opportunity to learn. He took St. Martin in at his personal expense and performed 238 experiments on him over several years. Beaumont had never attended medical school and had little idea how scientists work, yet he proved to be an astute experimenter. Under crude frontier conditions and with almost no equipment, he discovered many of the basic facts of gastric physiology discussed in this chapter.

"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." He put pieces of meat on a string into the stomach and removed them hourly for examination. He sent vials of gastric juice to the leading chemists of America and Europe, who could do little but report that it contained hydrochloric acid. He proved that digestion required HCl and could even occur outside the stomach, but he found that HCl alone did not digest meat; gastric juice must contain some other digestive ingredient. Theodor Schwann, one of the founders of the cell theory (see chapter 4), identified that ingredient as pepsin. Beaumont also demonstrated that gastric juice is secreted only in response to food; 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.

For his part, St. Martin felt helpless and humiliated by Beaumont's experiments. His fellow trappers taunted him as "the man with a hole in his stomach," and he longed to return to hunting and trapping in the wilderness. He had a wife and daughter in Canada whom he rarely got to see, and he ran away repeatedly to join them. He was once gone for 4 years before his poverty and physical disability made him yield to Beaumont's financial enticement to come back. Beaumont despised St. Martin for his drunkenness and profanity and was quite insensitive to St. Martin's embarrassment and discomfort over the experiments. Yet St. Martin's temper enabled Beaumont to make the first direct observations of the relationship between emotion and digestion. When St. Martin was particularly distressed, Beaumont noted little digestion occurring-as we now know, the sympathetic nervous system inhibits digestive activity.

Beaumont published a book in 1833 that laid the foundation for modern gastric physiology and dietetics. It was enthusiastically received by the medical community and had no equal until Russian physiologist Ivan Pavlov (1849-1936) performed his celebrated experiments on digestion in animals. Building on the methods pioneered by Beaumont, Pavlov received the 1904 Nobel Prize for Physiology or Medicine.

In 1853, Beaumont slipped on some ice, suffered a blow to the base of his skull, and died a few weeks later. St. Martin continued to tour medical schools and submit to experiments by other physiologists, whose conclusions were often less correct than Beaumont's. Some, for example, attributed chemical digestion to lactic acid instead of hydrochloric acid. St. Martin lived in wretched poverty in a tiny shack with his wife and several children and died 28 years after Beaumont. By then he was senile and believed he had been to Paris, where Beaumont had often promised to take him.

Life of Dr. William Beaumont (1785-1853) Father of Gastric Physiology