Medical Minute – Gunshot, Experimentation, and Ethics

By: Dr. James Lee

William Beaumont was born in Lebanon, Connecticut in 1785. He came from humble means, his father a farmer, and left home in 1806 to teach. In 1810, he began studying medicine through an apprenticeship. In 1812, he was deemed a “judicious and safe practitioner” and went on to serve as an assistant surgeon in the Army from 1812-1815. After failing in private practice, he went back to the Army in 1820 and was stationed at Fort Mackinac.

Alexis St. Martin was born in 1802 in Berthierville, Quebec, Canada. He was a Canadian fur trapper working as an indentured servant for the American Fur Company. On June 6, 1822, he was at a fur trading post on Mackinac Island, located on Lake Huron, Michigan. There he was accidently shot with a shotgun less than three feet away. This entered in his back and exited upper abdomen. Fortunately for Alexis, William Beaumont was available and able to evaluate him quickly. This was the beginning of a strangely intimate and important relationship between Alexis and William Beaumont that provided a literal window into how the stomach works

Beaumont described the gunshot wound as entering in the back and exiting the front of the abdomen. It created an exit wound the size of a man’s hand and broke ribs, injured the lung and diaphragm, as well as creating a hole in the stomach. Beaumont did what he could but did not expect Alexis to survive. When he did, Beaumont was faced with another problem. Due to the large hole in his stomach, anything Alexis was fed came out the wound. Beaumont remedied this by giving him nutrient enemas, until he was able to take food by mouth and a bandage could be placed to allow the food to stay in his stomach. After 5 weeks, St. Martin was healed except the wound in his abdomen. Unfortunately, the wound would never fully heal, and Alexis was left with a gastric fistula, a literal window between his skin and his stomach.

While this was not the first gastric fistula in recorded history, it was the first exploited for scientific research. Beaumont began experimenting, siphoning gastric juices out of the stomach for analysis, tasting his stomach, spooning different foods into the stomach and making observations; even dangling meat on a string in the stomach and removing it at various intervals remarking on the extent of digestion. These were just some of the experiments that were performed. Ultimately, Beaumont’s experiments were able to confirm many questions about digestion, in particular the presence of hydrochloric acid produced by the stomach and its role in digestion. This effectively vaulted William Beaumont from obscurity to being considered The Father of Gastric Physiology and Father of American Physiology.

Alexis, for his part, lost his job because of the accident. He was poor, homeless, unemployed, and would have been deported back to Canada because he had no community support. However, he was hired on as a house servant and laborer by Beaumont, at first because Beaumont was concerned that he would not survive the journey back to Canada. Alexis was given a modest salary, room and board, but very little freedom. In turn, he allowed Beaumont to conduct his experiments. Undoubtedly, Alexis was grateful that Beaumont had saved his life and likely felt indebted to him. However, this led to dubious ethical treatment of Alexis by Beaumont, who essentially made Alexis a guinea pig. The relationship was an oddity and certainly affected the trapper’s quality of life. It has been the source of ethical debate for a long time. In fact, Beaumont’s view and treatment of Alexis were suspect. He once wrote to others that Alexis had “absconded” back to Canada because he missed his wife and children. Beaumont tracked him down and brought him back to America with his wife and children, who were also hired on under contract. This did not last though, and Alexis eventually disappeared back into the Canadian woods. Even after his death, Alexis’ family was hounded by physicians for access to his body.
Next week we will learn more about gastroesophageal reflux disease.

Dr. James Lee serves as the Coroner of Winn Parish. He is a General Surgeon and Surgical Oncologist who has been practicing in Winnfield for over ten years. Dr. Lee attended the University of Colorado for his medical degree. He completed his residency in Surgery at the University of Oklahoma before completing a fellowship in Surgical Oncology and Endoscopy at Roswell Park Cancer Institute in Buffalo, NY. Dr. Lee and his wife Scarlett live in Winnfield with their son and are active in the community.

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