The Case of the Wounded Woodsman and His Dedicated Physician

Albert B. Lowenfels, MD

Disclosures

September 02, 2009

Brief History of the Physician and His Patient

William Beaumont (1785-1853) was born into a farming family and grew up in Connecticut, where he remained until his early 20s when he joined his brother in Upstate New York.[1] There, he taught school for several years, before deciding at the age of 25 to study medicine. Although it was possible in the early 19th century to practice medicine without any formal training, Beaumont became an apprentice to Dr. Benjamin Chandler, a prominent Vermont physician. This apprenticeship lasted for 1 year, covered both medicine and surgery, and led to certification by the Vermont Medical Society. His training never included any formal background in physiology, and it is unlikely that Beaumont was aware of the available rudimentary knowledge of gastrointestinal physiology.

Figure 1.

Portrait of William Beaumont, frontier doctor and scientist.
From Gillett MC. Early campaigns in the North, 1812 to 1813. In: Matloff M, ed. The Army Medical Department 1775-1818. Army Historical Series. Available at: http://history.amedd.army.mil/booksdocs/rev/gillett1 Accessed August 26, 2009

In 1812, a few months after receiving his certification, Beaumont enlisted in the US Army, and then actively engaged in war with the British Empire. Eventually, after the conclusion of the War of 1812, Beaumont was posted to Fort Mackinac, an important trading post located on a small, remote island between Lake Huron and Lake Michigan.

By good fortune, Beaumont was at the Fort on June 6, 1822, when Alexis St. Martin, a French-Canadian employee of the American Fur Company, was accidentally shot in the left chest. Beaumont had received some surgical training during his apprenticeship and additional experience while caring for injured soldiers during the War of 1812. Without Beaumont's presence, it is unlikely that St. Martin would have survived such a serious injury.

St. Martin came from a background that was very different from Beaumont's. According to his birth certificate, St. Martin was born in 1794, in the small Canadian village of Berthier. His family, who originated from Bayonne, France, was poor, and St. Martin grew up to be an illiterate trapper. He earned his living as a fur trader and voyageur (a porter and large cargo canoe man) in the region between what is now Michigan and Canada. When he was wounded, St. Martin was 28 years old and unmarried.

When St. Martin was sufficiently recovered, he signed a contract with Beaumont, who offered him employment as a handyman in return for a stipend, food, and permission to carry out experiments on St. Martin's stomach. To facilitate the research, and to ease the financial burden on the physician, the US Army made St. Martin a sergeant, paying him a small salary.

About a year after St. Martin's injury, when Beaumont realized that the gastric wound was unlikely to close, he began detailed studies of the process of digestion within St. Martin's stomach. These experiments, conducted with the often reluctant St. Martin, continued intermittently over the course of about a decade. St. Martin agreed to travel to Europe to be examined and studied by leading physicians, including Claude Bernard, but he changed his mind before embarking on the voyage. He never did go to Europe, but he did exhibit his fistula at several American medical schools.

Despite Beaumont's efforts, the wound never completely healed; nevertheless, St. Martin was able to resume a nearly normal life if he plugged up the gastric opening with a piece of cloth. Eventually St. Martin married and had several children. He was always poor, however, and frequently drunk. His health, despite the fistula, was sufficiently robust so that he could support his family by hard labor, such as chopping wood.

Regardless of his persistent gastric fistula and his heavy consumption of alcohol, St. Martin lived to be 86 years old; even now this is well above the normal life span for white men in North America. As for Beaumont, after completing his army service, he settled in St. Louis, Missouri, where he practiced medicine until he died in 1853 from a head injury after falling on an icy path. St. Martin outlived his physician by several decades.

Prior to St. Martin's death, prominent physicians, including William Osler, had tried without success to persuade the family and the patient to agree to an autopsy.[2] Osler was particularly anxious to examine St. Martin's famous stomach and to have it preserved in the US Army Museum. However, the family was vehemently opposed to any further contacts with the medical profession. To ensure that his body would not be disturbed, the family buried St. Martin in an unmarked deep grave. Only in 1962, more than 80 years after his death, did the Canadian Physiological Society place a marker at the approximate grave site.

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