The Case of the Wounded Woodsman and His Dedicated Physician

Albert B. Lowenfels, MD

Disclosures

September 02, 2009

What Beaumont Added to the Knowledge of Gastric Physiology

Before Beaumont's long-term observation of St. Martin's progress, other patients had sustained gastric wounds and lived with a gastric fistula, but none had been studied in a scientific fashion.[3] Toward the end of the 18th century, the Italian Lazaro Spallanzini conducted a series of experiments and concluded that the stomach contained an active principle and that digestion was more than a simple mechanical process. In 1803, Jacob Helm, a Viennese physician, studied a middle-aged woman with a gastric fistula, noting the ability of the gastric juice to act upon stomach content. Just prior to Beaumont's first publication, an English chemist, William Prout, noted that the stomach secreted hydrochloric acid.[4] It is unlikely that Beaumont knew about any of this work on the stomach: His observations are unique.

Without any formal training in physiology, gastroenterology, or any branch of science, Beaumont recognized a unique opportunity, and over the course of several years he performed numerous experiments that led to a solid foundation for gastric physiology. The astonishing aspect of Beaumont's research is that under difficult circumstances he took advantage of a rare chance to study digestion by visualizing the interior of the stomach and obtaining samples of gastric juice from a living subject under various circumstances. Moreover, he took careful, detailed notes.

Beaumont performed a series of 3 experiments on St. Martin at geographic locations separated by thousands of miles.

Figure 2.

Map listing locations and dates for major events in the lives of St. Martin and Beaumont.

The experiments were carried out under less than ideal circumstances on a patient who was not always cooperative. Today, it would be difficult to obtain approval to perform a similar series of experiments. Beaumont describes his first experiment as follows[5]:

EXPERIMENT 1. August 1. 1825 -- At 12 o'clock, A.M., I introduced through the perforation, into the stomach, the following articles of diet, suspended by a silk string, and fastened at proper distances, so as to pass in without pain -- viz.: -- a piece of high seasoned la mode beef, a piece of raw salted fat pork, a piece of raw salted lean beef, a piece of boiled salted beef, a piece of [unclear] bread, and a bunch of raw sliced cabbage; each piece weighing about two drachms, the lad continuing his usual employment about the house. At 1 o'clock, PM, withdrew and examined them -- found the cabbage and bread about half digested; the pieces of meat unchanged. Returned them into the stomach. At 2 o'clock, PM withdrew them again -- found the cabbage, bread, pork, and boiled beef, all cleanly digested,* and gone from the string...The lad complaining of considerable distress and uneasiness at the stomach, general debility and lassitude, with some pain in his head, I withdrew the string, and found the remaining portions of aliment nearly in the same condition as when last examined; the fluid more rancid and sharp...I did not return them any more.

*These experiments are inserted here, as they were originally taken down in my note-book....

Beaumont published his early results in January 1825, after his first series of experiments and about 3.5 years after St. Martin's injury.

His major contributions to our knowledge of the digestive process included:

  • Studies of gastric motility;

  • Studies of gastric acidity (recognition of the importance of hydrochloric acid);

  • An important role for neurogenic influences on digestion, which eventually led to vagotomy as a treatment for peptic ulcer disease; and

  • A suspicion that something other than acid accounted for the stomach's ability to digest food.

Of note, this last substance turned out to be pepsin, which was eventually identified by Theodore Schwan in 1836, shortly after Beaumont concluded his third series of experiments.

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