Controversial Physicians Seeking Medical Breakthroughs

Steven Rourke; Anya Romanowski, MS, RD

Disclosures

October 13, 2017

In This Article

The route to medical breakthrough is traveled by brilliant, independent-spirited researchers whose mind-sets and novel approaches force us to consider unthought-of possibilities that extend the boundaries of our knowledge. And yet, for a long list of reasons, the choices a researcher makes and the complex circumstances of medical experimentation can be the causes of bitter disagreement. In the following cases, we review the contributions of some of medicine's leading researchers whose paths toward breakthrough have been paved with controversy.

William Beaumont: Hundreds of Experiments Advance Gastric Physiology

The pioneering American physician William Beaumont (1785-1853) is considered the father of gastric physiology, thanks to his groundbreaking understanding of gastric juices and digestion obtained through hundreds of experiments, conducted over more than a decade, on his patient Alexis St Martin.[1,2,3]

William Beaumont
Image courtesy of National Institutes of Health

After a 2-year physician apprenticeship, Dr Beaumont was certified to practice medicine in Vermont in 1812.[1] He spent most of his medical career as an Army medical officer stationed across the United States in such places as New York, Wisconsin, and Missouri.[1] On a fateful day in 1822, Dr Beaumont was the only physician present on Mackinac Island in Lake Huron, Michigan, when an employee of the American Fur Company, Alexis St Martin, sustained a gunshot wound to the stomach.[1,2] Against the odds, St Martin survived this serious injury but had a gastrointestinal fistula for the rest of his life.[1,2,3]

A Fruitful Relationship

The ensuing physician/patient relationship was the source both of Dr Beaumont's research discoveries and of controversy. Alexis St Martin reportedly lived with Dr Beaumont after his accident,[2] in what has been described as a "master/servant" relationship, not untypical of the age.[4] From 1822 to 1833, Dr Beaumont performed some 238 experiments on St Martin.[2] In 1825, Dr Beaumont published in the Philadelphia Medical Recorder his first article ("A Case of Wounded Stomach") relating to these experiments.[2] The research that sealed his reputation, "Experiments and Observations on the Gastric Juice, and the Physiology of Digestion," was published 8 years later, in 1833.[1]

The complicated relationship[5] between Dr Beaumont and St Alexis has been described "in terms of the ideas and practices of contract labor, informal domestic servitude, indentures, and military service"[4] of the period. And although it is problematic to judge historical situations with contemporary viewpoints, it feels appropriate to question the dynamics of their relationship and the ethical foundations of the ensuing research. How did the power of the master manipulate the actions of the servant? How consenting was Alexis St Martin in such a great number of experiments? Might we even question why the gastric fistula never closed?

Prestige and Longevity

Dr Beaumont became professor of surgery at the Medical Department of Saint Louis University in 1837.[1] His understanding of gastric juices and digestion was revolutionary and enriched medicine. One reminder of Dr Beaumont's eminence is the William Beaumont Prize in Gastroenterology, which is awarded by the American Gastroenterological Association.[6]

Alexis St Martin returned to the Montreal region and died at the surprisingly old age of 78.

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