History in Medicine: Hard to Stomach - The History of Gastrointestinal Physiology

by Nicole Strickland
An engraving from Beaumont’s 1833 book “Experiments and Observations on the Gastric Juice and the Physiology of Digestion,” depicting St. Martin’s wound in his left upper abdomen.

Recently in Medical Physiology we learned about the gastrointestinal (GI) system, a seemingly simple yet complex organ system.

The GI system is essentially a continuous tube, with food entering in and eventually exiting out after traveling along a continuous tract. But it is what occurs along that tract—the interplay of chemicals, hormones, churning, grinding, and pumping—that makes the GI system a powerful digester and absorber of nutrients. Even with today’s technology of endoscopies and radioactive imaging (MRI, X-rays, etc.), there are still many unanswered questions about how exactly the GI organs work independently and with each other.

That made me all the more curious when our professor showed us a slide entitled “Great Moments in Gastric Medicine,” with the line “1825—William Beaumont and Alexis St. Martin.” How could someone in the nineteenth century, an era with rudimentary medical knowledge and virtually nonexistent medical technology, possibly make discoveries about the human stomach? What I found out was truly phenomenal not only in GI medicine but also of the doctor-patient relationship.

William Beaumont (1785-1853) was an Army doctor stationed in Fort Mackinac, Michigan, where in 1822 he treated a young fur trader named Alexis St. Martin for an accidental gunshot wound in the upper left abdomen. Despite the gaping hole and damage to the ribs, lungs, and stomach, St. Martin survived. He was able to breathe and eat normally within a month, completely recovered except for one thing—the hole, large enough to let a finger through, never completely closed. Beaumont, realizing this unique opportunity to observe digestion in the exposed human stomach, offered to hire St. Martin to conduct extensive experiments on him (and serve as a handyman around the house when experiments were not performed).

St. Martin, needing money and probably also feeling indebted to the doctor who saved his life, agreed to this unique doctor-patient relationship. Over the next several years, Dr. Beaumont inserted various foods (including raw oysters and melted butter) directly into the hole in St. Martin’s stomach and noted the degree of digestion. He also noted the internal temperature of the stomach and the composition of gastric juice, and made the groundbreaking discovery that digestion is mainly a chemical (not just mechanical) process. From his research Dr. Beaumont published his landmark 1833 book titled “Experiments and Observations on the Gastric Juice and the Physiology of Digestion,” a work that established him as the Father of GI Physiology.

I was fascinated with how these stomach physiology fundamentals were discovered so simply and early on, with little technology involved. What surprised me even more was this strange interaction between doctor and patient, a relationship more like that of an experimenter and test subject. St. Martin earned no fame or fortune from participating in those experiments, but his name is forever linked with that of the more famous doctor.

Of the many schools and public buildings named after Dr. Beaumont, one caught my eye—William Beaumont Army Medical Center in Fort Bliss, El Paso, Texas. The hospital’s cafeteria is aptly named “St. Martin Dining Facility.”