|
By
Some of the brightest lights of American medicine and surgery have been backwoodsmen. Ephraim McDowell, who did his wonderful operation of ovariotomy, was a backwoods practitioner. Marion Sims, who did so much to establish the science of surgery on this continent, and came to be the leading surgeon of his day, was doing his epoch making work “far form the maddening crowd.” So too, William Beaumont, another backwoodsman, was the pioneer physiologist of this country and the first to make a contribution of enduring value. William Hunter, the brilliant physician of the eighteenth century, brother of the immortal John Hunter, when lecturing to some students one day make this oft quoted remark, “Some physiologists will have it that the stomach is a mill, others, that its it a fermenting vat, others again, that it is a stew pan; but in my view of the matter, it is neither a mill, a fermenting vat nor a stew pan; but a stomach, gentlemen, a stomach.” It is the purpose of this sketch to discuss in brief fashion, the life an labors of the pioneer American physiologist, William Beaumont, whose work proved conclusively that the stomach is “neither a mill, a fermenting vat nor a stew-pan; but a stomach, gentlemen, a stomach.” William Beaumont, the third child of Samuel, was born November 21, 1785 in Lebanon, Connecticut, a few years after the close of the Revolutionary War. His father was a frugal, thrifty New England farmer who ploughed his land with wooden plow drawn by oxen, sowed his grain by hand, cut it with a scythe and threshed out the grain with a flail. His clothes were homespun and almost proof against wear, tear and time. The township in which they lived boasted of a population of four thousand, mostly farmers. The farms were small, rocky and not very productive. His parents were staunch Democrats and patriots of the old Jeffersonian school, members of the Congregationalist church but apparently there is n record of their son William having joined the church. However, he must have been a regular attendant as in latter life, he explained his non-attendance by stating that as a boy, he had made up for a lifetime. These New Englanders had strong religious and political views, and in this straitlaced puritanical atmosphere, young Beaumont was brought up and educated in the Lebanon school under a teacher named Tisdale, who had made the school famous in New England. We know nothing of his rank at school; in fact, very little record is preserved of his early life. It seems strange that he would preserve in writing all events of his adult life and not record a single incident of his boyhood. In 1806 young William Beaumont, then 21 years of age, not finding farming to his liking, became restless and desired to see more of the world. He left his fathers roof and went forth to seek his fortune. Setting out with a hoarse and cutter, barrel of cider and one hundred dollars in cash, he started northward, in mid-winter, without any particular destination and finally arrived the following spring at the little village of Champlain, New York, near the Canadian border. Being well educated he was entrusted with the village school, which he conducted successfully for three years. It was during this period of teaching that he decided to study medicine, and spent his leisure moments reading such medical works as he could secure. Teaching then was only a means to an end, the real object being to put sufficient funds to tide him over his two years apprenticeship. There being no physician in Champlain whom he considered worthy of being his preceptor, he crossed Lake Champlain in 1810 to St. Albans, Vermont, where Dr. Benjamin Chandler was the most prominent physician and surgeon. He made application to Dr. Chandler and was admitted into his home as an apprentice and student of medicine. Here he was thoroughly drilled in the duties and routine of a country practice. He spent two years there in diligent study—never wasting time, reading the best books on surgery and medicine, dissecting when the opportunity afforded, seizing every opportunity to do a postmortem, assisting in operations, making careful notes, preserving his case records and learning from the experience of his master. His notebook has been preserved, and two outstanding features are the excellent and minute case records of all patients he saw and his great interest in autopsies, which he was always eager to secure and which were always performed with exceeding care and attention to every detail. His notes demonstrate c9ndlusively that the power of keen observation and true scientific spirit was obvious at an early age of his career. When he had finished his apprenticeship the Medical Society of Vermont granted him a license to practice on the second Tuesday of June A.S. 1812. This same month war was declared against England and in September 1812, Beaumont joined the American Army as surgeon’s mate. His career in the army during the war of 1812 is graphically described in his diary, which has been preserved. He saw a most active and strenuous service but found time to write down many interesting medical observations and to try out original forms of treatment. Read from Diary page 44- Life and Letters, by Meyer. He suspended duty in the army for a time in 1813 and began the practice of medicine in Plattsburg, but soon returned to the army. In 1815, after peace had been concluded, he resigned from the army and again entered practice at Plattsburgh, associated with Dr. G. Senter, another army surgeon. They also opened a store containing a “general assortment of drugs, medicine, groceries, dye woods, etc., which they calculated to sell on liberal terms for cash or approved credit.” In 1820 he again joined the army and was commissioned Post Surgeon of the army by President Monroe on March 18. He was immediately ordered to Fort Mackinaw, on the northwestern frontier. It was while on duty at this post that the accident, which happened to Alexis St. Martin, gave Beaumont his chance, otherwise, he perhaps would never have been known to posterity. Frequently, however, by mere chance or an accident when it comes to a man with an alert, well-trained mind, gifted with imagination, may become a great opportunity. The discovery of the X-Ray was, in a sense, quite accidental, but the well-trained mind of roentgen immediately grasped its importance and possibilities for study and development. Many of Pasteur’s great discoveries were accidental in a sense, but back of them all were years of hard study and work, preparing a mind to grasp the importance and see the implication of chance observations. On a day in June 1822, on the island of Michili, Macinac, in the far off northern wilds, where the waters of Lake Michigan and Lake Huron unite, the annual return tide of the trading post was in full swing, and a noisy and excited crowd of Indiana, French-Canadians Voyageurs and soldiers were gathered about the palisades and block houses of the old fort. Fort Macinac was a station of the American Fur Company and the voyageurs were returning with the pelts of the winters catch. Suddenly, from the company’s store, there was a loud report of a shotgun – and a young voyageur dropped to the floor. There was tremendous excitement; wild rumors of a shooting scrape and messengers were hurrying to the fort in search of a doctor. Ina few minutes an alert straight young man in the uniform of a United States Army Surgeon, made his way through the crowd and was at the side of a young French-Canadian, who had been wounded by the accidental discharge of a gun. Thus we have Beaumont in contact for the first time with that “old fistulous Alexis,” by whose means he was to make his famed investigations. One of the officers of the fur company, a Mr. Hubbard, gave the following account of the accident. On the morning of June 6, a young French-Canadian Alexis St. Martin, was standing in front of the company’s store, where one of the party was holding a shotgun, which was accidentally discharged, the whole charge entering St. Martin’s body. The muzzle was not over three feet from him, I think not more than two. The wadding entered his body, as well as pieces of his clothing; his shirt took fire; he fell, as we supposed, dead. Dr. Beaumont, the surgeon of the fort, was immediately sent for and reached the wounded man in a very short time, probably three minutes. We had just gotten him on a cot and were taking off some of his clothing. After the doctor had extracted part of the shot, together with pieces of clothing, and dressed his wound carefully he lift him, remarking: “The man cannot live thirty-six hours; I will come and see him by and by.” In two or three hours he visited him again, expressing surprise at finding him doing better than he had anticipated. The next day, after getting out more shot and clothing, and cutting off the ragged edges of the wound, he informed M. Stewart, in my presence, that he thought he would recover.” This prediction, as we know, proved true. Alexis St. Martin, alas of 19 at the time of the accident, died at the ripe old age of 83, living 28 years after Beaumont’s death. Beaumont’s own description of the wound was given in his “memorial” to the Senate and House of Representatives: “The wound was received just under the left breast, and supposed, at the time, to have been mortal. A large portion of the side was blown off, the ribs fractured and openings made into the cavities of the chest and abdomen, through which protruded portions of the lungs and stomach, much lacerated and burnt, exhibiting altogether an appalling and homeless case. The diaphragm was lacerated and a perforation made directly into the cavity of the stomach, through which food was escaping at the time your memorialist was called to his relief. His life was at first wholly despaired of, but he very unexpectedly survived the immediate effects of the wound, and necessarily continued a long time under the constant professional care and treatment of your memorialist, and, by the blessing of God, finally recovered his health and strength. “At the end of about ten months the wound was partially healed, but he was still on object altogether miserable and helpless. In this situation he was declared “a common pauper” by the civil authorities of the county, and it was resolved by them that they were not able, nor required, to provide for our support, and finally declined talking care of him, and in pursuance of what they probably believed to be their public duty, authorized by the laws of the territory, were about to transport, in this condition, to the place of his nativity in lower Canada, a distance of about 1,500 miles. “ Believing the life of St. Martin must inevitably be sacrificed if such attempt to remove him should be carried into execution at that time, your memoralist, after earnest, repeated, but unavailing remonstrance against such a course of proceedings, resolved, as the only way to rescue St. Martin from impending misery and death, was to arrest the process of transportation and prevent the consequent suffering, to take him into this own private family, where all the care and attention were bestowed that his condition required. “St. Martin was, at that time, as before intimated, altogether helpless and suffering under the debilitating effects of his wounds –naked and destitute of everything. In this situation, your memorialist received, kept, and nursed, medically and surgically treated and sustained him, at much inconvenience and expense, for nearly two years, dressing his wounds daily, and for a considerable part of the time, twice a day, nursed him, fed him, clothed him, lodged him and furnished him with such necessities and comforts as his condition and suffering required. “At the end of these two years he had become able to walk and help himself a little, though unable to provide for his own necessities. In this situation your memoralist retained St. Martin in his family for the special purpose of making physiological experiments.” Beaumont was just beginning to realize the importance of the case and the opportunity vouchsafed him for the learning of essential scientific facts with him for the learning of essential scientific facts with regard to the physiology of digestion. At, or about this time, he wrote the following description of the case: “He will drink a quart of water, or eat a dish of soup and then by removing the dressings and compress, can immediately throw it our through the wound. On removing the dressings I frequently find the stomach inverted to the size and about the shape of a half blown rose. Yet he complains of no pain, and it wall return itself, or is easily reduced by gentle pressure. When he lies on the opposite side, I can look directly into the cavity of the stomach and almost see the process of digestion. I can pour in water with a funnel, or put in food with a spoon, and draw them out with as siphon. I have frequently suspended flesh raw and wasted, and other substances into the perforation to ascertain the length of time required to digest each; and at one time used a tent of raw beef, instead of lint, to stop the orifice, an found that in less than five hours it was completely digested off, as smooth and even as if it had been cut with a knife.” I the fall of 1824 Beaumont sent a complete report of the case to Surgeon General Lovell, who had it published in the Medical Recorder early I 1825. In the meantime Beaumont found that his isolation at Fort Mackinac militated seriously against successful experiments. There were no facilities for research nor physicians form whom he could receive suggestions or exchange ideas. Accordingly he applied for an Eastern post and was transferred to Fort Niagara. At this time, however, his experiments were interrupted by St. Martin taking “French leave” to his boyhood home in Canada. After much effort and no little expense St. Martin was located living about fifty-seven miles from Montreal. He had married and was supporting his family by the most incredibly hard work of a voyageur. Four years form the time he left Beaumont, St.Martin returned to him with a wife and two children. His stomach and side were in much the same condition as when he left. Beaumont now began again his experiments interruptedly until March 1831. During this time St. Martin enjoyed good health, became the father of more children and did a great deal of hard work. In these three years Beaumont made a series of Valuable experiments. Time will not permit to give a detailed account of these experiments, but for tedious effort, careful and clear observation while working with meager equipment, and under the most adverse circumstances, his conclusions which follow stands as an enduring monument to the man, to the science of physiology and to the medical profession: “Inferences from the foregoing Experiments and Observations.” 1. That animal and farinaceous aliments are more easy of digestion than vegetable. 2. That the susceptibility of digestion does not, however, depend altogether upon natural of chemical distinctions. 3. That digestion is facilitated by minuteness of division and tenderness of fiber, and retraded by opposited qualities. 4. That the ultimate principles of aliments are always the same, from whatever food they may be obtained. 5. That the action of the stomach and its fluids are the same on all kinds of diet. 6. That the digestibility of aliment does not depend on the quality of nutrient principles that it contains. 7. That the quality of food generally taken is more than the wants of the system require, and that such excess, if preserved in, generally produces not only functional aberration, but diseases of the coats of the stomach. 8. That bulk as well as nutrient is necessary to the articles of diet. 9. That oily food is difficult of digestion, though it contains a large proportion of nutrient principles. 10. That the time required for the digestion of food various, depending upon the quantity and quality of the food, state of the stomach, etc., but that the time ordinarily required for the disposal of a moderate meal of the fibrous parts of meat, with bread, etc., is form three to three and one-half hours. 11. That solid food of a certain texture is easier of digestion than fluid. 12. That stimulation condiments are injuries to the healthy stomach. 13. That the use of ardent spirits always produces disease of the stomach if persevered in. 14. That hunger is the effect of the distention of the vessels that secrete the gastric juice. 15. That the processes of mastication, insalivations, and deglutition, in an abstract point of view, do not in any way effect the digestion of food’ or in other words when food is introduced directly into the stomach in a finely divided state with out these previous steps it is readily and as perfectly digested as when they have been taken. 16. That saliva does not possess the properties of an alimentary solvent. 17. That the first stage of digestion is effective in the stomach. 18. That the natural temperature of the stomach is 100’F. 19. That the temperature is not elevated by the ingestion of food. 20. That the exercise elevates the temperature, and that sleep or rest, in a recumbent position, depresses it. 21. That the agent of chymification s the Gastric Juice. 22. That it acts as a solvent of food and alters its properties. 23. That its action is facilitated by the warmth and motion of the stomach. 24. That it contains Muriactic Acid ad some other active chemical principles. 25. That it is never found free in the gastric cavity, but is always excited to discharge itself by the introduction of food or other irritants. 26. That it is secreted form vessels distinct form the mucous follicles. 27. That it is seldom obtained pure, but is generally mixed with mucous and sometimes with saliva. When pure, it is capable of being kept for months, and perhaps for years. 28. That it coagulates albumin, and afterwards dissolves the coagula. 29. That it checks the process of purification. 30. That the pure gastric juice is fluid, and transparent, without odor, little salt, and perceptibly acid. 31. That, like other chemical agents, it commences its action on food as soon as it comes in contact with it. 32. That it is capable of combining with a certain and fixed quantity of food, when more aliment is presented for its action than it will dissolve, disturbance of the stomach, or “indigestion,” will ensue. 33. That it becomes intimately mixed and blended with the ingested in the stomach by the motions of that organ. 34. That it is invariably the same substance, modified only by admixture with other fluids. 35. That gentle exercise facilitates the digestion of food. 36. That bile is not ordinarily found n the stomach, and is not commonly necessary for the digestion of food, but 37. That, when oily food has bee used, it assists its digestion. 38. That chyme is hemogenous, but variable in its color and consistence. 39. That toward the latter stages of chymification it becomes more acid and stimulation, and passes more rapidly form the stomach. 40. That water, ardent spirits, and most other fluids are not affected by the gastric juice, but pass from the stomach soon after they have been received. 41. That the inner coat of the stomach is of a pale pink color, varying in its hues according to its full or empty state. 42. That in health it is constantly sheathed with a mucus coat. 43. That the gastric juice and mucus are dissimilar in their physical and chemical properties. 44. That the appearance of the interior of the stomach in disease is essentially different from that of its healthy state. 45. That the motions of the stomach produce a constant churning of its contents, and admixture of food and gastric juice. 46. That these motions are in two directions- transversely and longitudinally. 47. That the expulsion of the chyme is assisted by a transverse hand, etc. 48. That chyle is formed in the duodenum and small intestines by the action of bile and pancreatic juice on the chyme. 49. That crude chyle is semi-transparent, whey colored fluid. 50. That it is further changed by the action of the lacteals and mesenteric glands. This is only an inference from the other facts. It has not been the subject of experiment. 51. That no other fluid produces the same effect on food that gastric juice des, and that it is the only solvent aliment.
Beaumont was ordered to Fort Crawford, Michigan, early in 1830 to assist in the campaign against the Indians, and with his consent St. Martin returned to his home in Canada with the promise that he would return when time again permitted a continuance of the experiments. In 1832 the Indian war was ended and while Beaumont was on leave at Plattsburgh, St. Martin made his appearance according to promise. Here they entered into a most remarkable contract, which provided that St. Martin should sell himself to Beaumont for a year, to act as servant and for the purpose of experiments. The payment therefore to be board, lodging, all expense and 150.00 dollars in addition. During the next four or five months 116 experiments were recorded some of which were somewhat spoiled because of Alexis’ immoderate use of alcohol as he records that “the diseased appearance to the stomach at this examination was probably the effect of intoxication the day before.” In 1833 he succeeded in enlisting two of Americas leading scientist, Robert Dunglingson, professor of physiology in the university of Virginia, and Benjamin Silliman, professor of chemistry in Yale University. He submitted large samples of gastric juice to them and they rendered valuable aid in its analysis and in the execution of further experimental work. It was largely through them that the prominent scientists of Europe knew his investigations and result. In September 1833, Beaumont published a book on his experiments and observations on the gastric juice. The preface of the abstract sent to Surgeon-General Lovell is so typical of the man that I wish to reproduce it in part: “With an honest desire to contribute, if I may, a mite of the promotion to Medical Science, and in accordance with your wish and the general views of the Department under which I act, I have the honor very respectfully to submit for consideration the following experiments and observations upon the gastric juice and function of digestion as made upon Alexis St. Martin. In offering the following I can most truly assert that no favorite theory, system or hypothesis, pre-conceived opinions, or partiality for popular authority, have had any influence in making or recording them. A mere tyro in science, with a mind free from every bias, I commenced them, as it were, by accident, and continued desultorily to prosecute them, without regard to any particular arrangement, or the confirmation of anything save plain and palpable truths and physiological facts, aiming singly at the more perfect development of the nature of the gastric juice and process of digestion in the human stomach, subjects which neither time, nor talents, nor learning, has yet satisfactorily illustrated. If in any degree, I succeed in thus contributing to the cause of science, I shall be satisfied with having bestowed my time and patience upon the subject, simply even to afford the materials for the physiologists to cultivate and improve.” His career now is somewhat checkered. He presented a “memorial” to Congress to reimburse him for expenses incurred already and to enable him to continue his experiments. In this he had the support of the Surgeon-General and his scientific friends, but in spite of this, his appeal was refused, doubtless due to ignorance of the members of Congress in appreciating the importance of his work. He was disappointed at this, but not discouraged. His experiments had made of him and international character and he was determined to proceed with them as best he could with his limited resources. Again St. Martin proved a stumbling block, as he did not return to him according to agreement. Beaumont was now transferred to Jefferson Barracks, St. Louis, a post very much to his dislike, and at his request was transferred to the arsenal in St. Louis, where, in addition to his army duties, he could carry on a private practice. In the meantime Surgeon-General Lovell, who had encouraged and assisted Beaumont in his work, died-and Dr. Thomas Lawson had been appointed in his place. Dr. Lawson would not allow Beaumont the facilities for experimental work or for work outside his official duties. As a result Beaumont resigned form the army and thus ended his brilliant military career of more than 25 years. He entered private practice in St. Louis and was very successful. In 1841 he wrote his cousin he declined “more practice in a day than half of the doctors in the city get in a week.” Beaumont continued to negotiate with St. Martin for his return, almost to the time of his death, but never succeeded. In March 1853, while returning from a visit to a patient, he slipped on iced covered steps, striking his head violently when he fell. His injuries were considered trivial but he never recovered completely. The immediate cause of his death, April 25the, was a carbuncle of the neck. Thus closed and exceptional career. In the words of Osler, the highest praise that we can give it to say that his life fulfilled the ideal with which he set out, ad which he so well expressed in this sentence, “Taught, like beauty, is when unadorned adorned the most, ad when prosecuting these experiments and inquiries, I believe I have been guided by its light. His wife, Deborah, whom he had married while post surgeon at Plattsburgh, survived him by many years. Together they lie buried in beautiful Bellefontaine Cemetery in the city of St. Louis. “Few are the pilgrimages to his grave, and few there are ever know where like the remains of this unique and remarkable man; yet all mankind has profited by virtue of his having lived and worked.
|