Wednesday, 10 February 2016

Alex St. Martin: The Man with a (literal) Window into Digestion

Generally speaking, the things science teaches us are the result of small experiments that push forward our understanding of the world, a little bit at a time. However, every once in a while, an event or a person comes along that gives our knowledge a rapid jolt forward. When these people are scientists, we tend to remember their names (Newton, Einstein, Darwin, etc.), but we tend to forget the names of the ordinary people who, often through extraordinary circumstances, taught us things about our world that we otherwise wouldn’t know. A few months ago we learned about Phineas Gage – the man who took an iron bar through the head and lived to tell the tale – and everything he revealed to science about the brain. Today, we’ll meet another similarly unfortunate individual.

On the 6th of June 1822 , at Fort Mackinac, a fur trading post in northern Michigan, an 18 year-old man named Alex St. Martin was loading up his canoe for another hard day in the woods. St. Martin was a French Canadian fur trapper, a tough breed to begin with; but before lunch time he would prove himself to be of heartier stock than the average voyageur. Sometime that morning, a gun accidentally went off. Word arrived with the Fort’s doctor, William Beaumont, that St. Martin had been shot. He rushed to the scene and inadvertently stumbled into one of the most fruitful partnerships in medical history.

St. Martin lay bleeding in the street with a hole in his rib-cage about the size of the palm of his hand. Through the hole spilled all manner of gore. There were bits of bone, muscle, and even part of a lung. But what caught Dr. Beaumont’s eye was the meat, bread, and coffee which, hours earlier, had been St. Martin’s breakfast. The bullet, it appeared, had punched a hole into the man’s stomach. Beaumont stitched up the wound, and over the next several weeks, performed a number of surgeries without the aid of anesthetic or disinfectant. St. Martin miraculously survived all this, but understandably grew fed up with surgeries. The end result was that he reached a stable condition but still had a hole in his stomach.

The medical term for the hole is a fistula. Today, farmers routinely give them to cows so they can monitor their digestion, but back in 1822 it was a new and valuable concept. In the early 19th century, the stomach was something of a mystery. We knew that food went in and waste came out, but we had basically no idea what went on in between to turn food into muscle and energy. The opportunity wasn’t wasted on Dr. Beaumont who, under the guise of charitable action, offered St. Martin a job as a handyman at his home to make up for the fact that he could no longer trap. With few options, St. Martin agreed to take the job.

Things presumably started out normally enough, but eventually Beaumont somehow convinced St. Martin to allow for a few experiments. In 1825, Beaumont began lowering bits of food through the fistula and into St. Martin’s stomach on pieces of string. He would pull the items out after various amounts of time and record how digested they were. This is how science learned that hard-boiled eggs take three and half hours to digest and boiled animal brains take an hour and 45 minutes. Beaumont also took to tasting the stomach juices and the fistula itself to measure acidity… In short, things got weird.

In fact, they got so weird, that eventually St. Martin had enough and fled back to Canada where he started a family and even began trapping again. Beaumont didn’t give up; he wrote letters, pleading with St. Martin to come back, offering him money and land to support his family. Apparently having a hole in your stomach is a significant disadvantage in the fur trapping game, because St. Martin did agree to go back after several years.

It was during this second stint as Beaumont’s live-in guinea pig, that the fistula experiments really began to advance science. Beaumont eventually discovered that when food was introduced to the stomach, papillae emerged from the stomach wall and secreted a clear fluid that was the means of digestion. This was the first evidence that digestion is a chemical, and not a mechanical, process. Beaumont eventually proved this idea by removing some stomach acid and observing digestion outside the body.

This work made Beaumont famous. He toured the world demonstrating his findings, often with St. Martin in toe as a medical side-show of sorts.

St. Martin lived out the rest of his life (he lived to be either 78 or 84 depending on who you ask - either way, a long life) as an oddity. Upon his death in 1880, his family opted to delay burial so his body could begin to rot, eliminating the chance that doctors would dig him up for an autopsy. If we can take one additional thing away from St. Martin’s life story, it is that scientific leaps sometimes come at a cost. Modern medicine owes a pretty big debt to tough and tolerant patients like him.