The ducks of Mackinac Island are apparently not easily taken down. “Found a portion of the Lungs as large as a turkey’s egg protruding through the external wound, lacerated and burnt, and below this another protrusion resembling a portion of the Stomach, what at first view I could not believe possible to be that organ in that situation with the subject surviving, but on closer examination I found it to be actually the Stomach, with a puncture in the protruding portion large enough to receive my forefinger, and through which a portion of his food that he had taken for breakfast had come out and lodged among his apparel.” Thus reads Beaumont’s somewhat windy account of the injury.
Through that puncture—and in the slop of half-digested meat and bread suddenly visible in the folds of St. Martin’s wool shirt—lay Beaumont’s ticket to the spotlight of national renown. Italian digestion experimenters had pulled food in and out of live animal stomachs, soaked it up in sponges on strings, even regurgitated their own dinners, but St. Martin’s portal presented an unprecedented opportunity to document the human juices and processes in vivo. (We will step into the stomach in earnest in chapter 8; for now, it’s medicine’s oddest couple that I wish to explore.)
Beaumont was thirty-seven and on the lookout for something a little glossier than the anonymous rustic toil of an assistant surgeon at a military outpost. Exactly when he realized the value of the St. Martin hole—and how assiduously he did or didn’t work to close it—remain matters of conjecture. The recollection of a man named Gurdon Hubbard, the only eyewitness whose account of that morning remains, suggests the realization occurred earlier than Beaumont claimed. “I know Dr. Beaumont very well. The experiment of introducing food into the stomach through the orifice, purposefully kept open and healed with that object, was conceived by the doctor very soon after the first examination.”
Beaumont denied this. In his journal, he claims to have tried “every means within my power to close the puncture of the Stomach.” I imagine the truth lies midway between. Something closer to Hubbard’s version would serve to explain Beaumont’s puzzling dedication to a man he did not know and about whom he would have been inclined, by birthright, to care little about. St. Martin was a mangeur du lard—a “porkeater,” the lowest class of voyageur. Yet when county funds for St. Martin’s hospital care ran out, in April 1823, Beaumont moved him into his family’s home. The explanation he gives in his journal was that he did so “from mere motives of charity.” That I heavily doubt.
St. Martin was put to work around the house as soon as he was well enough. From the beginning, Beaumont had an eye on the fistula, more or less literally. “When he lies on the opposite side I can look directly into the cavity of the Stomach, and almost see the process of digestion,” wrote Beaumont in his journal. I would love to know how the experimental protocol was first broached. St. Martin had no understanding of scientific method. He was illiterate and spoke little English. He communicated in a French Canadian patois so heavily accented that Beaumont, in his notes from the day of the shooting, transcribed “St. Martin” as “Samata.” Beaumont kept diaries but neither I nor medical ethicist Jason Karlawish, who has written a fine and sleuthfully researched historical novel about the pair, could find mention of St. Martin’s initial reaction to the unusual proposition.
In “Working Ethics: William Beaumont, Alexis St. Martin, and Medical Research in Antebellum America,” historian Alexa Green explains the men’s relationship as clearly one of master and servant.” If the man wants to push a piece of mutton through your side, you let him. Other duties as assigned. (When St. Martin had healed sufficiently that the premise of providing continuing care began to seem a ruse, Beaumont provided a salary.)
For two people so firmly distanced by class and employment structure, Beaumont and St. Martin inhabited a relationship that could be oddly, intensely intimate. “On applying the tongue to the mucous coat of the stomach, in its empty, unirritated state, no acid taste can be perceived.”[36] The one image I eventually found of Alexis St. Martin as a whole young man is in a painting by Dean Cornwell entitled Beaumont and St. Martin—part of the Pioneers of American Medicine series commissioned in 1938 by Wyeth Laboratories for an ad campaign. Despite the unfortunate side-parted bob that St. Martin appeared to stick with all through his adult life, the man as Cornwell rendered him is striking: broad cheekbones, vertically plunging aquiline nose, and a firmly muscled, deeply tanned chest and arms. Beaumont is dashing but dandified. His hair is oddly waved and piled, like something squeezed from a cake decorator’s bag.
Cornwell’s painting is set at Fort Crawford, in Michigan Territory, during St. Martin’s second stint in Beaumont’s employ, around 1830. At this stage in his digestive explorations, Beaumont had been trying to determine whether the gastric juice would work outside of the stomach, removed from the body’s “vital force.” (It does.) He filled vial after vial with St. Martin’s secretions and dropped in all manner of foods. The cabin became a kind of gastric-juice dairy. Beaumont, in the painting, holds one end of a length of gum elastic tubing in St. Martin’s stomach; the other end drips into a bottle in Beaumont’s lap.
I spent a good deal of time staring at this painting, trying to parse the relationship between the two. The gulf between their stations is clear. St. Martin wears dungarees worn through at the knees. Beaumont appears in full military dress—brass-buttoned jacket with gold epaulettes, piping-trimmed breeches tucked into knee-high leather boots. “True,” Cornwell seems to be saying, “it’s an unsavory situation for our man St. Martin, but look, just look, at the splendorous man he has the honor of serving.” (Presumably Cornwell took some liberties with the costuming in order to glorify his subject. Anyone who works with hydrochloric acid knows you don’t wear your dress clothes in the lab.)
The emotions are hard to read. St. Martin appears neither happy nor aggrieved. He lies on his side, propped on an elbow. His posture and far-off stare suggest a man reclining by a campfire. Beaumont, admirably erect, sits in a buckskin chair by the bed. He stares into high middle distance, as though a TV set were mounted on the cabin wall. He looks like a hospital visitor who has run out of things to say. The prevailing mood of the painting is stoicism: one man enduring for the sake of science, the other for subsistence. Given the painting’s intent—the glorification of medicine (and Beaumont and Wyeth labs)—it’s fair to assume the emotional content has been given a whitewash. It can’t have been a hoot for either. At least once in his notes, Beaumont mentions St. Martin’s “anger and impatience.” The procedure was not merely tedious; it was physically unpleasant. The extraction of the gastric juices, Beaumont wrote, “is generally attended by that peculiar sensation at the pit of the stomach, termed sinking, with some degree of faintness, which renders it necessary to stop the operation.”
The disrespect displayed by Beaumont and the medical establishment—evident in their correspondences about St. Martin—can’t have helped. St. Martin was referred to as “the boy” well into his thirties. He was “the human test tube,” “your patent digester.” For the out-of-body digestion experiments, Beaumont had St. Martin hold vials of gastric juice under his arms to simulate the temperature and movements of the stomach. “Kept in the axilla and frequently agitated for one hour and half,” Beaumont’s notes read. If you’d never heard the term axilla, you’d think it was a piece of laboratory equipment, not a French Canadian’s underarm. Beaumont carried out dozens of experiments that required St. Martin to hold vials this way for six, eight, eleven, even twenty-four (corn kernel!) hours. Not surprisingly, St. Martin twice quit—“absconded,” as Beaumont termed it—partly to see his family in Canada, but also because he’d had enough. Only the second time did he do so in violation of a signed contract, and for this he earned Beaumont’s lasting ire. In a letter to the U.S. surgeon general composed around that time, Beaumont deplores St. Martin’s “villainous obstinacy and ugliness.”
36
Using the tongue is less peculiar than it seems. Before doctors could ship patients’ bodily fluids off to labs for analysis, they sometimes relied on tongue and nose for diagnostic clues. Intensely sweet urine, for instance, indicates diabetes. Pus can be distinguished from mucus, wrote Dr. Samuel Cooper in his 1823