Steven Shapin
Alexis St Martin was one of the 19th century’s most important scientific guinea pigs. In 1822, the illiterate young French-Canadian was working as a ‘voyageur’ for John Jacob Astor’s fur-trading company in northern Michigan. He was hanging out with a bunch of rowdies in the company store when a shotgun accidentally went off and he was hit below his left nipple. The injury was serious and likely to be fatal – his half-digested breakfast was pouring out of the wound from his perforated stomach, along with bits of the stomach itself – but a US army surgeon called William Beaumont was nevertheless sent for. Beaumont was pessimistic, but he cleaned the wound as best he could and was amazed the next day to find his patient still alive. It was touch and go for almost a year: St Martin survived, though with a gastric fistula about two and a half inches in circumference. It was now possible for Beaumont to peer into St Martin’s stomach, to insert his forefinger into it, to introduce muslin bags containing bits of food and to retrieve them whenever he wanted. Human digestion had become visible.Beaumont took over St Martin’s care when charity support ran out, and over the next ten years the patient lived intermittently with the doctor, as both his domestic servant and a contractually paid experimental object. St Martin’s fistula was soon to become one of the modern world’s most celebrated peepshows. The experiments were conducted at intervals over the eight years from 1825 and a remarkable contract survives which established a legal basis for scientific access to St Martin’s stomach:
Alexis will at all times … submit to assist and promote by all means in his power such philosophical or medical experiments as the said William shall direct or cause to be made on or in the stomach of him, the said Alexis, either through and by means of the aperture or opening thereto in the side of him, the said Alexis, or otherwise, and will obey, suffer and comply with all reasonable and proper orders of or experiments of the said William in relation thereto, and in relation to the exhibiting and showing of his said stomach and the powers and properties thereof and of the appurtenances, and powers, properties, situation and state of the contents thereof.
In return for letting Beaumont in and out of his stomach, St Martin was to get board, lodging and about $150 a year. But by 1833 he’d had enough: he went back to his old life as a voyageur, and, amazingly, lived well into his seventies. At his death he was survived by a wife and six children, who had him buried two feet deeper than usual so that the scientists could not retrieve the corpse and dissect his stomach.
St Martin’s fistula offered a unique form of scientific access to the living stomach, but throughout the 19th century ever more powerful technologies were being devised to get at its contents and to render it visible, audible and, finally, manipulable. Physicians became more skilled in such non-invasive techniques as auscultation, learning to distinguish and to mark the physiological significance of stomach sounds called, variously, ‘splashing’, ‘gurgling’, ‘ringing’ and ‘sizzling’. In 1868, the Freiburg physician Adolf Kussmaul invented a rigid tube, developed through experimentation with a sword-swallower, that enabled him to retrieve samples from the oesophagus and stomach and even to see a little of what was going on in there. In the 1890s, a New York doctor called Max Einhorn devised a small silver ‘stomach bucket’, secured to a string. Patients, suitably encouraged, swallowed the thing, and Einhorn would then pull up the bucket and have its gastric contents chemically analysed. From about the 1930s, endoscopy became a key diagnostic tool, and now upper-gastrointestinal endoscopy extends medical vision as far as the duodenum, the bit of the small intestine just downstream of the stomach. By the 1910s, X-ray technology was making a vital contribution to visualising the stomach and its lesions. Surgical access to the organs of the abdomen in the 19th century was slow in developing, partly because of problems with anaesthesia and infection, and partly because surgeons initially had little basis for understanding the significance of what they were seeing, but after the ‘Listerian revolution’ in antisepsis surgeons became increasingly comfortable with a range of abdominal operations, especially in connection with peptic ulcers.
Beaumont’s work with his experimental subject was aimed at understanding digestion in general, not St Martin’s digestion in particular. He wanted to know how digestion normally went on, and was not much interested in how it occasionally went wrong. He tabulated how long various types of food took to be digested; he recorded the temperature of the stomach under different dietary and climatic conditions; he compared digestion in St Martin’s stomach with the action of extracted gastric juice and food in vitro; he measured the dynamics of secretion of the juice; he analysed the juice and shipped samples to university chemistry laboratories at Virginia, Yale and Stockholm, which confirmed his judgment that its main active constituent was hydrochloric acid and that digestion was just a process of chemical decomposition, replicable in a test tube. St Martin’s guts were becoming universalised.
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