William Beaumont: the stubborn physician encounters the stubborn boatman, October 3, 1989

Moderator: University of Iowa, History of Medicine Society, Tuesday October 3rd 1989. The speaker this evening is James Christiansen MD, Professor in the Department of Internal Medicine at the University of Iowa College of Medicine. Dr. Christiansen's topic this evening is William Beaumont: The Stubborn Physician Encounters the Stubborn Boatman. Dr. R. Palmer Howard: Shall I repeat your title? Dr. James Christiansen: No. I've given this talk I think twice before in the last 10 or 12 years, and I lost my notes. Professor Lavine once told me "Whenever you work on the talk, always save the notes, 'cause you might need to do it again," and I didn't take that advice. I had to do all the footwork again, and this time I wrote out the text. It's such a complicated story I have a hard time remembering it. I'll read the text so I get all the details in, but I'll interpolate some things that I forgot to put in the text that didn't seem very important. This is the story of Beaumont and Satan. Martin and I would subtitle the story The Medical Sleuth and the Vagabond. The history of medicine and science often seem to be fairly unsentimental subjects because in the sciences, the impacts of the personalities of the principle actors rarely come to the forefront, whereas in the arts and politics, they do. Still, there are episodes in the history of medicine which have quite a romantic character because of the striking influences of the personalities of the actors involved, and this is one such story. This is the story of a pioneer physician, Dr William Beaumont, and his unique patient Alexis St Martin. By the way, I'll call him St Martin. I won't frenchify it. Fowler said that the French language contains sounds that the English tongue was not designed to twist itself around. I'll call him St Martin if I can remember. This now almost legendary story is of particular interest to me of course because I'm a Midwestern gastroenterologist, and it's a gastroenterological story and it took place in the Midwest, at least in large part. I cannot pretend to have made a full and scholarly study of the history, but I've summarized the story from the published accounts by those who did investigate in deterrence, including Sir William Osler, the founder of internal medicine. William Beaumont, The Medical Sleuth. Beaumont possessed many of those qualities that we hold as ideals in physicians and that we commonly idealize as American, such qualities as self reliance, persistence, the ability to capitalize on chance occurrences, rational objectivity, and so on. Since his possession of these qualities in an important part of this tale, I will review the early history of him to show you what kind of man he was and what kind of background he came from. Beaumont was born to a farming family in 1785 in Lebanon within Western Connecticut. He was the second son ... I drew a map here 'cause the geography is important in this story. He was the second son in a family of nine children. The Beaumonts had come to Connecticut from England in 1640, and they had married into other local families of similar origin so that the Beaumont family was a very well established family indeed in Connecticut after a century and a half. Most of the Beaumonts were farmers, but they had a tradition of a devotion to education and community service and community responsibilities. Beaumont was in the sixth American generation of this agrarian kindred. In 1785, this part of New England was only just recovering from the American Revolution. In Lebanon, the schools and the meeting houses, in fact all of the structures of society, had decayed because of the enormous magnitude of the effort given by that particular township to the American Revolution. The Beaumont farm was small and not very productive, and the farming of course was done by the crude methods of the 18th century. Thus, Beaumont grew to maturity in what was probably an especially Spartan environment. We know very little of his early years, for he left little in the way of childhood reminiscences. It is said that he was an adventurous child, for he told a story that as a child he stood too close to a cannon once on a dare, and the explosion when it fired left him deaf, which he was for the rest of his life. Not totally deaf, but hard of hearing. His primary education in Lebanon was not unusual for the school at Lebanon, which had once been a very famous one, was by now only an average school for the time, and he completed only the required education of the local community. He was introduced at home into the strong, democratic, patriotic, and congregationalist traditions of his family. This carried over, for in later years he was certainly a patriot, but he was neither an active politician nor a church man. By 1800, the new nation had been ushered out of its provincialism through the efforts of the Adams administration, as you remember, expanding contests with France, where Napoleon had just become the First Consul and was preparing to send an army to New Orleans. This led to a great expansion in the horizons of New England. Very soon after that, the Louisiana purchase, I think that's 1803, was negotiated and certain troubles with the British took place that were the prelude to the war of 1812. Beaumont, then, was 15 to 20 years of age in this period, and he followed these developments in the newspapers of the time, and seems to have caught the expansive and optimistic spirit of the period. When he was 21 in the winter of 1806 and 7, he rejected his father's offer of a farm for his livelihood, and he set out with a horse, a wagon, a barrel of cider, and a hundred dollars to seek his fortune northwards. He went north into Vermont. He settled apparently without any prior plan at all at the village of Champlain in Western New York on the shore of Lake Champlain. Must have been on this side somewhere. Here he immediately became the local schoolmaster. That suggests to us that he must have been an unusual young man. At this point, he determined upon a medical career and he began to read medical texts borrowed from a Dr Pomeroy, who was a physician across the lake in Burlington. At the end of three years as a school master and three years when he read these books, he apprenticed himself as a physician-in-training to a Dr Chandler in the nearby town of St Albans, just south of Burlington. The apprenticeship combines the roles of assistant and pupil. Notes that Beaumont made from this period indicate that he had access to some of the classic medical texts at the time, but his training must have been eminently pragmatic, based on observation of patients and occasional dissections; for that was the usual ordinary medical education of the time. University-based or hospital-based medical education in the United States had only just begun. After two years of such apprenticeship, Beaumont was licensed by something called the Third Medical Society of the State of Vermont. This was his only licensure. He left his association with his preceptor in September 1812, armed with his license and letters of reference from his two mentors, Dr Pomeroy in Burlington and Dr Chandler in St Albans. England had declared war on the United States in June 1812, and this was September, and Dr Beaumont, being both patriotic and poor, immediately enlisted in the American army as a surgeon's mate. Although the war was later to come all the way to Plattsburgh, New York, where Beaumont's infantry regiment was encamped, there was a lull in the conflict at the time so that he suspended active duty briefly for an interlude of private practice in the city of Plattsburgh. This suggests to me that Beaumont was troubled by the idleness of the lull in the war, by poverty, or perhaps by both. This was brief though, for within six weeks he reentered active duty, and the infantry regiment and camp at Plattsburgh left by ship to be involved soon in two great battles with the British forces, the first at Toronto and the second back at Plattsburgh. In these battles, Dr Beaumont was confronted with the massive forces of trauma, sepsis, and communicable disease that attended warfare in that era. These were fierce battles, and he probably had a very intense seasoning. He resigned his commission in 1815 after the war had ended, and he returned to private practice in Plattsburgh. That practice was only moderately successful apparently, and perhaps he also found it to be rather tame after his war experiences, so he reenlisted in the army after five years in 1820, and he was immediately transferred to the frontier army post at Fort Mackinac on Mackinac Island. Then called Michillimackinac, but I'll call it Mackinac because that's its modern name. At Fort Mackinac, Dr Beaumont found a prominent but typical frontier community. The stockade fort there had been captured by the British forces in the War of 1812, but eight years later now in 1820, it had reverted to American possession and it had been reconstructed. It was an important trading point, this island. It harbored not only the army forces but also a large civilian population consisting mainly of Indians, fur traders who were mostly French Canadians, a very small but stable business community, and various transients. Mackinac Island was the site of the headquarters of the then newly formed American Fur Company, which had been established by the famous John Jacob Astor. Astor had spent some, I guess 20 years before that wandering across the Middle West, establishing outposts upon which to build the fur trade, which was the foundation of the family fortune. He was sort of the quintessential 19th century tycoon, but he got started in the 18th century. A funny writer. Westbrook Pegler once described Astor as having survived in the great Northwest on a piece of salt pork tied to a string. At any rate, Astor had established this huge company, which was a monopoly. It had trading routes all across the North. The transport of the furs was carried out by means of large oar-driven canoes which were paddled by a class of men called the voyageurs. The American Fur Company employed three thousand of these voyagers. They formed a kind of brotherhood in fact, united by their common employment, their French Canadian background, their origin from an unsophisticated social background, the lack of firm roots in the countryside, and their knowledge of the inland waterways, which were the only means of transport at the time. They were described in one book as a fraternity of cheerful vagabonds. Doctor Beaumont was the only physician on the island, and he found himself responsible therefore, not just for the medical services for the army garrison, but also for such services to the large civilian population, from which he supplemented his small army salary. I read that his salary at the time was 40 dollars a month. I have no idea what that was in terms of purchasing power, but it was described as small. He must have found this busy and varied practice to his liking because after 18 months, he went back to Plattsburgh to be married, returning immediately to Mackinac Island with his bride. His new wife, whom he had met in Plattsburgh in earlier years, was a Quaker woman and a widow, Mrs Deborah Platt. Her parents ran a hotel or an inn in Plattsburgh, and I think she was a grass widow, if I interpret the books correctly; that is to say, she was divorced. She quickly adapted to the new life on Mackinac Island, and it was only a year later that the incident occurred which made Dr Beaumont famous. In June 1822, the island was crowded by voyageurs who were bringing the accumulated results of the winter harvest, the winter trapping season, to this trading center as soon as the water routes had thawed. On June 6th, a group of these voyageurs was lounging around the American Fur Company store ... They had a company store there ... And a shotgun held by one of the group accidentally discharged, felling another voyageur, a 19-year-old man named Alexis St Martin. The muzzle of the shotgun was only two feet from the victim, according to eye witnesses. The shot and wadding entered his left lower thorax. His shirt caught on fire and he fell as though dead. Dr Beaumont was summoned and arrived within probably 15 minutes. He extracted some shot and some pieces of wadding and clothing from the wound, and dressed it, and expressed the opinion that the victim could not survive 36 hours. Later that day, and on the next day, the man was still alive and in fact better. After repeatedly cleaning and dressing the wound, Dr Beaumont moved this French Canadian civilian into the army hospital. That was the only hospital available. It was later said by some who tried to put Dr Beaumont down that it was as early as this that he conceived of the experiments which he later executed that made him famous. That idea is contravened by Dr Beaumont's own notebooks. His own records accurately describe the wound as he first saw it. The skin over the left lower thorax was carried away from an area described as the size of the palm of a man's hand. The fifth and sixth ribs were fractured and the stomach was lacerated by a rib fragment. Part of the left lung and part of the stomach protruded through the wound, and the protrusion of the stomach contained this perforation, from which food escaped. One can conclude that the diaphragm was also perforated by this injury. Dr Beaumont's treatment of the wound, which was repeated every few hours in the first several days, consisted of manual reductions of the herniated left lung and the stomach, debridement, the removal matter, and the application of fermenting poultices made of flour, hot water, charcoal, and yeast. He also used venesection, or bleeding, and cathartics. Over the next several days, much necrotic tissue sloughed, and bone fragments and foreign matter was extruded. There was a prolonged period of fever and pneumonia, dyspnea, and [ilias 00:15:23]. The gastric fistula remained open, and all that entered his stomach came out again at the wound for 12 to 15 days, said Beaumont, so that nutrition had to be maintained by "nutritious injections per anus," some sort of nutritive enema, I presume, salt solutions and perhaps broth ... I don't know what ... Until it became possible for Dr Beaumont to seal the gastric fistula with compresses and adhesive straps. Then the man could eat. With such a description, the reader today is astonished to read that after three weeks, the victim's appetite became regular and healthy, defecation returned, and all functions seemed normal except for drainage from the wound itself. Dr Beaumont tried repeatedly to close the gastric fistula without success. The edges of the fistula became sealed to the remaining rib cage. Although the fistula remained open, it came in time to be covered by an inversion of the scar tissue such as to form a valve that sealed the opening to the stomach much of the time, but allowed easy access to the lumen. Continued dressings and close attention by Dr Beaumont in the hospital went on and on, for the healing was very slow. The extrusion of foreign matter and rib fragments continued for months. After a year had passed, the county refused to support further care of this civilian in the army hospital, and they resolved to send the patient to his home 2000 miles away in Quebec. It was somewhere near Montreal. This all happened over there at Mackinac Island. Even as is true today, the county officers were zealously monitoring the expenditure of public funds. Dr Beaumont recognized that the still-invalid patient was incapable of surviving such an arduous journey, so he took the man into his own modest quarters at the fort in the spring of 1823, where he and his wife cared for him for another two years. One can imagine the trouble this caused, for Beaumont and his wife now had a young child, and a second child soon followed. It was near the end of this two year period that Dr Beaumont seems to have first realized the importance of further studying this strange case, but he did not yet appreciate how long and troublesome a study this might be. We know now that it was long and fruitful. That it was troublesome is perhaps less well appreciated, but we can understand that it must have been troublesome if we consider that a man of Dr Beaumont's circumstances took into his home and into his daily care and company for so long an illiterate and rootless voyageur, a vagabond who could barely speak English and who seems neither to have understood nor cared about the experiments to which he was later required to submit. Then he must have felt some debt to the surgeon to whom he owed his life, so he submitted to the studies at the beginning, though, and as I'll show you, in the end the relationship ended in estrangement if not outright hostility. The Experiments The experiments began in May 1825 at Mackinac Island three years after the accident. One year in the hospital, two years in the Beaumonts' home. Two months after the experiments began, Dr Beaumont was transferred to Fort Niagara near modern Buffalo, New York. Only two months after the experiments began. He took his family and St Martin along there and studied in there for another two months. Then he obtained official leave and took his family with St Martin on to Burlington and to Plattsburgh for a visit to friends and relatives, intending to take his patient even further in order to show him to eminent physicians of the day in the major eastern cities. The nearness of Plattsburgh to French Canada was too much temptation for St Martin to resist, and he absconded to Canada without Dr Beaumont's leave. Thus, the first period of study amounted to only about four months. Dr Beaumont tried unsuccessfully to find his patient, and he finally returned disappointed from Plattsburgh back to Fort Niagara at the end of his furlough. Four years later, Dr Beaumont was now stationed at Fort Howard near present Green Bay, Wisconsin. There he received a letter from an employee of the American Fur Company. He had previously notified that company of St Martin's disappearance, and he had asked the company's agents to help him to find St Martin. This letter informed Dr Beaumont that St Martin had been found, that he had married, that he had two children, that his wound was worse, that his health was poor, and that he was destitute. After some negotiation, Dr Beaumont, by now transferred to Fort Crawford near Prairie Du Chien, managed to have St Martin and his wife and two children transferred the 2000 miles from lower Quebec to Prairie Du Chien, all by canoe. I presume Beaumont paid for it. Here Dr Beaumont, supporting the whole St Martin family ... I think there were four children ... Here he was able to extend his studies from December 1829 until April 1831, nearly 18 months. Then, discontent and homesickness led St Martin, now with Beaumont's permission, to return to his homeland. This was the fall, so he couldn't go by the northern routes. St Martin took his wife and four children by canoe down the Mississippi to the mouth of the Ohio River, up the Ohio River, to southern Ohio, across the state of Ohio to Lake Eerie, down Eerie and Ontario past the St Lawrence to Montreal. Dr Beaumont let him go, believing that he would be able to resume his studies after giving St Martin a vacation. He resolved to take his patient to Europe, where the best physiologists were, so he requested and received a one-year furlough from active duty. The furlough was quickly rescinded because of the troubles in the neighborhood of Prairie Du Chien, where he was still posted, and these troubles were to erupt quickly in the Black Hawk War of 1832. At the end of the Black Hawk War in 1832, Dr Beaumont took up his intentions to take St Martin to Europe, so he took his family back to Plattsburgh, now taking advantage of its furlough. From Plattsburgh, he was able to get in touch with St Martin, who was living in his hometown near Montreal, and he persuaded St Martin to return to service. This time, he secured St Martin's employment with a formal written contract, and then he set out for Europe by way of Washington DC, leaving his family behind. I think the St Martin family stayed behind too. He soon abandoned his idea of going to Europe however, but settled instead upon the plan of conducting any further experiments in Washington, which he did, and subsequently also in Plattsburgh and in New York City in the remaining months of 1833. In Washington, the army for the first time undertook to support the research by the simple expedient of inducting St Martin into the army. This is probably the first example of federally supported research on the [crosstalk 00:23:19]. St Martin returned to Canada in 1834, stating that he intended only a brief visit, but he subsequently refused to return to Dr Beaumont, who was now back at Fort Crawford, that is Prairie Du Chien, despite the doctor's many entreaties and offers of continued support and compensation. Within a year, Dr Beaumont was transferred to Jefferson Barracks in St Louis, the city where he was to live for the rest of his life. He resigned from his army commission in 1839 over a conflict with the new army surgeon general. Dr Beaumont wrote many times to St Martin in the years from 1836 to 1852, a period of 16 years, trying to get St Martin to come to St Louis for further study, without success. St Martin repeatedly agreed to specific plans and then failed to follow through. In 1846, Beaumont even sent his son to Canada in an unsuccessful effort to persuade St Martin to return. It is illuminating to consider the circumstances under which Dr Beaumont worked throughout most of this period. The facilities at Mackinac Island were relatively good. It was a major military post and trading center, and Dr Beaumont there came into contact with important and influential people, both in the army and in the American Fur Company. These contacts were later of great help to him in publicizing his observations. The other posts, Fort Niagara near Buffalo, Fort Howard near Green Bay, and Fort Crawford near Prairie Du Chien, were much less satisfactory. They were relatively minor stations in respect to the fur trade, and they were much more important as military posts actively concerned with dealing with the Indian conflicts at the American frontier. Facilities there were often very poor. There are descriptions at Fort Crawford of the fort being flooded and destroyed by floods and rebuilt and so on. Both the civilian and army populations there were frequently drunken and disease-ridden, and the physical facilities were at best primitive. As I have indicated, Dr Beaumont moved very often from one place to another, and the modes of travel at the time were also primitive, largely making use of small boats on the waterways and canals. In such circumstances, one is filled with wonder at Dr Beaumont's persistence in retaining St Martin. The few opportunities that he had to study St Martin in Plattsburgh and in Washington must have seemed luxuries to him. In Plattsburgh, he used the facilities of the inn operated by his wife's family, and in Washington he had the facilities of the army. Despite all the wandering and poor facilities, he was almost from the start in touch with the eminent physicians and physiologists of the day, even some in Europe. These contacts were possible because his studies had come very early to the attention of the army surgeon general, a Dr Lovell. Dr Lovell's support continued throughout the course of the observations, in fact, right up until he himself retired from the post in 1839, and it was his successor with whom Dr Beaumont had some conflict and resigned his commission. Now, what are the observations? In the total of about ... I guess probably about 26 months that he studied St Martin, Dr Beaumont made a total of 238 observations. He reported these almost from the start in letters and in brief published reports and in verbal communications, and the observations attracted wide interest. In the course of the whole study, his observations came to the attention of the greatest physicians and physiologists of the time. During the last period of observations, 1832 and 33, Dr Beaumont wrote a complete report of all the studies, and this was published in 1833 in Plattsburgh as a monograph with the title, "Experiments and Observations on the Gastric Juice and the Physiology of Digestion." The first edition was reprinted a year later, 1834, in Boston, and a German edition was published in the same year. A Scottish edition appeared four years later in 1838, and the second American edition in 1847 with minor corrections. Thus, the book attracted a wide attention. It was dedicated to Dr Lovell the army surgeon general, and that attests to the support that Dr Lovell had given to Dr Beaumont throughout the project from its beginning. The actual observations that Dr Beaumont made seem primitive to us today, but in the context of the times they were very advanced indeed. Beaumont were able to extract the gastric juice and to examine it. He could observe directly the changes occuring over time in the nature of food once it had entered the stomach. He did this, and he describes how he did this ... With solids he would tie a piece of meat, for example, to a string, and poke it in and leave it for a period of time and then pull it out, look, and see what had happened to it. In this way, he could compare the rates of digestion in different kinds of meat. Similarly, he would put slurries of oatmeal in and then aspirate it out after a specified period of time. It was such simple experiments that he could do. He could also open the fistula to directly observe the gastric mucosa and to directly observe gastric movements. These observations were carried out in the simplest manner, and the results were recorded candidly and carefully and in the plainest possible terms with the minimum of conjecture. If you read his book today, you will be impressed that it's a splendid example of objective and scientific writing. The value of Dr Beaumont's studies can be appreciated only if you consider the state of knowledge of the subject at the time. It was accepted at the time the foods were dissolved in some way in the gastric juice, but there was great uncertainty as to how this occurred. The chemical nature of the gastric juice was obscure. The processes of gastric grinding and secretion were only just beginning to be appreciated to exist. Dr Beaumont's observations can most easily be summarized in terms of the most important general facts that he established, some of which required many decades for confirmation in animal studies. First, he made the first complete physical and chemical description of the gastric juice. He described it as clear, transparent, lacking in odor, slightly salty, and acidic in taste. He noted its diffuse ability in aqueous solutions, that it effervesced with alkali, that it coagulated albumen, and that it had antiseptic properties. Second, he could provide samples of this gastric juice to chemists and he did. They were thus able to establish beyond doubt the presence of hydrochloric acid in the gastric juice. Third, he observed for the first time that the gastric juice and the gastric mucous are separate secretions. Fourth, he established by direct observation that emotional or mental disturbances profoundly altered the secretion of gastric juice, altered the intragastric digestion of food and the gross appearance of the gastric mucosa. Fifth, he was able to confirm a previously controversial observation that the gastric juice can bring about the digestion of food outside the lumen of the stomach. Sixth, he observed that the different rates of emptying from the stomach occur with different kinds of meals. Seventh, he made a comprehensive description of the motions of the stomach. Eighth, he could observe the wide variations in digestive ability that exist between meals of different compositions. Ninth, he could see directly the noxious effects of coffee, tea, and alcohol on the gastric mucosa. Tenth, he observed some quantitative aspects of gastric secretion; that is, that gastric secretion is very low in the fasting state, that most of gastric secretion occurs very soon after a meal, that the volume produced varies with the composition and the volume of the meal. These observations were not confirmed until Pavlov 60 years later performed the famous studies in dogs with gastric pouches. The Coda. Dr Beaumont died of the complications of an accident in 1853 in St Louis, but his fame at that time was secured. At the end of the century, Dr William Osler become interested in Dr Beaumont, and his observations are summarized in an address that he gave to the St Louis Medical Society in 1902. As for St Martin, he long survived his doctor. He lived out his life as a common laborer and farmer in New England and Quebec, but he also traveled about a good bit, exhibiting himself for pay to doctors and to medical societies as "The Man with the Lid on his Stomach." In 1870, 17 years after Beaumont had died, St Martin was in correspondence for a time with Dr Beaumont's son. St Martin family remained in poverty, and St Martin unsuccessfully sought financial support from Dr Beaumont's son. St Martin died of unknown causes in 1880 at the age of 83. He ended his life in poverty. Osler, who was living in Montreal not far from St Martin's village, learned of his death, and he tried unsuccessfully to obtain the body for autopsy. The family's attitude to physicians and to science is exemplified by its action at the time. The family deliberately kept the body from burial until decomposition had advanced so far as to preclude an autopsy, which they knew Osler and other physicians wanted to do. The advanced state of decomposition also precluded admission of the body to the church for the burial service. The grave was dug eight feet deep also to forestall efforts at exhumation for autopsy. Conclusion Why is this story so appealing? Certainly in part because of the fact that such original observations were made by such direct and simple means and recorded so clearly and objectively. It's appealing I think also because of the characters of the two principle players and the circumstances of the story. Dr Beaumont was a true child of his time, a man formed by the Protestantism and the enlightenment that suffused New England society at the heady beginning of the 19th century. He was a true Connecticut Yankee. He seems to have exhibited all those qualities that we associated with that society. A devotion to the cultivation of the intellect, a strong element of self denial, stubborn dedication to hard work, to service to others, and to his discipline, rejection of dogmatism, and a strong devotion to his family and to traditions. To judge from his notebooks and letters, which are available in our own library, he was a man of ... This is my own judgment ... He was a man of considerable rectitude, probably a little autocratic and humorless, probably a little rigid and uncompromising, and certainly inclined to be preachy. Still, he was a tolerant man. He must have been so in order for him to allow himself to associate so long and so intimately with a man like St Martin. St Martin seems to have been the antithesis of Dr Beaumont. We can only infer his character having very little direct judgment, but we know that he was illiterate, uneducated, speaking a patois that Dr Beaumont could scarcely understand, manifestly irresponsible, and a man who was capable of shamelessly exploiting his unique injury by exhibiting it to those who were willing to pay for it. Indeed, it's a pity that neither Dr Beaumont nor his family left anything in the way of direct statement of the personal interactions that must have occurred between the unsophisticated St Martin family and the cultivated Beaumont family over the long period of time they existed in such intimacy, moving about so often from one frontier post to another and even into the homes of Beaumont's relatives. We can only imagine the difficulties. Also, I wonder at the steadfastness of Mrs Beaumont, who was described as a gentle Quaker lady who left the sheltered environment of Plattsburgh to share this adventurous and wandering life with her husband and his obsession with St Martin's stomach. The story survives, I think, especially because it illustrates the way that chance or fate can lead to events that have very far reaching consequences. Fate brought together these two men who were so very unlike one another in the circumstances of a miraculous injury and recovery. Dr Beaumont could see the opportunity that the injury presented because of his own character, and he clearly denied himself and his family a great deal in order to be able to pursue his studies, investing not only his effort and time, but also his own money in supporting St Martin and the family for so long. St Martin may not have been wholly a scoundrel, for he too denied himself and his family sufficiently to have allowed Dr Beaumont a chance to do much of what he wanted to do, but he seems to me to have had not great sense of altruism. That is, I do allow some sense of personal obligation to have operated at first, but later he seems to have cooperated mainly for pay. We have this story as an enduring example of what can be done when people act unselfishly and persist in their goals. I think it's a story that deserves to endure, for such a story inspires today's [inaudible 00:36:56] also to be unselfish and to be alert to the opportunity to study chance occurrences in order to advance the greater good. Thank you. Dr. R. Palmer Howard: Very good. That was a delightful job. We had a delightful speaker. Audience Member: You referred to antagonism resolved between the two. [inaudible 00:37:36] come back to that [inaudible 00:37:37]. Dr. James Christiansen: The tone is there in the letters that Beaumont wrote in that 16 years after he went to St Louis. The tone is there of great frustration on the part of Dr Beaumont and great wiliness on the part of St Martin. The letters from St Martin of course were written by his friends, 'cause he was illiterate, but if you look at the exchange, you can see that Beaumont was mightily frustrated and probably unhappy. I think he was a man of such restraint he didn't really let his feelings be known in letters or in memoranda, but he must have been very frustrated. Audience Member: And he didn't read the scientific literature at the time? Beaumont? Dr. James Christiansen: Well, there wasn't much. Audience Member: Well, there was some ... Dr. James Christiansen: Yeah. Audience Member: ... then, because I'm reminded of Spallanzani of the University [inaudible 00:38:36] in the late [inaudible 00:38:36] tied a piece of string around a piece of meat and swallowed it, [inaudible 00:38:41] shoved it down the body of a snake and then retrieved it and found that it was ingested, but that was about all that was known. Dr. James Christiansen: That was about the level of knowledge. That is, Spallanzani had done that, but apparently he had been unable to show digestion outside the stomach. Audience Member: Oh, sure. Dr. James Christiansen: He couldn't get the juice. Even at that primitive level, that was an unknown. Audience Member: I know, but Beaumont seems to have been aware of that. Dr. James Christiansen: Yes. Audience Member: I think. He must have read some scientific matter. Dr. James Christiansen: He had the standard textbooks at the time, and he was clever enough to get in touch with ... He was in touch with Brazilius in Sweden. He sent him some gastric juice. He never got a report on it, but he didn't need it because [Dungleason 00:39:25] at Virginia had confirmed the presence of hydrochloric acid. He just wanted a duplication by Brazilius in Sweden, but the letter never got an answer, or it was answered so late it was too late. I've forgotten. Audience Member: Can you go through the libraries [inaudible 00:39:42]? Dr. James Christiansen: No. I've never- Audience Member: [Crosstalk 00:39:45] large [inaudible 00:39:48]. Dr. James Christiansen: His papers are there at Washington University in St Louis. Audience Member: [Crosstalk 00:39:54] [inaudible 00:39:55]. Audience Member: Shall I add one more measurement to what he contributed? Dr. James Christiansen: Yes. Dr. R. Palmer Howard: And that is body temperature, because at that time, they were working a little bit on mouth temperature, but that's about all they had. Today they measure four temperatures, but he contributed the second body temperature there was at the time. I know that the stomach is a chamber, but it's still a very hot chamber and a warm chamber, and he recorded the temperature [inaudible 00:40:34] in the body. Dr. James Christiansen: That's right. I remember that. He put thermometers into this thing. Partly to discover at what temperature gastric ... He wanted to reproduce the circumstances outside, so he would raise the temperature, then he'd aspirate the juice, put a piece of meat in it, and hold it in a constant temperature bath at that temperature he had recorded. Dr. R. Palmer Howard: Yeah, both the temperature of the rectal temperature [crosstalk 00:40:59] Audience Member: [Crosstalk 00:41:01] Dr. R. Palmer Howard: No, no. Does anybody know what [inaudible 00:41:04] stomach temperature was? Audience Member: [inaudible 00:41:08] Dr. James Christiansen: This truly core temperature [crosstalk 00:41:10] Dr. James Christiansen: It's core temperature. Audience Member: Probably supposed to be core temperature [inaudible 00:41:14]. Dr. R. Palmer Howard: Well, yes. Audience Member: What sort of experiments did Beaumont hope to continue [inaudible 00:41:23]? Dr. James Christiansen: Well, I asked myself. He didn't say, at least I didn't find any notes that he ever said what more he would do. He may have in a notebook that I didn't find. It's hard to imagine what more he might have done. He might have quantified things a little better. Perhaps ... I've thought about this a little bit. What might he have done? He might have put a catheter if he'd thought of it, in through the pylorus and got some bile out and given us some early descriptions of bile, for example. But he doesn't say he thought of doing that. He could have gotten some gastric mucosa and gotten histology, except that histology hadn't developed yet. Not in this country. Hans, what were Virkow in Vienna? Virkow was ... Audience Member: He was in Berlin. [Crosstalk 00:42:16] Dr. James Christiansen: Pathology in Austria and Germany was just beginning really, so that he couldn't have done that. Audience Member: [Crosstalk 00:42:29] Dr. James Christiansen: He really did about all that he could have done under the circumstances I think. Dr. R. Palmer Howard: It reminded me that he became quite a famous physician in St Louis [crosstalk 00:42:40] Dr. James Christiansen: He had a very successful practice I suppose after he [inaudible 00:42:43]. Audience Member: The autopsy done on Beethoven was in 1827. Perhaps was not perfect [inaudible 00:42:56] autopsy. The examination of the body was done by a young pathologist in Vienna who was being deemed to be very unknown for all the [inaudible 00:43:03]. The examination of the remains was really just an external examination. They didn't really have any means for studying [inaudible 00:43:18]. There are some museums in relation to people Beaumont. Certainly the one in Prairie Du Chien, which was ... That was established not very many years ago by the Wisconsin Medical Society and I think Wisconsin State Historical Society together had built an interesting small museum along the grounds of the ruins of Fort Crawford, and Prairie Du Chien is just across from McGregor, Iowa. Especially nice to go up in early October [inaudible 00:43:55]. Another is the museum in the house where Beaumont and all of this happened on Mackinac Island. [inaudible 00:44:07] because of the romance of this thing I've been keeping this story, and a few years ago I was driving [inaudible 00:44:14] Montreal and went to this little town [inaudible 00:44:19] which was the place he lived, which was about 25 miles northeast of Montreal. The only remnant that I could find was a plaque on the outside wall of the village church, which is really rather handsome today. It was renovated I don't know how many years ago. This plaque was put there in honor of [inaudible 00:44:45] and others who were the subjects of research that people would do in the college [inaudible 00:44:54] progress of mankind in homage to the subject of the research [inaudible 00:44:59] was put there a few years ago by, I think it was [inaudible 00:45:03] on the hundredth anniversary [inaudible 00:45:08] by the Canadian Gastroenterological Association. This place faces out into the graveyard of that little church, but the exact place where he was buried is not known. [inaudible 00:45:22]. Dr. James Christiansen: Still. Audience Member: Did they figure out how long St Martin was actually with Beaumont together [inaudible 00:45:36]? Dr. James Christiansen: The first period was four months. The second period was 18 months, and the third period was just about 12 months. Maybe 12 or 14 months. Audience Member: How long was that [inaudible 00:45:47]? Dr. James Christiansen: The first period was 1820 ... Well, it was in Mackinac. 1825 for four months. Then the second time was four years later, and four years went by. Then there was 18 months. Then the next interval was about two years, and then there was another 12 months time. Audience Member: [inaudible 00:46:11]. Dr. James Christiansen: Oh yeah. Yes. The last study was 1834, and St Martin was born about five ... There's some discrepancy in the dates. It was either 1797 or 1800, but he would have been about 30. He would have been between 35 and 40 at the end of the last study. It was really quite ... There were really three quite distinct, separate periods of time. Dr. R. Palmer Howard: [inaudible 00:46:42] six or seven children. Dr. James Christiansen: I think all together. I'm not sure. Audience Member: I recall that [inaudible 00:46:50] one time remarked that house that [inaudible 00:46:55] had at the University of Virginia, that is the Professor of Medicine there. He lived in the basement, and the laboratory, and he did the experiments which could verify that there was hydrochloric acid in the gastric juice received in a sample from Beaumont [inaudible 00:47:14]. That was the same house that [inaudible 00:47:17] grew up in [inaudible 00:47:20]. One of those faculty homes on the lawn. Dr. R. Palmer Howard: Well, I think we should hold an informal questioning perhaps. Audience Member: Are there other Beaumont hospitals besides the one in Royal Oak, Michigan? Dr. James Christiansen: Well, there's an army hospital within Beaumont Hospital. Is it in San Antonio? Audience Member: El Paso. Dr. James Christiansen: El Paso. I didn't know about the one in Royal Oak. Dr. R. Palmer Howard: Well, I think we should call it a day, but I wanted to... a little announcement moment. Our next meeting will have a guest speaker from East Carolina. A historian Todd Savin. He'll be speaking here on Thursday the 16th of November at this time on this topic that's been circulated to you on the history of sickle cell anemia, which Todd Savin has done some recent genealogical historical work. He also is speaking at a history symposium on another historical medical subject at 12:30 on that day [inaudible 00:48:49]. [inaudible 00:48:53] wishing that she will [inaudible 00:48:54]. Traditionally, I haven't [inaudible 00:49:00], nor have I cooked. So we'll return to tradition and I'm pleased to offer you a tie. You're not wearing one. I was frightened you were going to be coming with both the colors that you had. But this family is on the poor side and they didn't purchase things in advance. Dr. James Christiansen: Thank you very much. Dr. R. Palmer Howard: Would you [crosstalk 00:49:26]? Dr. James Christiansen: Oh, the red one. It's beautiful. Yeah. I would prefer the red one over any other color. [crosstalk 00:49:32] Dr. R. Palmer Howard: Well, the other is blue. That makes him a liberal and not a conservative I suppose. Well, thank you very much. It was an absolute excellent time. [inaudible 00:49:48] more refreshments. If anybody got through this mess without signing the book, he'd appreciate a signature.