Gastric Fistula
Canada 1822
The crack of a musket shot.
Then a man screaming.
Canada. Fort Mackinac to be
precise, was inhospitable even in summer.
Inhospitable – a fitting adjective: the hospital
was a converted storehouse. Bitterly cold in
winter, the fires filled the place with plenty
of smoke but little heat. Snow crept into the
wards as a grimy slush. And now, in June, the
roof leaked drizzles of rain, as full of holes as
the Sixth Regiment, nine years earlier when
the British had blown-up the main magazine
at York.
Doctor William Beaumont had spent a
full two days, back then, amputating arms and
legs and trepanning fractured skulls to relieve
pressure on the brain. He had seen his share
of blood and guts, so it was to Dr Beaumont
that Alexis St Martin was carried.
St Martin was a voyageur. He plied
his canoe to the far reaches of Lake Huron,
the second largest of the Great Lakes, trading
with the Indian trappers and selling pelts to
the American Fur Company on Macinac Island.
He was stretchered in by two of the
townsfolk, being careful not to slip on the
wet floor. Beaumont had him laid on a bed,
manoeuvred away from the dripping roof.
“He suffered a musket wound,”
someone said. “An accident. Shot out his
stomach.”
There was a hole in the upper left
abdomen; the man’s breakfast of bread and
rabbit sloshed through.
Beaumont ensured that his assistants
held the man still as he made his examination;
the wound was as large as his hand.
“His name’s St Martin,” said a voice
as Beaumont swabbed at the blood and loose
shards of rib.
Three years later
Unable to continue working as a
voyageur, St Martin was employed by Dr
Beaumont as a handyman. The holes in the
hospital roof were duly repaired. The gastric
fistula in St Martin’s stomach however failed
to close.
Beaumont removed the dressing and
cleansed the scar, creased like the bark of a
tree, around the cavity leading through to the
stomach. “I wonder,” said he, “would you
permit me some experimentation with gastric
juices?”
St Martin stared into Beaumont’s
gaze, judging his intentions, then he agreed.
Beaumont lowered quarter-ounce
pieces of food into St. Martin’s stomach on
strands of silk string, removing them after
one, two and three hours to observe the rate
of digestion. There was movement in the
muscles of the stomach, was digestion a
mechanical process of grinding?
The process appeared to be chemical.
Gastric juices had solvent properties, like
acid, dissolving corned beef in two hours.
Juice extracted to a glass vessel worked five
times slower, even when body temperature
was maintained. Cold juice had no effect at
all. Chicken digested slower than beef,
vegetables slower still, and St. Martin’s mood,
when foul, hindered digestion still further.
Exercise was found to quicken the process.
When Dr Beaumont came to publish
his observations, he deliberated for some
time before settling on a name for his book.
‘Experiments and Observations on the Gastric
Juice and the Physiology of Digestion’. Not
the snappiest of titles, but one he hoped
would be remembered in years to come.
London 2022
The pop of a champagne cork.
Then everyone cheering.
London. The Shard hospital to be
precise, glinted in the glow of a summer
sunset. From the observation terrace,
converted from offices, even London could
look serene.
It was Professor White’s moment: a
celebration of all he and his assistant, Martin,
had achieved. They watched the editors of
the newspapers and magazines gather for the
naming of their new endoscopic capsule.
White grinned, thinking of how much
the sponsors had spent, must have cost them
an arm and a leg.
“Relieved?” asked Martin, “now that
it’s over? No more pressure.”
White felt that he had seen more than
his fair share of Martin’s guts. A voyage of
twenty-four meters, he had plied his capsule
to the far reaches of Martin’s digestive tract.
White stood on a small podium and
addressed the company of dignitaries in their
suits and furs. “A toast, ladies and
gentlemen,” he announced. “To the world’s
first fully manoeuvrable endoscopic capsule.
And to the research team who made it
possible.
“I’d like to pay particular tribute to
my long-suffering assistant, Martin Prince,
who is, in my opinion, far too fond of a full
English breakfast. Porridge is far easier to
navigate through.”
The editors laughed and ensured their
assistants had noted this quote, ready for
their next edition.
“The name of the capsule,” continued
White, “will reflect this magnificent building,
the Shard Hospital, our ‘beautiful mountain’.
It will be called Beaumont.”
Three years earlier
Professor White gave Martin a
capsule to swallow. “This one’s the size of a
vitamin pill. But I know that I can make it
smaller still. About the size of a grain of rice,
and fully manoeuvrable.”
Martin adjusted the chunky belt of
sensors around his abdomen. “The smaller
you make the capsule, the bigger the
associated paraphernalia.”
“We must be able to track the
capsule, beam power to it and receive the
pictures. It’s good of you, Martin, to permit
me these experiments.”
Martin stared into Professor White’s
gaze, and saw his passion. Then he
swallowed the capsule.
“I managed to pull a few strings,”
White said. “We’re getting state of the art
equipment in the next budget, and rather
exciting new premises. I’ve said we need it to
keep ahead of the Japanese teams.”
Martin watched the monitor screen
as the capsule slid down into his gastric juices.
“This new capsule is better resistant
to hydrochloric acid,” White said. “Don’t
want you digesting this one too much, they’re
too expensive.”
Martin lay back on a raised bed as
Professor White controlled the movement of
the capsule and camera sliding through his
part digested bacon, egg and sausage.
“Beaumont?” Martin’s face was
sceptical. “You haven’t really named it after
the shard, have you?”
White winked. “Got to keep the
sponsors happy,” he said. “But just between
you and me… There’s another Beaumont, Dr
William. Look him up. It’s quite a story.”
