The Man with a Window in His Stomach

William Beaumont didn’t know what to expect when he was called to a fur shop to examine a gunshot victim, but he also knew there was no other alternative. As the only physician present at Fort Mackinac in the Michigan territory in 1822, Beaumont represented the victim's lone chance of survival.

When Beaumont entered the shop and saw a portion of the man’s lungs sticking out from his chest, those chances didn’t look good.

The protruding organ part was “as large as a turkey’s egg,” Beaumont later wrote, and was accompanied by an external portion of the patient’s stomach “with a puncture … large enough to receive my fore-finger.”

Beaumont prodded the man, Alexis St. Martin, considered that any effort to save him would be “useless,” and pondered what to do next. Despite the grim odds, he treated the gunshot wounds, and the doctor wound up with more than just a grateful patient. He had inadvertently struck up a friendship with the man who would offer medicine unprecedented—and literal—insight into the body’s digestive tract. Beaumont could see right into St. Martin’s stomach, watching as it digested the food he lowered into it with a string.

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Beaumont had originally been urged to join his family’s farming business in Connecticut. In 1806, at the age of 22, he headed out of state, eventually settling in Vermont to apprentice under a physician. Armed with his medical license, Beaumont enlisted, treating wounded soldiers during the War of 1812. After spending several years in private practice, he reenlisted in 1819 and was dispatched to Fort Mackinac, where he encountered St. Martin for the first time.

His patient-to-be was a 19-year-old French-Canadian (although he might have been older) who made his living transporting fur from Indian traders to storefronts. While at the American Fur Company, St. Martin had been the accidental recipient of a musket shot full of duck load from less than 3 feet away. As Beaumont tended to him, he noticed the force of the projectile had injected bits of clothing into his stomach and lungs. The former leaked portions of St. Martin’s breakfast.

“After cleansing the wound from the charge and … replacing the stomach and lungs as far as practicable,” Beaumont wrote, “I applied the carbonated fermenting poultice and kept the surrounding parts constantly wet.”

The prognosis is poor for most anyone who endures that kind of wound at close range. With the limited scope of medicine in 1822, St. Martin’s chances were slim: he spiked a raging fever. But just a few days later, the young man seemed to be on the rebound—save for the fistula under his right nipple that wouldn’t close. Beaumont kept the wound covered and administered nutrition and hydration through St. Martin’s rectum until the dressing was able to retain his stomach’s contents, an event marked by the arrival of “very hard, black, fetid stool.”

Just over a year and a half later, St. Martin was as healed as he would ever be. His stomach hole, measuring 2.5 inches in circumference, had developed a fine skin of lining that kept contents in but could ooze gastric juices and bits of food if depressed like a valve. Though Beaumont had suggested they try to suture the edges closed, St. Martin refused. Lethargic and depressed, his days as a fur courier appeared over.

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Beaumont sensed opportunity. With St. Martin out of work, he invited the young man to come live with him and perform odd jobs on Beaumont’s property. For the doctor, it meant having a live-in guinea pig for scientific curiosity regarding the stomach, which was still decades away from being visualized by scopes.

St. Martin, whose options were limited, agreed. Beaumont began his studies in 1825, tying bits of beef, bread, and cabbage to a string and lowering it into the fistula. He would then instruct St. Martin to spend a few hours tending to household chores. When he returned, Beaumont would retrieve the food and log the rate of digestion. At one hour, the bread and cabbage was half-digested, the meat untouched. At hour two, the boiled beef was gone, but some salted samples remained.

Other times, Beaumont siphoned out gastric juices to see if they had the same effect outside of the stomach and in a test tube as they did inside: Although most often the test tubes were kept warm in a sand bath, he also occasionally stuffed the tubes into St. Martin's armpit to keep them warm. While it took far longer, the liquid still broke down food, which revised the commonly-held belief that digestion was mostly a mechanical process. Beaumont would also request St. Martin fast, or allow a thermometer to be introduced into the fistula to gauge his stomach temperature—usually a flat 100 degrees.

After several years working for Beaumont, St. Martin left without his consent and returned to Canada. The two didn’t meet again until 1829, when Beaumont hired the American Fur Company to find St. Martin and convince him to return. This time, Beaumont conducted his experiments at Fort Crawford, Wisconsin. Again, the doctor lowered bits of food into the fistula, eyeing it for a response to various foods. When St. Martin grew annoyed at the experiments, Beaumont jotted down that anger had an effect on digestion.

This new arrangement lasted for two years, at which time St. Martin and his family moved back to Canada. In 1832, Beaumont was able to reunite with his singular patient briefly, and took the opportunity to examine how St. Martin’s stomach responded to food and how food responded to stomach acid before the two split for the third and final time.

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St. Martin intended to allow Beaumont to continue his studies, but the death of one of St. Martin's children halted any further travel. With enough clinical material collected, Beaumont published a book in 1833 titled Experiments and Observations on the Gastric Juice and the Physiology of Digestion. For the first time, medicine had an understanding of the role of hydrochloric acid in the stomach, how it differed from mucus, and discovered how the stomach’s motility aided food processing. His contributions were so significant that he was later lauded as the “father of G.I. physiology."

Though St. Martin arguably made the biggest contribution in the partnership, he was not as well-regarded. Prone to excessive drinking, he complained frequently of the discomfort created by the fistula, took demeaning public appearances for money, and was coolly referred to as “old fistulous Alex” by Beaumont.

In 1853, the doctor died after taking a bad fall on ice. Despite his chronic ailment, St. Martin outlived him by 27 years, succumbing to old age in 1880. He had endured roughly 238 of Beaumont's experiments. One of their last meals together was on October 26, 1833, when St. Martin enjoyed fricasseed breast of chicken, liver, gizzard, boiled salmon, boiled potato, and wheat bread. All of it was pre-chewed and stuffed into tea bags. St. Martin's stomach did the rest.

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George Orwell's 11 Tips for Proper Tea Making
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Public Domain // Mendhak // CC Attribution-Share Alike 2.0 Generic (Wikimedia Commons)

More than 70 years ago, in the January 12, 1946, edition of the Evening Standard, George Orwell wrote up 11 tips for making and consuming tea. Published under the title "A Nice Cup of Tea," Orwell noted that "at least four [points] are acutely controversial." That's a bold claim!

So what does it take to make an Orwellian cup of tea? Read on.


If you look up 'tea' in the first cookery book that comes to hand you will probably find that it is unmentioned; or at most you will find a few lines of sketchy instructions which give no ruling on several of the most important points.
This is curious, not only because tea is one of the main stays of civilization in this country, as well as in Eire, Australia and New Zealand, but because the best manner of making it is the subject of violent disputes.

When I look through my own recipe for the perfect cup of tea, I find no fewer than eleven outstanding points. On perhaps two of them there would be pretty general agreement, but at least four others are acutely controversial. Here are my own eleven rules, every one of which I regard as golden:


First of all, one should use Indian or Ceylonese tea. China tea has virtues which are not to be despised nowadays—it is economical, and one can drink it without milk—but there is not much stimulation in it. One does not feel wiser, braver or more optimistic after drinking it. Anyone who has used that comforting phrase 'a nice cup of tea' invariably means Indian tea.


Secondly, tea should be made in small quantities—that is, in a teapot. Tea out of an urn is always tasteless, while army tea, made in a cauldron, tastes of grease and whitewash. The teapot should be made of china or earthenware. Silver or Britanniaware teapots produce inferior tea and enamel pots are worse; though curiously enough a pewter teapot (a rarity nowadays) is not so bad.


Thirdly, the pot should be warmed beforehand. This is better done by placing it on the hob than by the usual method of swilling it out with hot water.

(Ed. note: a hob is a stove burner in this context. Depends a bit on what sort of pot you're using whether it's safe to put in on the burner!)


Fourthly, the tea should be strong. For a pot holding a quart, if you are going to fill it nearly to the brim, six heaped teaspoons would be about right. In a time of rationing, this is not an idea that can be realized on every day of the week, but I maintain that one strong cup of tea is better than twenty weak ones. All true tea lovers not only like their tea strong, but like it a little stronger with each year that passes—a fact which is recognized in the extra ration issued to old-age pensioners.


Fifthly, the tea should be put straight into the pot. No strainers, muslin bags or other devices to imprison the tea. In some countries teapots are fitted with little dangling baskets under the spout to catch the stray leaves, which are supposed to be harmful. Actually one can swallow tea-leaves in considerable quantities without ill effect, and if the tea is not loose in the pot it never infuses properly.


Sixthly, one should take the teapot to the kettle and not the other way about. The water should be actually boiling at the moment of impact, which means that one should keep it on the flame while one pours. Some people add that one should only use water that has been freshly brought to the boil, but I have never noticed that it makes any difference.


Seventhly, after making the tea, one should stir it, or better, give the pot a good shake, afterwards allowing the leaves to settle.


Eighthly, one should drink out of a good breakfast cup—that is, the cylindrical type of cup, not the flat, shallow type. The breakfast cup holds more, and with the other kind one's tea is always half cold before one has well started on it.


Ninthly, one should pour the cream off the milk before using it for tea. Milk that is too creamy always gives tea a sickly taste.


Tenthly, one should pour tea into the cup first. This is one of the most controversial points of all; indeed in every family in Britain there are probably two schools of thought on the subject. The milk-first school can bring forward some fairly strong arguments, but I maintain that my own argument is unanswerable. This is that, by putting the tea in first and stirring as one pours, one can exactly regulate the amount of milk whereas one is liable to put in too much milk if one does it the other way round.


Lastly, tea—unless one is drinking it in the Russian style—should be drunk without sugar. I know very well that I am in a minority here. But still, how can you call yourself a true tea lover if you destroy the flavour of your tea by putting sugar in it? It would be equally reasonable to put in pepper or salt. Tea is meant to be bitter, just as beer is meant to be bitter. If you sweeten it, you are no longer tasting the tea, you are merely tasting the sugar; you could make a very similar drink by dissolving sugar in plain hot water.

Some people would answer that they don't like tea in itself, that they only drink it in order to be warmed and stimulated, and they need sugar to take the taste away. To those misguided people I would say: Try drinking tea without sugar for, say, a fortnight and it is very unlikely that you will ever want to ruin your tea by sweetening it again.

Orwell concludes:

These are not the only controversial points to arise in connexion with tea drinking, but they are sufficient to show how subtilized the whole business has become. There is also the mysterious social etiquette surrounding the teapot (why is it considered vulgar to drink out of your saucer, for instance?) and much might be written about the subsidiary uses of tealeaves, such as telling fortunes, predicting the arrival of visitors, feeding rabbits, healing burns and sweeping the carpet. It is worth paying attention to such details as warming the pot and using water that is really boiling, so as to make quite sure of wringing out of one's ration the twenty good, strong cups of that two ounces, properly handled, ought to represent.

Let the arguing commence, tea lovers!

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