Open Wound is a novel crafted from the extensive documents of an unsettling, little-known, yet remarkable episode in the history of medicine.

In the summer of 1822, Dr. William Beaumont was practicing medicine at a rugged military outpost on Mackinac Island in Lake Huron, part of the Michigan territory.  His assignment as Assistant Surgeon, US Army represented about the best circumstances he could expect from his training as a medical apprentice without a university education.  In addition to soldiers and officers, Beaumont sometimes attended patients from the American Fur Company, whose warehouses shared the island's harbor.  On June 6, an accidentally discharged gunshot cratered the abdomen of an indentured, French-speaking Canadian trapper.  Fortunately for him, Beaumont served during the War of 1812 and knew how to care for devastating wounds.   With the surgeon's medical attention and willingness to house and feed the hapless trapper, Alexis St. Martin's body unexpectedly survived the assault.  But his wound didn't fully heal.  As a result, it left an opening in his flesh and ribs that allowed access to his damaged stomach.  Through the fistula, Beaumont dangled bits of food, collected "gastric liquor," and made unprecedented observations about the process of digestion.  

His clever and meticulously documented experiments, conducted on the captive St. Martin over several years, corrected prevailing assumptions about digestion.  Once thought to depend on grinding and putrification, normal digestion, Beaumont observed, was a healthy chemical process.  Any signs of putrification or fermentation indicated pathology.  In 1833 Beaumont published his thesis on the chemistry of digestion in Experiments and Observations of the Gastric Juice and the Physiology of Digestion.  Shortly before completing the book, he received a temporary leave from his military service to restart his research in Washington.  But to carry on his project, Beaumont had to persuade St. Martin-who entered and exited his physician-researcher's life several times before-to leave his growing family in Canada and once again become a research subject.  St. Martin does return, with pay, and briefly accepts his role.  But he also confronts Beaumont about whether the long confinement on Mackinac Island was more necessary for the patient's survival or the doctor's research agenda.  Or for the doctor's subsequently improved station in life. 

Although some of Beaumont's academically trained colleagues found fault with his methodologies, the farmer's son and frontier doctor did achieve a gratifying level of professional accomplishment and wealth.  To enjoy them, he had to set aside humiliations he experienced along the way, accept his lot after military service as an ordinary practitioner in St. Louis,  and weather an unforeseen turn near the end of life.    


Author Jason Karlawish, Professor of Medicine and Medical Ethics at the University of Pennsylvania, is in an excellent position to understand and write about William Beaumont's research and contribution to medical knowledge.  Fascinating as that is, Open Wound takes a greater interest in the human relationships, motivations, cultural circumstance, and ethical complications that fold into the doctor's story: novelistic concerns.  As a result, those who appreciate well researched and written historical novels and those who want to learn informally and imaginatively about the history of medicine can appreciate Karlawish's attention to recreating the past.      

More significantly, the fictional account engages the ethical imagination, leaving readers to reflect on what to make of Beaumont, St. Martin, and the culture of medicine they operated in.  Yes, the doctor gave his patient life-saving care and provided charity, even paying the balance owed on his indenture.  But Beaumont benefited professionally and personally from opportunistically turning St. Martin into a research subject, one who was not invested in furthering knowledge about the science of digestion.  Yes, the doctor made an important contribution to medical knowledge, but by subjugating an uneducated and poor patient.  Do we read Beaumont's robust ambition and assiduous dedication to a goal as admirable personal and American cultural values? Or do we see them as aberrations of the human spirit when success depends on taking advantage of the vulnerable?  Does Beaumont's rise from humble origins make him sympathetic?  And what do we make of St. Martin?  Do patients, especially unique ones, have a duty to participate in a project that will serve humankind?  Does St. Martin make an admirable sacrifice or was he exploited?  What do we make of a medical system that enlists the  poor and vulnerable to benefit others, including physicians and medical researchers?   These questions continue to resonate. 


At the end of Open Wound, Jason Karlawish lists his primary and secondary sources and identifies the key changes he made to Beaumont's biography and the larger American history represented in the narrative.  He also notes the existence of a facsimile of Beaumont's book (New York: Dover Publications, 1996) for readers wishing to pursue his medical contributions.  Readers wishing to learn more detail about Beaumont's science will, of course, need to read beyond the novel.   


University of Michigan Press

Place Published

Ann Arbor



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