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Exclusive Excerpt from the Book ‘Open Wound’

A shotgun misfires inside the American Fur Company store in Northern Michigan, and Alexis St. Martin’s death appears imminent. It’s 1822, and, as the leaders of Mackinac Island examine St. Martin’s shot-riddled torso, they decide not to incur a single expense on behalf of the indentured fur trapper. They even go so far as to dismiss the attention of U.S. Army Assistant Surgeon William Beaumont, the frontier fort’s only doctor.

Dr. Jason Karlawish, author of 'Open Wound'

But in the name of charity and goodness, Beaumont ignores the orders and saves the young man’s life. What neither the doctor nor his patient understands—yet—is that even as Beaumont’s care of St. Martin continues for decades, the motives and merits of his attention are far from clear. In fact, for what he does to his patient, Beaumont will eventually stand trial and be judged.

Rooted deeply in historic fact, Dr. Jason Karlawish’s marvelous new book traces the peculiar career of 19th century clinician-turned-scientist Dr. William Beaumont, who became a scientific one-hit-wonder by exploiting the body of the man who’s life he saved.

Open Wound artfully fictionalizes the complex, lifelong relationship between Beaumont and his illiterate French Canadian patient. The young trapper’s injury never completely heals, leaving a hole into his stomach that the curious doctor uses as a window to understand the mysteries of digestion. Eager to rise up from his humble origins and self-conscious that his medical training occurred as an apprentice to a rural physician rather than at an elite university, Beaumont seizes the opportunity to experiment upon his patient’s stomach in order to write a book that he hopes will establish his legitimacy and secure his prosperity.

As Abigail Zuger writes in her review of the book in Tuesday’s New York Times:

Over the next few decades, the two danced around each other in an extraordinary display of mutual dependence, hostility, loyalty, guilt, gratitude and greed. Who owed whom, and how much? Where did the moral right lie? With the doctor, who had saved St. Martin’s life, supported him financially for years, and aimed to benefit all of humanity with his investigations? Or with St. Martin, a hopeless alcoholic but still a free man with the right to walk away, as he repeatedly did?

Ultimately, in perhaps the only such document to link doctor and patient until today’s informed consents for research subjects, a legal contract was drawn up between them, the patient promising to “serve, abide and continue,” and the doctor promising reasonable compensation. It worked, for a little while.

Dr. Karlawish, a physician and medical ethicist at the University of Pennsylvania, is well attuned to the overtones of his compelling story, from the graphic examples of the principles of autonomy and beneficence to the clear parallels between the rough American frontier and the primitive state of medical research. His Beaumont is a true tragic hero, an unpedigreed nobody determined to succeed on his own merits, yet undermined by exactly that determination.

Beaumont, always growing hungrier for more wealth and more prestige, personifies the best and worst aspects of American ambition and power.

The excerpt below takes place at the moment when Dr. Beaumont, a dedicated clinician, first recognizes the value of his patient’s wound to medical science and also to his career. On this day, Doctor Beaumont would begin his transformation from doctor to researcher, to employer, to entrepreneur, while Alexis would suffer his parallel transformation from patient, to subject, to employee, to object.

Excerpt from Open Wound: The Tragic Obsession of Dr. William Beaumont

Part I – The Taker Made Mad

By early October, three months after the shooting, summer was fast vanishing. Days were shorter but the light brighter, as if the sun were burning more intensely in a futile gesture to stall the onset of winter. The agents from the American Fur Company, and the American soldiers and their officers prepared Mackinac Island for the interminable months of frozen isolation. The brigades of voyageurs and Indians dismantled their tent and lean-to village along the lake shore and embarked in their bateaux and canoes and paddled north to Canada or south to the Michigan Territory to take shelter in the pine and hardwood forests of the mainland. The white children returned to school.

Alexis’ days had settled into a routine which began when Beaumont stepped into the infirmary of the ramshackle hospital carrying his basket of medical supplies.

“Good morning Alexis.”

He smiled as he watched Alexis yawn and rub the mount of his palms against his eyes.

“Good evening mon Doctor Beaumont.” Alexis laughed. “Good morning. Morning.” His accented English ran hard on the d’s, swallowed the r’s.

Still sore from his wound, Alexis lay flat upon his back, gathered his nightshirt under his armpits, then folded over the thin blanket to reveal his abdomen swaddled with the bandages Beaumont had applied the previous evening. Beaumont took care to wrap the bandages tightly around Alexis’ torso from his breasts to his navel. To keep them in place, he passed a final wrapping like a Sam Browne belt, across his right shoulder. The bandages themselves revealed the progress of the wound’s healing. It had been at least four weeks since the outer layer showed the ruddy stain of discharge.

As usual, Alexis gazed straight up at the ceiling, waiting patiently, blinking. “Madame Beaumont, she is well?”

“She’s well. Quite well.”

Alexis nodded and smiled. “Little Sarah?”

“Very well, thank you. They wish you well too. Now please Alexis, if you could just lie still as usual.”

Beside Alexis’ cot Beaumont placed the simple brown wicker basket that held bandage rolls, his surgeon’s pocket kit and a bottle of diluted muriatic acid he had gathered from the supply room. He sat on the edge of the bed, just inches from Alexis. The bed frame creaked as it always did.

Beaumont took his surgeon’s kit from the basket, unrolled it on the mattress, took up his jack knife and set to work methodically cutting away the dressings. Someone whistled as he passed close to Alexis’ window, and Beaumont hummed a few bars of that tune. He found himself tapping his foot to the timing of the blacksmith’s hammer.

He folded away the sliced bandages to reveal a wad of carefully packed bandages the size of a tea saucer. The skin around the wound was still inflamed but no longer grossly purple. It blanched under the gentle press of Beaumont’s thumb. He had not bled Alexis in over eight weeks.

He began to peel away the lint packing and with that packing now removed, the pink ruggated puckering of the inner lining of stomach bloomed through the wound like some large rose. Alexis coughed and the bloom expanded, glistening and covered with a limpid fluid, uniformly spreading over its whole surface and trickling to the edges of the wound. Beaumont gazed upon this display for some moments, then he applied three fingers of gentle pressure to the center of the bloom and it slowly depressed into the blackness of the space that was Alexis’ stomach. An amazing sight each time he witnessed it.

Beaumont folded a clean lint bandage into a square, soaked this with muriatic acid and began to wipe the edges of the wound and the track where once Alexis had a fifth rib. In time, Beaumont thought, all in time, this wound will close and I will have a case worthy of the Medical Recorder.

Alexis coughed again. A bit of meat, chewed, but unmistakably meat, popped out from the aperture and onto the bandages and a slow trickle of gastric juice flowed out from the lower margin of the wound.

Beaumont picked up the meat and inspected it. He had instructed Alexis to keep an empty stomach to prevent just such soiling of the wound during morning dressing changes. Now he held in his hand the evidence that Alexis had stolen a meal some time in the early morning hours. He was disobedient to be sure, yet this clandestine meal also was another sign of his slow, but now certain recovery.

Alexis laughed and muttered in French. Beaumont had seen food in just this state before. There was nothing unique about this morning and this piece of meat.

As he held the partly digested bit of meat between his thumb and forefinger and gazed at the wound, two facts came together for him. He felt as he did that morning some ten years past when he first stepped into his assigned hospital tent at the camp in Plattsburgh. Or when taking calls as apprentice to Dr. Chandler. It was the same sense in his guts and rush of blood to his head as when he was a boy jumping from the barn’s rafters into the hay pile.

For weeks he had observed that the hole into Alexis’ stomach gave off no odor or other evidence of putrefaction. Perhaps the cavity did not work as he had been taught, like a barrel to churn and ferment food, but in some other and, it seemed, more elegant manner. The action of the muriatic acid with which he painted the wound to cleanse it and stimulate healing was the same as the action of the stomach upon this piece of salt pork. The action was like a solvent upon the flesh, a solvent that affected a steady dissolution of the tissues. The stomach was perhaps not as he and so many of his colleagues had thought it to be some grinding bag or fermenting vat. It was some manner of chemistry, like an alchemist’s trick that made flesh disappear.

On this morning, an idea kindled not reason’s ordered plans, but desire laid to make the taker mad.

Alexis was his patient, of course, but he could be something else too. Beaumont could not conjure that proper word but whatever the word, on this morning he realized that this man, this wound, was his window to discovery.

Wondrous discoveries. Discoveries of the secrets of digestion and diet that would rival the work of the famous Parisian physicians. There wasn’t another proper doctor within hundreds of miles, a situation not only conducive to a steady and good income but now there was also the discovery of this treasure. It was his and it was simply waiting to be explored and written into a book. It was like the vast western lands that President Jefferson purchased and Captains Lewis and Clark charted and from which the American Fur Company extracted profits. The unknown was waiting to be known, and once known, rewards would follow. Promotion to Surgeon secured, election to medical societies. He would erase the humility of his medical training as an apprentice and the condescension of the medical college graduates. His reputation would be solid and preserved for posthumous time.

He shook his head like a drinker who’d swallowed more than his fill.

I am a doctor, not a scientist, he thought. This was work he had no sense of how to do, where to begin or how to finish before the wound fully healed and sealed its secrets. How would he convince Deborah of the worth of this sacrifice of time and their family’s money? And if it was ever done, whatever it really was, he had no idea how to sell it. The idea was swallowed bait, a folly even.

“God-damn,” he muttered.

Alexis grew concerned.

“What is it? Is there problem? A type of what you call, what you call, pains. Oui?” His smile had vanished.

Beaumont tried to calm his patient. He began to quickly wrap the bandages into a wad.

“Nothing’s wrong, Alexis. Nothing at all. You’re doing well. Truly, yes, all is well.” He reached out and embraced Alexis. He smiled as best he could. “You’re the very model of recovery.”

Alexis wrinkled his brow, then relaxed and returned his doctor’s smile like a moon reflecting the light of its sun but ignorant of the nature of fire that kindled that illuminating light. He spoke in unusually clear English.

“No, my Doctor Beaumont, I am your miracle.”

To learn more, visit www.press.umich.edu/titleDetailDesc.do?id=3849699 and www.jasonkarlawish.com.

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