Science at the bedside: the footprints of Yale and Johns Hopkins.

William Osler in an address before the St. Louis Medical Society on October 4, 1902, entitled "William Beaumont-A Pioneer American Physiologist" beckoned his audience to: Come with me on a lovely June day in 1822, to what were then far-off northern wilds, to the Island of Michilimacinac, where the waters of Lake Michigan and Lake Huron unite and where stands Fort Mackinac, rich in the memories of Indian and voyageur. The fort was occupied by United States troops, .... and the place had become a rendezvous for Indians and voya-geurs in the employ of the American Fur Company. Suddenly from the company's store there is a loud report of a gun, and there is a hurrying of messengers to the barracks for a doctor. In a few minutes an alert-looking man in the uniform of U.S. Army surgeon made his way through the crowd and was at the side of a young French Canadian (Alexis St. Martin) who had been wounded by the discharge of a gun. Though youthful in appearance, Surgeon Beaumont had seen much service, and at the capture of York he had shown a coolness and bravery under fire which had won high praise from his superior officers. The man and the opportunity had met. St. Martin, of course, developed a gastric fistula. In May 1825 Beaumont began experiments on the juice issuing from St. Martin's fistula which were continued with several lengthy interruptions for eight years. In these studies, which were published in 1833, Beaumont made many important physiological observations. He discussed the length of time it takes various foods to digest in the stomach, noting that animal foods are digested more easily than vegetable and that oily substances retard digestion and delay the passage of foodstuffs from the stomach; he gave the first accurate description of the gastricjuice, and determined that mental disturbances have a profound influence on the secretion of gastric juice and digestion. But Beaumont was more than a pioneer physiologist. He carried out the first important clinical investigation done in America. The evolution of clinical science in the United States, the development of the clinical scientist and his important role in the creation of medicine's scientific base seem an 569