The Long Stillwater

Robert Morris surgery at Bellevue Hospital, NY
Robert Morris operating at Bellevue Hospital, NY, c. 1895

The Long Stillwater is a chapter Robert Morris, M.D. wrote to celebrate a love of nature from a trove of memories. Stillwater is hardly a dictionary word, but it made sense yesterday as I floated on a mirror-perfect patch of still water on the inside bend of Powhatan Creek. A few yards away, tidal water surged upstream to revisit saltmarshes to a terminus in a swamp of bald cypresses. Morris wrote:

When a man retires from the swift rapids of an active professional life he arrives at a long stillwater, but the banks of that stillwater are so alive that his days continue to be brimful. Unlike Gibbon who felt desolate after completing his history, the doctor goes on, for medicine has been collateral to many other interests which were always in the clover field just over the fence. I look forward with almost boyish eagerness to new work and playtime to re-read the old classics and to enjoy choice literature, and time to live in the out-of-doors. I shall stalk the moose and bear, not with a gun but a camera. Now I can go when the Red Gods call.

He must go ― go ― go away from here!
On the other side the world he’s overdue.
‘Send your road is clear before you when the old Spring-fret comes o’er you,
And the Red Gods call for you!

Several years ago, I left a determined bass of violent nature and fancy greenish luster under a crawfish bank in the swift-running waters of the upper Mississippi. I know just where he is this very minute, and I can now go back to him and cast a black raven fly into that white foamy eddy. When corn is in the shock and autumn leaves are falling, Lou Smith and I shall climb over the frosty top rail of a shaky old fence just before sunrise to hear a woodcock go twittering up through the alders. I know an inlet for safe anchorage by the sea where halyards will slap against the mast and the boom will bump, bump, bump while surf is roaring and growling on the outer bar and brant geese go filing overhead.

The saddle will creak monotonously on my broncho as I plod hour after hour through scattered mesquite and cacti in the overpowering, awe-inspiring silence of the desert. Once more, I may enjoy the fragrance of sage brush after a rain and see the ocotillos in bloom with no more hurry than that of a Navajo Indian when he feels like resting. For companionship in the desert, I shall choose a friend for whom hardship is nothing but a diversion.

Then back perhaps to Eastern Canada, where all is green when it is not blanketed with snow. From somewhere among the tangled viburnums and blue Clintonia berries two white-throated sparrows will sing to me and my companion in clear tones in clean air. The wind will be moving in the forest, and gold flakes of sunlight will filter through the birches to the mossy logs. A hermit thrush will send tones of spiritual ecstasy ringing through the silence, modulating from minor key to major key and back again, while evening lights fall slanting through the somber tops of pointed spruces. And neither my companion nor I shall speak, for we have learned that “music begins where words end.” And when the grandest of all music, that of storm, is approaching, I shall go forth to meet it, high up among the crags and peaks.

How I love a storm! The wind slowly dies, and an ominous quiet settles down over motionless gray lichens. From out of the west, bold rolling heads of cumulus come marching with martial front into the afternoon’s clear blue heaven; volume crowding volume, on they come! The sky darkens and blackens. In massive majestic motion, the heavy clouds sink lower than the crags. Darkness is everywhere. My fingertips tingle with electricity for a moment. Suddenly, there is a brilliant flash of startling light; then a devastating crash makes the solid rock quiver under my feet. Reverberations go bounding along in diapason from canyon to canyon—grand organ pipes of nature. Thundering echoes roll on in deepest bass. On to distance, distance, distance—lost! A momentary hush of ponderous quiet, as the affrighted air stands still before the next, the impending crash.

Jove’s message is delivered and his heralds rapidly disband into vast loose volumes of nimbus, shot through and through with long shafts of crimson and titanic fan rays of deeper red. Bright sunshine lights the evening sky once more and high peaks glow, but soon long shadows creep down to darkening vales for night and deeper dark. ‘Tis then I am the mountaineer, and yet at times, when all is still, I seem to hear loud surf—but that is only memory for one who loves the sea.

Extracted from A Surgeon’s Story. The Autobiography of Robert T. Morris. Compiled and edited by Roger Gosden and Morrris’s granddaughter, Pam Walker (2013)

Robert T. Morris

Trust your Microbiome (Gut)

The gut feelings of psychic “scatomancers” who studiously examined the color, shape, and buoyancy of poo to forecast well-being and life prospects were more reliable than palm-reading, tarot cards, and astrology. They had “data,” and now we have the microbiome.

Who would have guessed a few years ago that traffic passing through the colon destined for elimination could be dignified with the name “organ,” or fecal transplants become a state-of-the-art medical therapy, or a national stool bank opened at M.I.T.?

The fermentation services of gut microbes were taken for granted, like their brethren in the garden compost heap. But no more!  The microbiome has a larger role in health than the digestion of food, and might even fill mysterious voids in human psychology and behavior. Since it is now being mined by researchers funded by the NIH Human Microbiome Program, the US military, European governments, and Big Pharma, the microscopic living soul of poo is no longer derided as an odious subject. The W.C. has swung open for scientific limelight to shine inside.

Friends or foes?
Friends or foes?

The first rays were focused on gut microbes by Elie (Ilya) Metchnikoff who introduced the concept of probiotics over a century ago. He studied people in the Caucasus Mountains reputed to live longer than anywhere else (their claims now repudiated), attributing their luck to fermented yogurt for conquering the putrefying bacteria supposed to release poisons into the body. He thought an unhealthy diet promoted growth of malign microbes with pro-inflammatory (pro-aging) effects that could lead to cardiovascular and other diseases which curb our years. Yogurt was proclaimed an elixir of life.

But his radical idea wasn’t sustained until modern bacteriology and genomics revealed the microbiome world and endorsed therapeutic probiotics. A recent study found that probiotics extended longevity in mice, but more surely they restore and rebalance the gut’s microbiome after antibiotic treatment and various intestinal ailments. It is easy to imagine that patients will soon take capsules packed with beneficial bugs for Crohn’s disease and irritable bowel, although cartoonists may rue the day when this more discreet treatment replaces fecal transplants for C. diff. infections.

Wilder speculations about the impact of microbes in mental health and ability were made by one of Metchnikoff’s contemporaries. Robert T. Morris who helped to bring aseptic surgery to America, wrote in Microbes and Men (1915): “A man is only what his microbes make him … freedom of the will is subject to dictation by the microbe.” He dared to suggest that microbes affect human character, psychopathy, and even genius. Sounds exaggerated?

He was not the first to notice that some of the most creative people had poor health—Nietzsche, Schopenhauer, and you name the rest. We might imagine a melancholic George Orwell inspired to write stories during his last tuberculous years, but is it really plausible that microbes themselves or their products boost the highest and the meanest achievements of the human mind? Morris’s big idea was nebulous, but at least a nice contradiction of Hereditary Genius (1869, 1892) by Francis Galton, the man leading the charge to eugenics who thought that genius and psychopathy ran in families. Since they occur rather sporadically, it is not quite so ridiculous to wonder if microbes play a role, or at least in combination with certain genetic alleles. Besides, we know the rabies virus affects behavior– rage, fear, and hydrophobia—and cumulating evidence suggests that Lyme disease and infectious mononucleosis cause chronic fatigue and other neurological symptoms.

So why not the microbiome too, which consists mostly of bacteria that vastly outnumber cells in the body? A gathering breeze of data supports the idea.

Tiny viruses slip easily through the blood-brain barrier, but bacteria can assault the fortress indirectly via fatty acid metabolites or triggering inflammation and powerful cytokine molecules from the immune system. The data are still far from sure, but animal experiments and association studies offer tantalizing clues that the microbiome affects the brain.

Germ-free mice have subtle neuroanatomical differences compared to normal animals—less serotonin (linked with depression in humans) and myelination (affecting nerve conduction), and altered transmission at synapses. More compellingly, gut microbes transplanted from one strain of mouse to another change the behavior of the recipient to mirror the donor’s.

Human populations are much harder to study but, for example, when Walkerton was flooded in 2000 the Canadian town’s water supply was contaminated with E. coli and Campylobacter many of its residents developed irritable bowel syndrome, anxiety, and depression. The question remains—were their symptoms “purely psychological” (a non sequitur?), or were they caused by inflammation from the original infection? Persistent, low-grade effects are hard to expose, as we know from the controversy over “chronic Lyme disease,” although science will eventually get to the bottom of it.

The neuroscience community with its refined sensibilities isn’t accustomed to musing about stool stories, but we hear murmurs about a relationship between the microbiome and autism, anxiety, Alzheimer’s disease, and schizophrenia.  The prospect of research grants is bending ears.

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Last Flight of the Dough Bird (Eskimo curlew)

Everyone knows the most abundant bird in North America was driven to extinction a century ago by market hunting and habitat destruction. The very last passenger pigeon, called Martha, died in Cincinnati Zoo in 1914. But few people know the story of the Eskimo curlew that suffered the same fate.

This was a shore and wetland species that bred in the Canadian tundra but wintered in South America. Vast flocks headed south to escape the Arctic chill, but stopped to refuel on crowberries in the peat bogs of the Maritime Provinces, and stop again in the southern U.S. before the final wing home.

They were easy targets for hunters, and very profitable. A reporter noted 2,000 birds hanging at the Hudson’s Bay Company in Labrador that had been shot the same day in the late 19th Century. They were so plump from overfeeding for the journey that when a victim fell from the air it sometimes split open showing the white fat that gave their name, “dough bird.” Their meat was a delicacy served in eastern cities and even as far away as London after shipment in barrels and cans. But they had become rare by the end of the century, and the last one was sighted in 1963.

Dough bird
Eskimo curlew by John James Audubon

Over-hunting before the Migratory Bird Treaty Act of 1918 put the species into an irreversible tail-spin towards extinction, and ruined hunting income. Local people missed the wheeling and calling of flocks that visited them seasonally. And Robert Morris, a surgeon-naturalist from New York, celebrated a memory of them in prose and poetry from his exploring days in the wilds of eastern Canada.

“One day in August when standing on a bold crag in the mountains of Labrador, I listened to the lilt of marlins (Eskimo curlews) almost out of sight in the clear blue sky and leaving that day for Argentina on a non-stop flight. A whale was playing in the distant sunlit heaving sea that sent but a passing puff of its thunder up to the heights where I stood. The heavy rumble of a sundering iceberg moving in colorful majesty and flashing dignity down its lane of deep ocean current could not drown out the exultant note in voices of carefree birds that were bound for somewhere of joyful memory for them. The thought was so overwhelming that I sat down on the soft white caribou moss and began to pencil in my notebook some lines that were later published in Surgeon’s Philosophy. I had to stand up to finish the note feeling reverence for a scene that made sitting down in its presence a profanation. In an atmosphere so clear that one could look straight up to infinity the birds rose high before heading south. They became mere specks in the sky and were then lost to view while their voices still came faintly back. The measure of the lines corresponds to that of the wing-beat of the birds otherwise I could not have remained in tune with nature.

RTM poem

When men’s hands point toward him, they’re lifted up toward Heaven. On the homeward bound steamer from the North that year a group of travelers in the cabin asked me to read extracts from my notebook, but these lines to the marlin seemed to have been “written for myself only.” No one referred to them in the subsequent conversation that evening, but there were plenty of questions about wolves and bears. In the audience there had been a rough old seasoned captain who sailed the seven seas on roving commission. He had recently lost his ship in the ice and was getting himself and survivors of his crew back to a port. Next morning he stopped me as we were passing on the deck, and said, “Them words that you read about the dough-birds (marlins) last night was about right. I wish you would let me see that log of yours again if you don’t mind.” He had doubtless put many a cask of stewed dough-birds in his larder aboard ship, and I was astonished at any sentimental interest in the big gentle birds as it came from that old salt.

Perhaps I was one of the last men to witness a flight of the marlins that were so delicious for the table. Subjected to murderous massacre at both ends of their flight and on the spring return journey by way of the Mississippi Valley they melted away like the passenger pigeon, and only a little later on.” (Extracted from A Surgeon’s Story by Roger Gosden and Pam Walker).

Bryan Watts, an ornithologist at the College of William and Mary, has recently written a beautiful and impassioned vignette about the dough birds. It illustrates how quickly we can shrink biodiversity and rob ourselves of natural wonder.

“The extinction of the dough birds was driven by the tragedy of the commons, a force that stretches back before human civilization itself and that is still alive and well today. The market hunters that encountered the birds in different places throughout their annual cycle were more concerned about their own profits and enjoyment than they were about the future of the birds or about the other hunters along the Great Circle.  We may legislate hunting regulations, but what about the destruction of critical habitat, the consumption of coastal resource or human-caused climate change?  Until we are all able to rise above our own self-centered concerns to see a future beyond our own and recognize that cooperation is not merely a kind gesture but an imperative for the future, no species is secure, not even our own.”

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