Robert Tuttle Morris
Encyclopedia
Robert Tuttle Morris, also known as Bob Morris (May 14, 1857, Seymour
Seymour, Connecticut
Seymour is a town located in western New Haven County, Connecticut, United States. The town was named for Governor Thomas H. Seymour. The population was 15,454 at the 2000 census.-Geography:...

, Connecticut
Connecticut
Connecticut is a state in the New England region of the northeastern United States. It is bordered by Rhode Island to the east, Massachusetts to the north, and the state of New York to the west and the south .Connecticut is named for the Connecticut River, the major U.S. river that approximately...

- January 10, 1945, Stamford) was an American
United States
The United States of America is a federal constitutional republic comprising fifty states and a federal district...

 surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 and writer. He married Aimee Reynand Mazergue on June 4, 1898.

Early life and the call of medicine

Robert Tuttle Morris was the eldest of six children. His father was a lawyer, probate judge and Governor of Connecticut, and his mother Eugenia was an author. He went to school at Hopkins Grammar School in New Haven before studying biology at Cornell University
Cornell University
Cornell University is an Ivy League university located in Ithaca, New York, United States. It is a private land-grant university, receiving annual funding from the State of New York for certain educational missions...

 in Ithaca from 1875-1879.
Since he was a child, he had developed an acute interest in nature and animals, learning how to observe a phenomenon. While at high school in New Heaven he planned to go on to the college course in biology organised by Dr. Burt G. Wilder at Cornell. This one was the first pre-medical course of the country.

He started then to consider to go into medicine, but still he had some difficulties making up his mind, when one day an incident occurred and helped him to make the right decision: one day a boy in the town happen to be bitten by a dog, probably mad. He was dying of hydrophobia
Hydrophobia
Hydrophobia or hydrophobe may refer to:* Rabies, especially a set of symptoms of the later stages of an infection, in which the victim has difficulty swallowing, shows panic when presented with liquids to drink, and cannot quench his or her thirst....

. So he went there to see the boy with Dr.P. C. Gilbert, who was in charge for this case. Thanks to his fine observation skills, he was able to give some help, noticing that the little boy could have been just affected of hysteria
Hysteria
Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...

 instead of rabies
Rabies
Rabies is a viral disease that causes acute encephalitis in warm-blooded animals. It is zoonotic , most commonly by a bite from an infected animal. For a human, rabies is almost invariably fatal if post-exposure prophylaxis is not administered prior to the onset of severe symptoms...

 (which was the most accredited hypothesis). And his statement happened to result correct. By the practice of hypnosis
Hypnosis
Hypnosis is "a trance state characterized by extreme suggestibility, relaxation and heightened imagination."It is a mental state or imaginative role-enactment . It is usually induced by a procedure known as a hypnotic induction, which is commonly composed of a long series of preliminary...

 he eventually cured the boy. This incredible experience produced a profound impression on him, and convinced the young Robert to continue his studies in order to become a doctor.

Pursuing studies and travelling

In 1879 he worked as assistant with Dr. F. J. and F. H. Whittemore. After that in 1880 he got into the College of Physicians and Surgeons of New York
Columbia University College of Physicians and Surgeons
Columbia University College of Physicians and Surgeons, often known as P&S, is a graduate school of Columbia University that is located on the health sciences campus in the Washington Heights neighborhood of Manhattan...

 and then graduated in 1882.

Then he went up for examination for position on the Bellevue Hospital staff and he eventually got into the Fourth Surgical Division, so he spent a two-year internship there. At that time the Bellevue Hospital was the largest general hospital in the country.

After his internship he studied in various surgical European clinics.
While visiting Europe, he met Lister
Joseph Lister, 1st Baron Lister
Joseph Lister, 1st Baron Lister OM, FRS, PC , known as Sir Joseph Lister, Bt., between 1883 and 1897, was a British surgeon and a pioneer of antiseptic surgery, who promoted the idea of sterile surgery while working at the Glasgow Royal Infirmary...

 in London in 1884, and was one of the first to introduce Lister's teachings about surgical hygiene in the United States. Watching Lister at work he noticed how strongly his method was rejected by his British confreres. Then he wrote a little brochure ″How We Treat Wounds Today″ and published it in 1886.

He also had been a delegate to the International Medical Congress in Copenhagen of 1887 and 1890 and he accomplished a visit to various European clinics.

Decision to specialize

In the end of the 1880s he had decided to make his work wholly surgical. Just around 1890 surgery started to be split up into its various specialties. Before that time, surgery was considered more like a general concept: in those days a surgeon would make everything concerning surgical operations.

The post-graduate Robert was then fascinated by surgical experimental work. His general practice had included nearly every type of service, and on the whole, his knowledge and results were fine. But in order to be a good doctor, it is important to develop skills and craftsmanship that only the experiences of specialization could give.

Genito-urinary work was extremely appealing to him, certainly because of his two skilled teachers Dr. Gouley and Dr. Fluhrer, but also the field of neurology
Neurology
Neurology is a medical specialty dealing with disorders of the nervous system. Specifically, it deals with the diagnosis and treatment of all categories of disease involving the central, peripheral, and autonomic nervous systems, including their coverings, blood vessels, and all effector tissue,...

 and psychiatry
Psychiatry
Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioural, cognitive and perceptual abnormalities...

 was particularly fascinating to him too, because of its speculative sides. So he ended up taking surgery as a specialty.

No one of the laity can realize how much time, pains, mistakes, imagination, mental distress, and money have gone into the making of an experienced surgeon.

The practice of surgery offered various cases that certainly increased Morris' skills, which will lead him to his greatest merits in different medical fields.

After internship

After internship he settled at first in Albany
Albany, New York
Albany is the capital city of the U.S. state of New York, the seat of Albany County, and the central city of New York's Capital District. Roughly north of New York City, Albany sits on the west bank of the Hudson River, about south of its confluence with the Mohawk River...

, then moved to New York
New York City
New York is the most populous city in the United States and the center of the New York Metropolitan Area, one of the most populous metropolitan areas in the world. New York exerts a significant impact upon global commerce, finance, media, art, fashion, research, technology, education, and...

 and began teaching at the New York Post-Graduate Medical School
New York University School of Medicine
The New York University School of Medicine is one of the graduate schools of New York University. Founded in 1841 as the University Medical College, the NYU School of Medicine is one of the foremost medical schools in the United States....

 in 1889. He was given a position as instructor in surgery. This led step by step to a full professorship. He became a professor
Professor
A professor is a scholarly teacher; the precise meaning of the term varies by country. Literally, professor derives from Latin as a "person who professes" being usually an expert in arts or sciences; a teacher of high rank...

 of surgery in 1898, a position he held until 1917.

In the beginning teaching made him uncomfortable because of his radical attitude on some subjects. His post-graduate teaching lasted for nearly thirty years until the time of retirement. He was asked to teach surgery at Ann Arbor and at the University of Virginia
University of Virginia
The University of Virginia is a public research university located in Charlottesville, Virginia, United States, founded by Thomas Jefferson...

, but he refused. His chief purpose in teaching was to stimulate his students to think.

Morris was a member of most of the national societies. He became a member of the American Association of Obstetricians and Gynecologists in 1890 and its President in 1907; in 1900 he was elected as a member of the Southern Surgical Association and then a senior fellow later on, in 1923. He was also President of the American Therapeutic Association in 1916.

In 1916 he accepted a position as a visiting surgeon to Broad Street Hospital in New York.
He decided to continue professional work until he had completed fifty years of unbroken activity.

Experimental work

In the course of his experimental work he had elaborated new techniques and methods, which happened to be useful, and later on adopted by other surgeons.
The drainage wick later called the B. M. drain (short for Bob Morris) was his own application of the principle of capillarity in the form of a small wick drain enclosed in a waterproof covering, applied in closing septic wounds. This is now best known as the cigarette drain.

He made some important experiments in cases of apoplexy
Apoplexy
Apoplexy is a medical term, which can be used to describe 'bleeding' in a stroke . Without further specification, it is rather outdated in use. Today it is used only for specific conditions, such as pituitary apoplexy and ovarian apoplexy. In common speech, it is used non-medically to mean a state...

, suggesting that if a drainage could be promptly established in some of these cases and in cases of sub-arachnoid hemorrhage, the following surgical operation would at time be useful. He also accomplished a number of experiments concerning the practical application of peroxide of hydrogen for the cleansing of wounds.

Morris had invented a sort of artificial synovial fluid
Synovial fluid
Synovial fluid is a viscous, non-Newtonian fluid found in the cavities of synovial joints. With its yolk-like consistency , the principal role of synovial fluid is to reduce friction between the articular cartilage of synovial joints during movement.-Overview:The inner membrane of synovial joints...

. Made out by a mixture of boroglyceride, glycerine and normal saline solution, it resulted to be antiseptic and hygroscopic, so that it had a tendency to draw serous fluids towards itself. The consequences of all of its specific characteristics were that when injected into a joint, this fluid resisted absorption longer that an oil could. And these properties were particularly useful in cases of painful joints (especially those one of knee and shoulder).

Furthermore he made some attempts at anastomosis
Anastomosis
An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....

 of blood vessels and a number of experiments to determine if trypsin, pancreatic acid and pepsin would liquefy, in situ, sloughs and coagula that were difficult to remove from cavities. And he actually found out that pepsin acted best and was able to turned blood clot into semi-fluid form. Moreover pepsin was useful since it would also remove dead bones (after been decalcified with hydrochloric acid), without showing any notable effects upon living bones.

Antisepsis enters

In his book Fifty Years; A Surgeon he gives a clear and complete description of hospital conditions at that time before the entrance of antisepsis in the world of surgery as a normal and necessary routine.
So then at some point the Bellevue had to make some changes, due to the fact that Lister theories about the antisepsis had been accepted in the world of medicine. In the Surgical Division an extremely rapid change in method took place, so that the antiseptic surgery had changed the whole appearance of wards in the hospital. Morris was one of the main supporter of the new method enounced by Lister, and later on, of the new theories about asepsis, introduced by Dr. Ernst von Bergmann
Ernst von Bergmann
Ernst von Bergmann was a Baltic German surgeon. He is the beginner of aseptic surgery.Born in Riga, Livonia , in 1860 he earned his doctorate at the University of Dorpat, and later returned to Dorpat in 1871, where he was a professor of surgery until 1878...

 in 1892.

Soon other discoveries in the field of Medicine made techniques to advance.
In 1884 Morris was a member of the audience in Berlin when Karl Koller
Karl Koller (ophthalmologist)
Karl Koller was an Austrian ophthalmologist who began his medical career as a surgeon at the Vienna General Hospital, and was a colleague of Sigmund Freud.Koller introduced cocaine as a local anaesthetic for eye surgery...

 gave his first public demonstration of cocaine as a local anesthetic in eye work. Later on in the United States this experimentation will see his leader in the figure of Dr. William Stewart Halsted
William Stewart Halsted
William Stewart Halsted was an American surgeon who emphasized strict aseptic technique during surgical procedures, was an early champion of newly discovered anesthetics, and introduced several new operations, including the radical mastectomy for breast cancer...

. So then anesthetics started to be used regularly during surgical operations.

Hospitals' growth

One of the most astonishing changes remarkable in those days, was for sure the new attitude of the public toward hospitals. Since the day antiseptic surgery was adopted, hospitals became in a certain way recognized. Before that, people had fear to go to the hospital (a reasonable fear, since in certain cases surgical death rate was 79 per cent in one year). Clinics and hospitals grew all over the United States.

Morris was one of the doctors that have promoted the construction of an hospital at Ithaca, the Memorial Hospital
Memorial Hospital
Memorial Hospital can refer to many hospitals.Some include:* Memorial Hospital in Massachusetts* Memorial Hospital of Rhode Island...

, which was finished in 1889 (but the formal opening of the Hospital was on January 1, 1892) and later on a College Infirmary.

The fourth era in surgery

Robert Morris makes a distinction in his autobiographical book of his idea of the existence of four distinct eras in surgery, one by one characterized by a certain aspect.
So he talks about a Heroic Era, then an Anatomic Era, a Pathologic Era and finally a Physiologic Era.

The first one is about all that happened before doctors concentrated their studies upon Anatomy. So it lasts from the time of Hippocrates since the introduction of a rigorous study of the structure of human body. Since then operations were made with brutal rapidity, and there was no regard for antisepsis.

The second era is signed by progress in knowledge and skills, but still surgeons would make unnecessary long incisions for their operations, ignoring the damage they could procure by using this method, making after all the body of the patient in front of a higher risk to get infected.

Then with Lister and Pasteur discoveries there it came the third era, characterized by the consciousness that the microbe had to be consider bigger than the man (In the First and Second Eras of surgery man was bigger than the microbe; in the Third Era the microbe was bigger than the man). But still, using Morris' own words, incisions suitable for killing bears were being applied to weak patients and also surgeons made multiple incisions for purpose of drainage and these also caused shock.

The last one era is based upon the revolutionary and recent idea that the patient, on the whole, is his own best antiseptic. He was a pro of this new point of view, which was contrasted for a long time, since it had come universally accepted. Inspired by an experiment made by Dawbarn (who was able to demonstrate that the pus originated in an abdominal infection could not be all removed in the course of the surgical operation by making a sort of try by pouring milk into the abdominal cavity of a cadaver and then trying in vane to get it completely out), he started to operate appendicitis with a new revolutionary method based upon the reduction of shock for the patient, making small incisions, and omitting pads (used for the purpose of protection) and the excessive drainage.

So he made a number of operations of the appendicitis using his own method, and then he was able to present in 1896 at the Academy of Medicine statistics of one hundred consecutive unselected appendicitis cases with a death rate of 2 per cent. His first formal presentation of these principles of the Fourth Era of Surgery (as he named it) was made before the Section of Surgery and Anatomy of A. M. A. and reported in the Transaction of the year. He also presented it at the International Medical Congress in Budapest in September 1909, and published his idea in Surgery, Gynecology and Obstetric for December. And he also published a book, Dawn of the Fourth Era in Surgery in 1910.

Anyway his results were not completely appreciated by other surgeons, for the appendicitis cases had at that time a high death rate. Some surgeons affirmed that those statistics were not to be taken seriously, since what they proved was impossible.
He still improved his methods and skills and he furnished a contribution on Abdominal Surgery for Sajous' Cyclopedia.

Merits

Robert Morris has a quite impressive list of merits he accomplished during his career as a surgeon.
First of all while at the Bellevue Hospital he and Dr. Frase Fuller, a surgeon of another Division, had performed the very first cases of wiring of simple fracture of the patella that had been done in the United States, and probably in the world. In those days this type of operation would be considered non-sense and inappropriate, since the idea of opening an uninfected knee joint was mad, because it would have certainly lead to a disaster, like an infection.

He developed a method for palpation of the appendix
Appendix
Appendix may refer to:In documents:*Addendum, any addition to a document, such as a book or legal contract*Bibliography, a systematic list of books and other works...

 and published a report upon the subject.

He made up a method consisting in wound repairing through the agency of a moist blood clot, which became known and adopted in the world over as Schede method. Dr. Max Schede
Max Schede
Max Schede was a German surgeon who was a native of Arnsberg.Schede studied medicine at the Universities of Halle, Heidelberg and Zurich, and earned his medical doctorate in 1866...

was indeed the one who decided to carry out this method in a number of different cases, after seeing Morris' demonstration, and he finally published a report upon this plan of procedure in the Deutzsche Medizinische Wochenschrift, 1886.

Morris made some experimenting with grafting of ovaries in rabbits. In his notes he recorded a frequent trouble in the effort to make one set of rabbits immune to blood serum of another set of rabbits. The main issue was that tissue of any sort taken from one individual and planted in another is physiologically a stranger. The subject of gland grafting engaged his interest in the Nineties. He also noticed that ovarian grafting was so much more frequently possible than testis grafting, first of all because of the number of women donors, which he reported were much more ready than men to sacrifice a solid organ.

He performed the first human ovarian grafting in 1895. and so he published the same year a presentation of his idea of gland grafting, description of technique and a report upon cases. And in May 1906 he published a great report of the birth of a living child after heteroplastic ovarian grafting in the New York Medical Record. After this report, he received tons of letters from women who had lost their ovaries and wished to have a gland grafting. Some of them would offer a contingent fee, condition that Morris had never accepted, since he thought that such a fee would presuppose a work for the money regardless of the rendering of human service.

Moreover he was one of the founders of The American Society of Endocrinologists.
Furthermore he adopted early intervention for appendicitis in 1890, and wrote about its treatment.

Curiosities

He is known for several aphorisms. Some of the best are "The last living thing on earth will most certainly be a microbe." and "No one can be a one-hundred-per-cent doctor until he has himself had some serious illness or surgical operation."
Morris told the Cornell Club that World War One was like a Darwinian struggle, but that countries would better recognise the importance of mutual dependence, and he believed that races and hybrids of them depended on "protoplasm" for their success. He also argued that many great writers wrote how they did due to the influence of bacterial toxins on their brains.
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