Robert Tuttle Morris, M.D. Early pioneer of transplantation His ideas founded modern reconstructive surgery and regenerative medicine
Robert Tuttle Morris: The Little-Known Surgeon Whose Ideas Launched Modern Reconstructive Surgery and Transplantation
Summary: Robert Tuttle Morris, MD served as Professor of Surgery, New York Post-Graduate Medical College and Hospital from 1898-1917. He was an early pioneer of some of the surgical techniques necessary for transplantation and his ideas are some of the essential pillars of modern reconstructive surgery and regenerative medicine. One of his early achievements was the transplantation of ovarian tissue in women in the 1890s. His greatest practical contribution was the now fully accepted theory that the inner lining of blood vessels is the key to holding and sealing the anastomosis.
Synopsis: What if Newton never got credit for discovering gravity’s force or Einstein relativity? What if another scientist found their manuscripts, did a few experiments, and won international renown—instead of the original discoverers? This is what effectively happened to Dr. Robert Tuttle Morris. The seeds of his ultimate success and anonymity were sown early in life.
A boy who studied muskrat habits to trap them more easily than his friends, Morris learned early how to cope with jealousy, and wrote that “this antagonism on the part of the other fellows was just simply one of the habits of the boy animal. . . if one made the habits of antagonists a matter of interest from a natural history standpoint, there would be no necessity for defence or revenge, and all of the energy that would otherwise be diverted to such channels could be utilized for accomplishing something of real importance” (1).
As he suspected, Morris’ eventual immersion in biomedical subject matter led him to discover 4 foundational concepts of modern reconstructive surgery and regenerative medicine:
tissues and organs are not absolutely dependent for proper function on their immediate connections to nerves,
animals share with plants a body-wide communication system of chemicals or hormones which is largely independent of the nervous system,
it is possible to restore organ function by transplanting small bits of glandular tissue, or
whole organs may be transplanted by severing and reconnecting their blood vessels, if their inner lining is incorporated in the surgical reconnection (“anastomosis”).
Although Morris’ success in transplanting ovarian tissue in women in the 1890s is increasingly heralded (2,3), he has never been fully credited for his single greatest practical contribution: the now fully accepted theory that the inner lining of blood vessels is the key to holding and sealing the anastomosis (4). Morris’ original theoretical prediction always had a good chance of success because he had based it on abundant animal and human pathological evidence gathered in the mid-19th century suggesting that the lining of blood vessels is similar in its biological and healing properties to the lining of the abdominal cavity, then also known as endothelium (but now known as mesothelium) (5-7). Abdominal surgeons had found that the endothelial lining of abdominal organs was key to successful adhesion and sealing of both cut ends of intestine in intestinal anastomosis, and the blood vessel endothelium seemed to be equally important (8).
Much as Einstein’s theories were not fully corroborated until measurement of light bending during an eclipse of the sun many years after his theory was published, Morris’ prediction in the early 1890s that the arterial lining “endothelium” would prove key to successful blood vessel anastomosis was not proven until the Nobel prize winning experiments of Alexis Carrel in the 1910s (10,11), and has now been borne out by years of clinical success in reconnection and transplantation of appendages and organs.
In broad historical perspective, we can see the importance of the guidance provided by Morris’ theory, even for the eventually successful experiments conducted by Carrel. In the early 1900s, Carrel had originally left the inner lining layer out of the blood vessel anastomosis altogether (12). And it was only after careful study of the Morris-inspired method used by J.B. Murphy, MD (as Carrel confirmed in his Nobel address) which relied on the holding power of the endothelium and included it in the stitch (13), that Carrel began to formulate his now famous method of triangulation. The underlying purpose of triangulation was actually to assure that the endothelia of each cut end of blood vessel are closely apposed, to facilitate endothelial regeneration and full healing that prevents any blood leakage from the anastomotic site (14).
Although Carrel’s triangulation method did not stand the test of time, Morris’ basic precept that the intimal endothelium must be included and that all-layer techniques of blood vessel anastomosis are superior still assures the success of thousands of reconstruction and transplantation procedures all over the world.
If plants function without nerves, so can organs. A serious student of botany and medicine in the 1870s and 1880s, Dr. Robert Tuttle Morris grafted branches of one fruit tree to another. He learned from his horticultural experiments that plants carry out many of the same physiological functions that animals do, but without aid of a nervous system.
The dogma at the time was that the function of each organ in an animal’s body was dependent entirely on its connection to nerves (“nervism”). This prevented any serious consideration of transplantation.
Intrauterine ovarian transplantation as depicted by R.T. Morris in 1895.
Prior to the discovery of hormones, Morris deduced that tiny fragments of transplanted ovarian tissue might produce a substance and carry eggs that would restore both menstruation and fertility of women.
In the early 1890s, in fact, he did just that by transplanting bits of ovarian tissue into the fallopian tubes, uterus, or uterine ligaments. His abdominal surgeries taught him that successful closure of the abdomen and healing of organs within it depended largely on stitching through its lining layer, known as “peritoneum.”
The peritoneum was already known to be covered by special healing cells, then known as “endothelial” cells (but now known as “mesothelial” cells).
Transplanting ideas from abdominal surgery to blood vessel surgery. Also in the early 1890s, Morris began to realize that the cavity of each blood vessel has a lot in common with the cavity of the whole abdomen. Both blood vessels and the abdomen develop as hollow tubes which are later lined by specialized endothelial cells. As had already been known for the abdomen, using the healing capacity of the endothelial lining was proving key to repairing aneurysms and cuts in arteries.
A remaining challenge was to find a way to re-unite the two cut ends of an artery, which would prove essential for sewing a donor organ into a recipient’s body.
Morris postulated that the key to successful blood vessel “anastomosis” would be to utilize the healing and sealing properties of the arterial endothelium. He suggested to a fellow abdominal surgeon named J.B. Murphy that he give it a try.
Inversion In 1912, inspired by J. B. Murphy’s approach incorporating the endothelium in patients with ,severed arteries, Alexis Carrel won the Nobel Prize in medicine for his work with blood vessel ,anastomosis and organ transplantation in laboratory animals.
His famous “triangulation” method was the first successful means of everting and aligning the Inner lining endothelium of blood vessels. The abdominal surgeons had been re-uniting (anastomosing) cut ends of intestines together by puckering in the surfaces of each end, to assure that the overlying peritoneal endothelial layers touched and healed together (inversion).
Eversion: Puckering out the cut ends of a blood vessel to get endothelia to kiss.
For blood vessel anastomosis, it was necessary to “pucker out” the two cut ends of the artery, in order to assure that the inner lining endothelia did not retract away, directly touched (“kissed”), and healed to hold the anastomosis together.
1. Morris, R.T., Hopkins pond and other sketches (NY: GP Putnam and Sons, 1896), p. 12.
2. Morris, R.T., The ovarian graft. New York Medical Journal 62:436, 1895.
3. Gosden, R.G., Robert T. Morris, M.D.—appreciation of an enlightened surgeon and pioneer of ovarian transplantation. Fertility and Sterility 94(6):1960, 2010.
4. Kingsnorth, A. and Majid, A., Eds. Fundamentals of Surgical Practice, 2nd edition (Cambridge: Cambridge University press, 2006), p. 88.
5. Morris, R.T., IV. The serous coats of blood vessels compared with the peritoneum. Annals of Surgery 48(1):18, 1908.
6. C. Balance and W. Edmunds, The ligation of the larger arteries in their continuity: an experimental inquiry, Medico-chirurgical Transactions 69:443, 1886.
7. E. Ziegler, A., Textbook of Pathological Anatomy and Pathogenesis, v. ii, Special Pathological Anatomy (London: MacMillan and Co., 1884), p. 11.
8. Watts, S.H., The suture of blood vessels. Implantation and transplantation of vessels and organs. An historical and experimental study. The Johns Hopkins Hospital Bulletin, 1907, p. 388.
9. Dyson, F.W., Eddington, A, Davidson, C., A determination of the deflection of light by the Sun’s gravitational field, from observations made at the total eclipse of 29 May 1919. Philosophical Transactions of the Royal Society of London 220A:291, 1920.
10. Morris, R.T. Fifty Years a Surgeon (NY: E.P. Dutton and Co., Inc., 1935), p. 206.
11. Carrel, A. Nobel lecture. In: Nobel Lectures: Physiology and Medicine 1901-1921 (Amsterdam: Elsevier Publishing Co., 1967).
12. Watts, S.H., The suture of blood vessels. Implantation and transplantation of vessels and organs. An historical and experimental study. The Johns Hopkins Hospital Bulletin, 1907, pp. 382-383.
13. Murphy, J.B., Resection of arteries and veins injured in continuity—end to end suture—experimental and clinical research. Medical Record (NY) 51:73, 1897.
14. C.H. Harris, Blood vessel suture with report of cases. Texas State Journal of Medicine 12:191, 1916.