|The following feature article appeared
in the campus publication Mosaic in November, 2001.
An innovative pediatrician in an insular community
As a pediatrician and primary care giver,
Dr. D. Holmes Morton, IDP ’79, sees his share of ear infections and
stomach flu. But in Morton’s practice, such common afflictions can be
catalysts for acute illnesses and even death. This is because the 500 to
600 patients he treats at his Clinic for Special Children in rural
Pennsylvania have genetic diseases, which can make even minor illnesses be
catastrophic. Patients with Crigler-Najjar syndrome, for example, lack the
ability to produce the enzyme that breaks down bilirubin in the body. An
excess of bilirubin can be triggered by a common cold, and the result can
be irreversible brain damage within hours.
Rare in the general population, these
genetic disorders affect larger numbers of Old Order Amish and Mennonites,
who share a very small gene pool and who make up 90 percent of Morton’s
young patients. The rest come from all over the country and the world
seeking Morton’s expertise in the diagnosis and treatment of a variety
of genetic disorders. “His work is seminal in the field of genetic
medicine,” asserts Charles A. Dana Professor of Biology Craig Schneider,
who stays in touch with his former student. “It has been recognized and
will continue to be recognized as something very special.”
A “Hero of
Morton, who received the Albert Schweitzer
Prize for Humanitarianism in 1993 and who was lauded as one of Time
magazine’s “Heroes of Medicine” in 1997, has made a profound impact
on the communities he serves, has advanced scientific understanding of
genetic illnesses and their treatment, and in the process has created a
practice that is a model for rural health care. But Morton continues to
measure success on a case-by-case basis.
“The biggest reward has to be
understanding one of these diseases in a way that makes a difference to
the individual child you’re taking care of,” he says.
Morton’s clinic was built in 1990 by Amish and Mennonite carpenters and farmers in barn-raising fashion. Its beautifully crafted post-and-beam walls house not only the usual pediatric examination rooms, but also sophisticated laboratory instruments—mass spectrometers, gas chromatography equipment, and the like—that analyze urine and blood samples. “We are a general care clinic but at the same time we have laboratory services here that many university hospitals don’t have,” says Morton. A caring pediatrician and a renowned geneticist, Morton is deep down a biologist. Many genetic disorders can be treated with diet modifications or medications, and Morton’s approach to disease management is based on an understanding of biological processes at the molecular level.
Morton, who joined the College’s
Individ-ualized Degree Program in his mid-twenties, says that Trinity
cultivated his interest in biology. A former member of the Merchant
Marine, Morton had spent his free time reading everything from literature
to books on developmental psychology, neurobiology, and child development.
At Trinity, he took full advantage of the liberal arts environment.
Professor of Psychology William M. Mace recalls, “He was the type of
student where you could say, ‘here’s something you might read,’ and
he would actually read it and come back with comments and questions.”
After Trinity, Morton attended Harvard Medical School, followed by a residency at Children’s Hospital in Boston. His interest in biochemical genetics research led him to Children’s Hospital of Philadelphia, Johns Hopkins University, and ultimately Lancaster County. To many in the medical community, it looked like Morton, who could easily have garnered a post at a prominent research institution, was throwing away a promising career. Choosing the less-traveled road, Morton and his wife, Caroline, established the clinic as a nonprofit organization. With Morton as the medical partner and Caroline as the administrative partner, the clinic charges nominal fees and runs on an operational budget that relies upon an annual auction of hand-made quilts and donations of equipment and in-kind services. Craig Schneider, who has attended many of the auctions and witnessed Morton’s interactions with his patients, says Morton is the rare outsider who has been fully accepted by the insular communities he serves. “The people love him,” Schneider says.
Expanding to pursue greater goals
In July, the Mortons celebrated the opening of a new wing at the clinic. The practice has also expanded recently to include a second full-time physician and a laboratory scientist with a Ph.D. in molecular biology. These additions are helping Morton pursue goals that were out of his reach as a solo practitioner working long hours. “We’ve had a lot of successes in terms of showing that many of these disorders are quite understandable and quite treatable,” says Morton. “And I think the next challenge is to take the information we’ve gleaned from this work and publish it and teach it to other doctors and assume much more of an educational role.”
Meanwhile, Morton is hoping his patients will be among the first to test new kinds of gene therapies. “What we all would like to have is the ultimate treatment for a genetic disease, which is to go in and actually repair the gene mutation itself,” he says. “I think that within my lifetime we will see routine repairs of point mutations in genes as an ideal therapy for diseases like Crigler-Najjar disease.”
Humble about his own contributions, Morton
notes that the Amish will be remembered for their role in advancing our
understanding of genetics. “We are greatly indebted to these people who
have made their genealogies available and have participated in studies for
many years,” he says. “One of the most satisfying things is to be able
to take this information that we’ve gleaned from them
over the years and not only make use of it but also bring it back out
here—in a cornfield—and make it available as part of their health care