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Integrative Gastroenterology
 Weil Integrative Medicine Library

Published and Forthcoming Volumes

series editor

andrew weil, md

Donald I. Abrams and Andrew Weil: Integrative Oncology

Timothy Culbert and Karen Olness: Integrative Pediatrics
Gerard E. Mullin: Integrative Gastroenterology
Victoria Maizes and Tieraona Low Dog: Integrative Women’s Health
Randy Horwitz and Daniel Muller: Integrative Rheumatology
Daniel A. Monti and Bernard Beitman: Integrative Psychiatry
Stephen Devries and James Dalen: Integrative Cardiology
Integrative Gastroenterology

edited by
Gerard E. Mullin, MD
Associate Professor, Medicine
Johns Hopkins University School of Medicine
The Johns Hopkins Hospital
Baltimore, MD

1
 1
Published in the United States of America by Oxford University Press, Inc.,
198 Madison Avenue, New York, NY, 10016
United States of America

Oxford University Press, Inc. publishes works that further Oxford University’s objective
of excellence in research, scholarship, and education

Oxford is a registered trademark of Oxford University Press in the UK and

in certain other countries

© Oxford University Press, Inc. 2011

All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted, in any form or by any means,
without the prior permission in writing of Oxford University Press, Inc., or as expressly
permitted by law, by licence, or under terms agreed with the appropriate reproduction rights
organization. Inquiries concerning reproduction outside the scope of the above should be sent
to the Rights Department, Oxford University Press, Inc., at the address above

You must not circulate this work in any other form and you must impose this
same condition on any acquirer

____________________________________________
Library of Congress Cataloging-in-Publication Data

Integrative gastroenterology/[edited by] Gerard E. Mullin.

p.; cm.—(Weil integrative medicine library)
Includes bibliographical references and index.
ISBN-13: 978-0-19-537110-9 (alk. paper)
ISBN-10: 0-19-537110-0 (alk. paper)
1. Gastrointestinal system—Diseases. 2. Integrative medicine. I. Mullin, Gerard E.
II. Series: Weil integrative medicine library.
[DNLM: 1. Gastrointestinal Diseases—therapy. 2. Complementary Therapies—methods.
WI 140 I605 2010]
RC817.I47 2010
616.3’3—dc22
2009023877
978-0-19537110-9
____________________________________________

1 3 5 7 9 10 8 6 4 2

Typeset in Minion Pro Regular

Printed on acid-free paper
Printed in the United States of America

This material is not intended to be, and should not be considered, a substitute for medical or other professional advice.
Treatment for the conditions described in this material is highly dependent on the individual circumstances. And,
while this material is designed to offer accurate information with respect to the subject matter covered and to be
current as of the time it was written, research and knowledge about medical and health issues is constantly evolving
and dose schedules for medications are being revised continually, with new side effects recognized and accounted
for regularly. Readers must therefore always check the product information and clinical procedures with the most
up-to-date published product information and data sheets provided by the manufacturers and the most recent codes
of conduct and safety regulation. The publisher and the authors make no representations or warranties to readers,
express or implied, as to the accuracy or completeness of this material. Without limiting the foregoing, the publisher
and the authors make no representations or warranties as to the accuracy or efficacy of the drug dosages mentioned
in the material. The authors and the publisher do not accept, and expressly disclaim, any responsibility for any
liability, loss or risk that may be claimed or incurred as a consequence of the use and/or application of any of the
contents of this material.
To the more than 70 million Americans who are known to suffer from
digestive disorders.
To my loved ones for their unwavering support over the years.
To the many who mentored me throughout my career.
To Andrew Weil MD for selecting me to edit this textbook.
And the beloved memory of my parents.
This page intentionally left blank
 FOREWORD

A
few years ago, a leading gastroenterologist in Tucson asked me to
meet with him. Over dinner, he expressed the hope that integrative
medicine (IM) might have something to offer him. He was frustrated,
he said, because, “ninety percent of the patients I see have problems that my
training does not enable me to solve.”
At that time, the Arizona Center for Integrative Medicine was offering a
comprehensive IM fellowship in distributed learning format to physicians and
nurse practitioners. We were training family medicine doctors, internists, and
surgeons, but had not yet had a GI specialist apply. That disappointed me,
because I knew that integrative medicine could greatly enrich the field of gas-
troenterology, increasing its efficacy and reducing the frustration expressed by
my colleague in Tucson and shared by many others.
One of the core curricular areas of IM is mind/body medicine. It covers the
theory and evidence base for interactions between mental/emotional states
and physiology, as well as therapies that take advantage of those interactions.
Steven Gurgevich, PhD, a clinical psychologist on the faculty of the American
Society of Clinical Hypnosis, helped design the mind/body medicine module.
He has said, “Patients with gastrointestinal problems should be seen by hypno-
therapists before they go to gastroenterologists,” and over the years, I have
referred many patients with GI complaints to him and other mind/body prac-
titioners, with good outcomes. His reasoning is that the organs of the GI
system, along with the skin, have the greatest amount of innervation of any
organs and, as a result, are the most frequent sites of expression of stress-
related disorders. Michael Gershon, MD, chairman of the Department of

vii
viii FOREWORD

Anatomy and Cell Biology at Columbia University Medical Center, in an excel-

lent book on enteric neurology, refers to the gut as the “second brain.”
Many common GI disorders arise from disturbed function of the gut—in
particular, an imbalance between its intrinsic motility and extrinsic control by
the autonomic nervous system (often caused by stress-related overactivity of
the sympathetic nerves). Without harmonious coordination, gut motility is
abnormal and digestion impaired. In late stages of these disorders, we can
visualize or otherwise detect pathological changes, but early on they present as
functional complaints. Patients seek relief of GI symptoms; there are few or no
measurable correlates of the symptoms.
“Functional disorder” is a loaded term in conventional medicine. Often it is
used to dismiss complaints of patients without visible pathology; at worst, it is
used as a synonym for “imagined disease.” Patients are easily angered by sug-
gestions that their GI problems are all in the mind. Practitioners must be able
to help them understand the underlying somatopsychic mechanism that
accounts for their very real symptoms.
Traditional Chinese medicine (TCM) classifies diseases as “visible” or
“invisible” and postulates that all visible disease is preceded by an invisible
stage, in which “energy” (chi) circulation through the body is disturbed. TCM
practitioners believe that if invisible disease goes untreated (by acupuncture,
herbal therapy, dietary adjustment, etc.), it will eventually produce pathologi-
cal changes in the physical structure of the body. Therefore, TCM prioritizes
the diagnosis and treatment of what conventional Western medicine often dis-
misses as functional disorders. Doctors here tend to minimize the significance
of these problems, in part because they find it frustrating to manage them.
Their training does not enable them to do so.
Because dietary habits and other lifestyle factors can both trigger and aggra-
vate this class of GI disorders, it is not sufficient to send patients to stress-
management training or hypnotherapy. Physicians must also give them specific
recommendations about foods, beverages, physical activity, rest and sleep, and
more. And they should know when the pharmaceutical drugs now so widely
prescribed for GI problems are really indicated, and for how long patients
should be on them. Proton-pump inhibitors for GERD and steroids for inflam-
matory bowel disease may be useful for short-term suppression of symptoms,
but over time the benefit-to-risk ratio changes significantly and unfavorably,
and data on the risks are accumulating.
Practitioners of integrative medicine are fully trained to diagnose and treat
invisible and functional disease before it damages tissues and organs and
requires drastic, costly intervention. They work from the premise that the body
can heal itself if given a chance, that mind/body interactions are real and often
very relevant to issues of health and illness, that all aspects of lifestyle must be
 FOREWORD ix

considered in evaluating patients, and that the doctor/patient relationship is a

key factor in the outcome of treatment. In addition, they are familiar with a
wide range of therapeutic options other than drugs. In recommending thera-
pies not commonly included in mainstream practice, they pay attention to the
evidence that supports them, always working from the principle that the
greater the potential of a treatment to cause harm, the stricter the standards of
evidence for efficacy it must be held to.
A major initiative of the Arizona Center for Integrative Medicine is
“Integrative Medicine in Residency” (IMR). We have developed a 200-hour,
comprehensive curriculum in IM, much of it taught online, that is currently a
required component of eight residency programs around the United States.
This is a pilot phase of IMR; the center’s long-range goal is to have this com-
prehensive curriculum become a required, accredited part of all residency
training, including that of specialists and subspecialists. Then all physicians
(and surgeons), including gastroenterologists, will know the basics of nutri-
tional medicine, botanical medicine, mind/body medicine, lifestyle influences
on health, the indications for and strengths and weaknesses of other systems
(like Chinese and Ayurvedic medicine) and of complementary and alternative
therapies.
I am certain that the resulting transformation of medicine is a prerequisite
for building a functional, cost-effective health care system, one that empha-
sizes disease prevention and health promotion and that uses costly, technol-
ogy-based interventions (including pharmaceutical drugs) only when they are
really indicated, managing common forms of illness with simpler, less expen-
sive interventions. It is my hope that this series of volumes from Oxford
University Press will help achieve these goals.
I have looked forward to the publication of Integrative Gastroenterology
with great anticipation. Not only does it give all clinicians an overview of the
subject and specific guidance about the integrative management of common
GI problems, it has the potential to hasten the day when integrative gastroen-
terology will be a vital field of research and practice. The editor, Gerard Mullin,
MD, has done a commendable job of assembling expert contributors and
informative articles. I have learned much from working with him on the proj-
ect, and I hope the information in these pages will lessen the frustration of
practitioners faced with GI problems that conventional education and training
does not enable them to solve.
Andrew Weil, MD
Series Editor
Tucson, Arizona
May, 2009
This page intentionally left blank
 CONTENTS

Contributors xv

1. Why Integrative Gastroenterology? 

Gerard E. Mullin
2. The American Digestive Disease Epidemic 
Gerard E. Mullin
3. An Overview of Digestive, Sensing, and
Immune Functions of the Gut 
Patrick J. Hanaway, Laura K. Turnbull, and Gerard E. Mullin
4. The Intestinal Microbiota in Health and Disease: Bystanders,
Guardians, or Villains? 
Fergus Shanahan
5. Alternative Laboratory Testing for Gastrointestinal Disease 
David M. Brady, J. Alexander Bralley, Richard S. Lord,
and Gerard E. Mullin
6. New Molecular Techniques Revolutionize Understanding
of the Influence of Gut Microbiota on Health and Disease 
J. Alexander Bralley
7. Principles of Integrative Gastroenterology: Systemic Signs
of Underlying Digestive Dysfunction and Disease 
Laura K. Turnbull, Gerard E. Mullin, and Leonard B. Weinstock
8. The Skin and the Gastrointestinal Tract 
Andrew G. Franks, Jr.
9. Premenstrual and Menstrual Exacerbation of IBS: An Integrative
Medicine Analysis of the Bi-Directional Connection
between Female Hormones and Gut Health 
Joel M. Evans

xi
xii CONTENTS

10. Fibromyalgia and Gastrointestinal Disorders 

David M. Brady and Michael J. Schneider
11. Acupuncture for Digestive System 
Sanghoon Lee and Ta-Ya Lee
12. Ayurveda and Digestive Health 
David Simon and Valencia Porter
13. Osteopathic Medicine 
Diane Clawson
14. Gastroenterology and an Integrative Chiropractic Approach 
Loren Marks and David M. Durkin
15. Energy Medicine and Gastrointestinal Disorders 
Ann Marie Chiasson
16. Guided Imagery and Gastroenterology 
Martin L. Rossman
17. Hypnosis and Gastrointestinal Disorders 
Anastasia Rowland-Seymour
18. Homeopathy Origins and Therapeutic Principles 
Savely Yurkovsky
19. Massage for Digestive Health 
Stephanie Porcaro and Gerard E. Mullin
20. Mindfulness Based Stress Reduction
for Health and Diseases 
Padmini D. Ranasinghe
21. Naturopathic Medicine and Digestion 
Joseph Pizzorno
22. Taiji, Qigong, and Digestive Health 
Yang Yang and Bob Schlagal
23. Digestive Health and Reiki Energy 
Beth Nolan
24. Self-Care Journaling for Digestive Health 
Danna M. Park
25. Spirituality 
Frederic C. Craigie, Jr.
26. What Patients Want from Their Doctors 
Donna Jackson Nakazawa
 CONTENTS xiii

27. The Value of Support Groups 

Pearl L. Lewis and Gerard E. Mullin, with a foreword
by Bernie Siegel
28. Overview of Visceral Manipulation for the
Integrative Gastroenterologist 
Jean-Pierre Barral and Gail Wetzler
29. Probiotics in the Prevention and Treatment of
Gastrointestinal Disease 
Gerald Friedman
30. The Role of Nutritional Genomics and Functional Medicine
in the Management of Crohn’s Disease 
Sheila G. Dean and Kathie M. Swift
31. Functional Foods for Digestive Health and Disease 
Elizabeth Lipski
32. The Role of Herbal Medicine in Integrative
Gastroenterology 
Tieraona Low Dog
33. Brief Review of Mind–Body Medicine in
Gastroenterology Practice 
Miranda A.L. van Tilburg, Stephan R. Weinland,
and Olafur S. Palsson
34. Mind–Body Medicine in Digestive Disease 
Douglas A. Drossman and William E. Whitehead
35. Yoga and Digestive Health 
Sajida Chaudry and Beth Nolan
36. Integrative Approaches to Abdominal Pain 
Robert A. Bonakdar and Emily G. Singh
37. Over-the-Counter Remedies for Digestive Health:
Potion or Poison? 
Jerry Hickey and Gerard E. Mullin
38. Systemic Interactions Between Dental and
Gastroenterological Diseases 
Philip E. Memoli
39. Upper Gastrointestinal Disorders: Dyspepsia, Heartburn,
Peptic Ulcer Disease, and Helicobacter pylori 
Anil Minocha
xiv CONTENTS

40. Celiac Disease 

S. Devi Rampertab and Peter H.R. Green
41. Food Reactions and Their Implications in the
Irritable Bowel Syndrome 
Trent W. Nichols, Gerard E. Mullin, and Laura K. Turnbull
42. An Evidence-Based Review of Complementary and
Integrative Approaches for Irritable Bowel Syndrome 
Octavia Pickett-Blakely, Ashwini S. Davison, and Gerard E. Mullin
43. Nutrition Strategies for the Treatment of IBS and the
Prevention of Digestive Complaints 
Ashley Koff
44. Alternative Approaches to the Patient with
Inflammatory Bowel Disease 
Leo Galland, Katarzyna Kines, and Gerard E. Mullin
45. Obesity 
Lawrence J. Cheskin and Katrina Seidman
46. Nutrition and Colorectal Health 
Mitra Rangarajan and Gerard E. Mullin
47. Liver Disease 
Matthew Cave, Naeem Aslam, Christopher Kulisek,
Luis S. Marsano, and Craig J. McClain
48. Integrative Approaches to Diseases of the
Pancreas and Gallbladder 
Vinay Chandrasekhara and Anthony N. Kalloo
49. An Integrative Approach to Gender-Specific
Digestive Health Issues 
Laura K. Turnbull, Gerard E. Mullin, and Sharon Dudley-Brown
50. Gastrointestinal Disorders and Eating Disorders 
Carolyn Coker Ross
51. Ethical Issues in Integrative Gastroenterology 
Julie Stone
52. There Is No Alternative to Evidence 
Ronald L. Koretz

Index 653
 CONTRIBUTORS

Naeem Aslam, MD J. Alexander Bralley, PhD

Fellow, Department of Medicine Chief Executive Officer
Division of Gastroenterology and Metametrix Clinical Laboratory
Hepatology Duluth, GA
University of Louisville School of
Medicine Matthew Cave, MD
Louisville, KY Assistant Professor of Medicine
Division of Gastroenterology/
Jean-Pierre Barral, DO Hepatology
Director of the Department of Department of Medicine
Osteopathic Manipulation University of Louisville
University of Paris, School of Medicine Louisville, KY
Paris, France
Vinay Chandrasekhara, MD
Robert Alan Bonakdar, MD, FAAFP
Clinical Fellow
Director of Pain Management
Division of Gastroenterology &
Scripps Center for Integrative
Hepatology
Medicine
Johns Hopkins University School of
Assistant Clinical Professor
Medicine
Department of Family and
Baltimore, MD
Preventative Medicine (Voluntary)
University of California, San Diego,
Sajida Chaudry, MD, MPH
School of Medicine
Family Medicine and Preventive
San Diego, CA
Medicine
David M. Brady, ND, DC, CCN, Johns Hopkins Community Physicians
DACBN Odenton, MD
Vice Provost, Health Sciences Division
Director, Human Nutrition Institute
Associate Professor of Clinical Sciences
University of Bridgeport
Bridgeport, CT

xv
xvi CONTRIBUTORS

Ann Marie Chiasson, MD, Ashwini S. Davison, MD

MPH, CCFP Senior Resident
Clinical Assistant Professor of Department of Internal Medicine
Medicine Johns Hopkins Hospital
Arizona Center for Integrative Baltimore, MD
Medicine
University of Arizona Sheila G. Dean, DSc, RD, LD,
Tucson, AZ CCN, CDE
Integrative Nutrition Solutions
Lawrence J. Cheskin, MD, FACP Adjunct Professor of Nutrition
Associate Professor of Health, Science
Behavior & Society University of Tampa
Joint Appointment in Medicine Palm Harbor, FL
(Gastroenterology)
Director, Johns Hopkins Weight Douglas A. Drossman, MD
Management Center Professor of Medicine and
Johns Hopkins Bloomberg School of Psychiatry
Public Health Co-Director, UNC Center for
Johns Hopkins University School of Functional GI and Motility
Medicine Disorders
Baltimore, MD Division of
Gastroenterology and Hepatology,
Diane Clawson, DO Department of Medicine
Attending Physician University of North Carolina at Chapel
Department of Psychiatry Hill
Department of Pediatrics Chapel Hill, NC
University of New Mexico
Albuquerque, NM Sharon Dudley-Brown, PhD,
FNP–BC
Frederic C. Craigie, Jr., PhD Co-Director, Gastroenterology &
Psychologist/Faculty, Maine- Hepatology Nurse Practitioner
Dartmouth Family Medicine Fellowship Program
Residency Johns Hopkins Hospital
Associate Professor of Community and Assistant Professor
Family Medicine Johns Hopkins University Schools of
Dartmouth Medical School Medicine & Nursing
Visiting Associate Professor Baltimore, MD
Arizona Center for Integrative
Medicine David Durkin, DC
University of Arizona School of Chiropractor
Medicine Durkin Chiropractic Center
Augusta, Maine Gastonia, NC
 CONTRIBUTORS xvii

Joel M. Evans, MD Jerry Hickey, RPh

Assistant Clinical Professor Scientific Director
Department of Obstetrics, Gynecology, InVite Health, Inc.
and Women’s Health New York, NY
Albert Einstein College of Medicine
Bronx, NY Anthony N. Kalloo, MD
The Moses and Helen Golden Paulson
Andrew G. Franks, Jr., MD, FACP Professor of Gastroenterology
Clinical Professor of Dermatology and Chief, Division of Gastroenterology
Medicine (Rheumatology) and Hepatology
Director, Skin Lupus, and Connective Johns Hopkins Hospital
Tissue Disease Baltimore, MD
New York University School of
Medicine Katarzyna Kines, MS, MA, LDN,
New York, NY CNS, CN
Holistic Nutrition Naturally, LLC
Gerald Friedman, MD, PhD, MS, Contractual Practitioner with
FACP, MACG Johns Hopkins Integrative Medicine
Clinical Professor of Medicine and Digestive Center
Department of Medicine, Division of Green Spring Station,
Gastroenterology Lutherville, MD
The Mount Sinai School of Medicine
New York, NY Ashley Koff, RD
Founder, AshleyKoffApproved.com
Leo Galland, MD
Director Ronald L. Koretz, MD
Foundation for Integrated Medicine Emeritus Professor of Clinical
New York, NY Medicine
David Geffen–UCLA School of
Peter H.R. Green, MD Medicine
Professor of Clinical Medicine Department of Medicine
Celiac Disease Center Olive View–UCLA Medical Center
Columbia University College of Sylmar, CA
Physicians and Surgeons
New York, NY Christopher Kulisek, MD
Resident, Department
Patrick Hanaway, MD of Medicine
Chief Medical Officer University of Louisville School of
Genova Diagnostics Medicine
Asheville, NC Louisville, KY
xviii CONTRIBUTORS

Sanghoon Lee, OMD, PhD, DiplAc, LAc Tieraona Low Dog, MD

Associate Professor of Acupuncture & Director of the Fellowship
Moxibustion Arizona Center for Integrative
College of Oriental Medicine Medicine
WHO Collaborating Centre for Clinical Associate Professor
Traditional Medicine Department of Medicine
East–West Medical Research Institute University of Arizona
Kyung Hee University Tucson, AZ
Seoul, South Korea
Dan Lukaczer, ND
Ta-Ya Lee, MSN, CRNP, MAc, LAc, Associate Director of Medical
MBA, MPH Education
Johns Hopkins Community Physicians Institute for Functional Medicine
Wyman Park Internal Medicine Gig Harbor, WA
Canton Crossing Integrative Medicine
Baltimore, MD Loren Marks, DC, DACBN
Diplomate American Clinical Board
Pearl L. Lewis of Nutrition
Founder, Maryland Chapter Crohn’s Integrative Assessment Technique,
and Colitis Foundation Founder
Founder, Maryland Patient Advocacy 200 W 57 St. Ste 1010 NY
Group
Maryland Renal Advocate Luis S. Marsano, MD
National Kidney Foundation of Professor of Medicine
Maryland Jewish Hospital Distinguished
National Kidney Foundation Professor of Hepatology
Malignancy Advisory Board Division of GI/Hepatology
Author, Access to Care for Special University of Louisville School of
Needs Populations (19 states) Medicine
Ellicott City, MD Louisville, KY

Liz Lipski, PhD, CCN Craig J. McClain, MD

Director of Doctoral Studies Professor, Departments of
Hawthorn University Medicine and Pharmacology &
Founder of Innovative Healing Toxicology
Founder of Access to Health Experts Associate Vice President for
Asheville, NC Translational Research
Distinguished University Scholar
Richard S. Lord, PhD University of Louisville School of
Chief Science Officer Medicine
Metametrix Institute Louisville, KY
Duluth, GA
 CONTRIBUTORS xix

Philip E. Memoli, DMD, Danna Park, MD, FAAP

FAGD, CNC Medical Director
Founder, Institute of Systemic Integrative Healthcare Department
Medicine and Dentistry Mission Hospital
Attending, Overlook Hospital Asheville, NC
Summit, NJ
and Octavia Pickett-Blakely, MD
Private Practice Post Doctoral Fellow
Berkeley Heights, NJ Division of Gastroenterology
Johns Hopkins School of Medicine
Anil Minocha, MD Baltimore, MD
Professor of Medicine
Joseph Pizzorno, ND
LSU Health Sciences Center
Editor-in-Chief, Integrative Medicine,
Chief of Gastroenterology
A Clinician’s Journal
VA Medical Center
Co-Author, Textbook of Natural Medicine
Shreveport, LA
President Emeritus, Bastyr University
Seattle, WA
Donna Jackson Nakazawa
Author and Lecturer Stephanie Porcaro, LMT
The Autoimmune Epidemic Massage By Stephanie
www.autoimmuneepidemic.com Baltimore, MD

Trent W. Nichols, Jr., MD Valencia Porter, MD, MPH

Center for Digestive Disorders and Director of Women’s Health
Nutrition The Chopra Center for Wellbeing
Hanover, PA Carlsbad, CA

Beth Nolan, LMT S. Devi Rampertab, MD

Massage Therapist Assistant Professor of Medicine
Life Support Wellness Center Division of Gastroenterology
Butler, NJ Penn State College of Medicine
Hershey Medical Center
Olafur S. Palsson, PsyD Hershey, PA
Associate Professor of Medicine
Division of Gastroenterology and Padmini D. Ranasinghe, MD, MPH
Hepatology Assistant Professor of Medicine
Department of Medicine Division of General Internal Medicine
University of North Carolina at Johns Hopkins University School of
Chapel Hill Medicine
Chapel Hill, NC Baltimore, MD
xx CONTRIBUTORS

Mitra Rangarajan, MSN, ANP-BC, Michael J. Schneider, DC, PhD

MPH, CDE, MS, RD Visiting Assistant Professor
Nurse Practitioner, Advanced School of Health & Rehabilitation
Therapeutic Endoscopy & GI Sciences
Motility University of Pittsburgh
Division of Gastroenterology & Pittsburgh, PA
Hepatology
Johns Hopkins University School of Katrina B. Seidman, MS, RD, LDN
Medicine Registered Dietician
Baltimore, MD Johns Hopkins Weight Management
Center
Carolyn Coker Ross, MD, MPH Department of Health, Behavior and
Clinical Assistant Professor of Society
Medicine Johns Hopkins Bloomberg School of
University of Arizona, Tucson, AZ Public Health
Eating Disorder, Addiction Medicine Baltimore, MD
and Integrative Medicine
Consultant Fergus Shanahan, MD
Denver, CO Professor and Chair, Department of
Medicine
Martin L. Rossman, MD Director, Alimentary Pharmabiotic
Clinical Instructor Centre
Department of Family and Cork University Hospital and
Community Medicine University College Cork
University of California San Francisco National University of Ireland
Medical School
San Francisco, CA David Simon, MD
Medical Director, Co-Founder
Anastasia Rowland-Seymour, MD The Chopra Center for
Assistant Professor of Medicine Wellbeing
Division of General Medicine Carlsbad, CA
Department of Internal Medicine
Johns Hopkins University School of Emily G. Singh, MD
Medicine Division of Gastroenterology
Baltimore, MD Scripps Clinic Carmel Valley
San Diego, CA
Bob Schlagal, PhD
Professor Julie Stone, MA, LLB
Department of Language, Reading, & Visiting Professor, Peninsula Medical
Exceptionalities School
Appalachian State University Universities of Exeter and Plymouth
Boone, NC United Kingdom
 CONTRIBUTORS xxi

Kathie Madonna Swift, MS, RD Gail Wetzler, PT, EDO, BI–D

Director, Food As Medicine Director of Physical Therapy
Center for Mind Body Medicine Center for Alternative Medicine
Washington DC University of California, Irvine
and and
Lead Nutritionist Director of Curriculum and Program
Kripalu Center for Yoga and Health Development
Stockbridge, MA Barral Institute
and
Laura K. Turnbull, BA, RNc Owner of Wetzler Integrative Physical
Johns Hopkins University School of Therapy Center
Nursing Newport Beach, CA
Baltimore, MD
William E. Whitehead, PhD
Miranda A.L. van Tilburg, PhD Professor of Medicine and Adjunct
Assistant Professor of Medicine Professor of Obstetrics and
University of North Carolina School of Gynecology
Medicine Co-Director of the Center for
Department of Gastroenterology and Functional GI and Motility
Hepatology Disorders
UNC Center for Functional GI and University of North Carolina at Chapel
Motility Disorders Hill
Chapel Hill, NC Chapel Hill, NC

Stephan R. Weinland, PhD Yang Yang, PhD

Assistant Professor of Medicine Adjunct Faculty
University of North Carolina at Department of Kinesiology and
Chapel Hill Community Health
Center for Functional GI and Motility University of Illinois at Urbana-
Disorders Champaign
Chapel Hill, NC and
Director
Leonard B. Weinstock, MD Center for Taiji and Qigong Studies
Associate Professor of Clinical New York, NY
Medicine and Surgery
Washington University School of Savely Yurkovsky, MD
Medicine Private Practice
Director, Specialists in Chappaqua, NY
Gastroenterology, LLC
St. Louis, MO
This page intentionally left blank
Integrative Gastroenterology
This page intentionally left blank
 1
Why Integrative Gastroenterology?
GERARD E. MULLIN

key concepts

■ Digestive diseases encompass more than 40 acute and chronic

conditions of the gastrointestinal tract, ranging from common
digestive disorders to serious, life-threatening diseases.
■ More than 70 million Americans are afflicted with diseases of
the digestive system.
■ Digestive diseases are the second leading cause of disability
due to illness in the United States, with more than 2 million
Americans impaired to some degree.
■ The annual economic impact on the U.S. economy is more than
$141 billion.
■ Westernized diet and lifestyles are the major cases of the
digestive disease epidemic.
■ Many of the most common digestive diseases in the United
States are also common in Canada and Europe, but are uncom-
mon in Asia and Africa, suggesting that these diseases are pre-
ventable through dietary and lifestyle modifications.
■ The escalating prevalence of obesity, anxiety, depression, stress,
fast food consumption, and food-borne illnesses, is contribut-
ing to the digestive disease epidemic.
■ Adoption of an integrative model by physicians would achieve
more effective prevention and treatment of digestive disease.
■

3
 Introduction

A
s gastroenterologists, internists, primary-care practitioners, nurse
practitioners, or alternative providers, we need to realize that over
50% of patients with digestive disorders incorporate complementary
and alternative medicine (CAM) into their treatment regimen. Studies have
shown that approximately 72% of patients who utilize alternative strategies are
reluctant to disclose this to their providers for fear of being stigmatized.
Since our patients seek our guidance and expertise in overseeing their
healthcare, it is time for us to realize that consumer demand has driven the
present dynamic of patients paying out of pocket to achieve improved health
and well-being by “integrating” alternative strategies into their lives.
There is a body of experiential and evidence-based literature to support the
utilization of these “alternative” strategies in digestive healthcare. Thus, the
ongoing utilization of alternative strategies by the public, the evidence sup-
porting its use, and the expanding groups of practitioners achieving improved
health outcomes, led Dr. Andrew Weil to commission me to synthesize a com-
prehensive how-to guide for advising digestive disease patients, aimed at the
everyday practitioner.
Integrative medicine is a rapidly growing and highly credible field that seeks
to integrate the best of Western scientific medicine with a broader understand-
ing of the nature of illness, healing and wellness.
Dr. Andrew Weil defines integrative medicine as a “healing-oriented medi-
cine that takes account of the whole person (body, mind and spirit), including all
aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of all
appropriate therapies, both conventional and alternative.”

The Principles of Integrative Medicine by Dr. Andrew Weil:

• A partnership between patient and practitioner in the healing process
• Appropriate use of conventional and alternative methods to facilitate
the body’s innate healing response
• Consideration of all factors that influence health, wellness, and disease,
including mind, spirit, and community, as well as body
• A philosophy that neither rejects conventional medicine nor accepts alter-
native therapies uncritically
• Recognition that good medicine should be based in good science, be
inquiry driven, and be open to new paradigms
• Use of natural, effective, less invasive interventions whenever possible
 Why Integrative Gastroenterology? 5

• Use of the broader concepts of promotion of health and the prevention of

illness, as well as the treatment of disease
• Training of practitioners to be models of health and healing, committed to
the process of self-exploration and self-development.

Integrative medicine aims to transform healthcare by moving the boundar-

ies of the existing field of medicine to include the wisdom inherent in
healing the “whole person”—mind, body and spirit.

The Digestive Disease Epidemic

Digestive disease is known to affect more than 70 million Americans today.

An estimated 70% of Americans have either digestive disease or digestive
symptoms over their lifetime. Countless others have migraines, arthritis, fibro-
myalgia, chronic fatigue, depression, neurological disease, osteoporosis, skin
disorders, menstrual irregularities, premenstrual syndrome (PMS), and other
conditions that are related to undiagnosed core digestive discord.
This emerging epidemic of digestive disease is a social disease that results
from a breakdown in the infrastructure of society as we promote stress, meals
on the run from fast-food vendors, unhealthy norms in food choices, and
exposure to carcinogens and xenobiotics, while producing record rates of
mental disorders, social isolation, obesity, and inactivity, which all adversely
affect the gut.
The end result is a nation in which one in three individuals have a digestive
disorder, 63 million either have or show signs of autoimmune disease, and
125 million overall have a chronic disease. This is no accident!

Roots of Integrative Gastroenterology

“A person whose basic emotional and physical tendencies are in balance,

Whose digestive power is balanced,
Whose bodily tissues, elimination functions and activities are in balance,
And whose mind, senses and souls are filled with vitality,
That person is said to be healthy.”

Sushruta Samhita, 2000 B.C.

6 INTEGRATIVE GASTROENTEROLOGY

AYURVEDIC MEDICINE

The human digestive system is our inside track to balanced health and
vitality. This principle has been the fundamental basis of health and healing for
centuries in Eastern civilization, which comprises most of the world’s popula-
tion today. Sushruta Samhita is one of the founders of modern Ayurdevic
medicine, which is used by healers worldwide to prevent disease and promote
health. The driving principle of Ayurveda (translated as the wisdom and
science of life) is that disease is the absence of vibrant health, which begins in a
breakdown of the spirit, and evolves in definable stages beginning with
improper digestion. According to Sushruta Samhita, the Ayurvedic secret to a
long, happy, and vital life is predicated upon balanced energetic, metabolic,
and protective forces; strong digestion; optimal cellular, tissue and organ func-
tion; efficient elimination; and clear senses, joyful mind, and transpersonal
connection. For more about Ayurveda and digestive health, see Chapter 12.

TRADITIONAL CHINESE MEDICINE

Traditional Chinese medicine (TCM) was the first formalized system of health
and healing in modern civilization. In Eastern philosophy, all life occurs within
a circle of nature, with all things in this matrix interconnected and mutually
dependent upon each other. Human beings represent a microcosm of nature
and are the juncture between heaven and earth. In TCM, health and vitality
are predicated upon spiritual connection, balanced living, a vegetable-based
diet, proper digestion, and peace of mind. The flow of energy, or chi, is the
essence of health and well-being. A blockage in the flow of chi through energy
channels called meridians is the beginning of illness, and loss of adaptability is
the beginning of disease.
In TCM, the foods we eat are not merely nutrients but are vehicles of energy
to be dispersed to our body in either a healthy or unhealthy manner, as deter-
mined by the outcome of digestion. When the digestive fire is too weak or too
strong, the resultant energy imbalances create disharmony and illness. In
TCM, chi is centered around the digestive tract in a ball of energy called the
don tien. This virtual force field of energy circling our digestive tract is essen-
tial to health and well-being.
Ayurveda and TCM principles guide the care of billions who are among
the world’s healthiest people. These well-proven models of healthy living
share in common sound mind, peace, wholeness and harmony, a healthy
 Why Integrative Gastroenterology? 7

vegetarian-based diet, spiritual connection, and herbs for early symptoms of

illness. In both systems, individuals are the sum of their diet and lifestyle
choices. Proper digestion of a healthy diet is the key to a life filled with vibrant
health and free of disease.

WESTERN MEDICINE

“Let food be thy medicine and let medicine be thy food.”

“Leave your drugs in the chemist’s pot if you can heal the patient
with food.”
“Above all else, do no harm.”
—Hippocrates, 450 B.C.

The Western model of healthcare has been traced to Hippocrates, who is con-
sidered to be the father of medicine. As physicians, we recite the Hippocratic
Oath at our medical school graduation. What I remember most, while reciting
a moving self-proclamation of service to mankind by facilitating healing, is
Hippocrates, as well as Sushruta Samhita and the early emperors of China,
who believed that physicians are healers of the body, mind, and spirit. Th e job
of the physician was to provide proper instruction of diet in the prevention
and treatment of illness. Hippocrates also strongly believed that the body,
mind, and spirit were inseparable in health and disease.

“As man thinketh in his head, so shall his life be made.”

—Hippocrates, 1450 B.C.

Western Philosophy: The Doctor as Mechanic

In the seventeenth century, Rene Descartes and Sir Isaac Newton introduced
the principle of “reductionism,” whereby human beings were viewed as the sum
of their parts, and the matters of the “spirit” were left to religious organizations.
This unfortunate sustained separation of “church and state” excommunicated
the very soul of Western medicine, the doctor–patient relationship. People were
merely the sum of body parts and molecules. The Cartesian principle of medi-
cine forever transformed the delivery of care to its present-day assembly line of
10-minute office visits, whereby the doctor writes a prescription and barely has
time to lay eyes upon his or her patients. Rene Descartes began what managed
care has finished—the near extinction of the physician as a healer.
8 INTEGRATIVE GASTROENTEROLOGY

Western medicine is a very sophisticated and advanced form of health-

care for acute illness, emergencies, curable malignancies, sustaining chronic
disease, and surgical miracles. When it comes to optimizing health and pre-
venting disease, our results are inferior compared to every country in the
industrialized world. For example, the United States is 41st in longevity among
industrialized countries—dead last! Despite our poor results, Western-trained
physicians still consider the long-standing and highly successful Eastern heal-
ing arts to be archaic and quackery, and proudly view our modern system of
care to be far superior.
As a profession, we perpetuate this reductionist approach more than ever
before. Doctors in training are now taught that our health is merely the result
of the genes that we inherited from our parents, and that health is all prepro-
grammed and predetermined. This view excludes the possibility that health
also reflects the accumulation of the choices that we make and the circum-
stances around us.
The reality is that our health and well-being are the result of how our envi-
ronment interacts with our genes. How we were parented, whether we were
breastfed, how we connect to spirit, ourselves, and others, what we eat, how we
process our food and emotions, and whether our lives are balanced or toxic, all
have profound influences on health. Our genes can either become our protec-
tors and partners for wellness, or target practice for pollutants and toxins in
producing illness and disease. We do make choices every day that influence
the expression of our genes.

Table 1.1. Comparison of Conventional, Western-Based Medicine

versus Integrative Medicine
Aspects of care Conventional Integrative

Focus Disease detection Disease prevention

Orientation Doctor-centered Patient-centered

Treatment Drugs only All inclusive

Healing Drugs only Self-healing

Empathy Variable Loving

Office visits Rushed, inattentive, Open mind, open heart,

prescription-oriented healing

Doctor–Patient Doctor-centered Partnership

Relationship

Satisfaction Low High

 Why Integrative Gastroenterology? 9

Nutritional genomics is an evolving field, started by Nobel Laureate

Dr. Linus Pauling and championed by his protégée, Dr. Jeffrey Bland. There has
been an explosion of research showing how nutrients derived from food
directly influence genetic expression and cellular function. There is more to
health and wellness than just the genes that we inherit from our parents.

The Doctor–Patient Relationship:

Returning to the Roots of Medicine

Digestive disease specialists are fighting to stay afloat financially by severely

limiting their allotment of time to perform procedures and see patients for
office visits. In the end, patients are being treated as though they are on an
assembly line, rather than being present in the nurturing environment of a
doctor’s office. Likewise, physicians are speeding through patient care encoun-
ters like a “rat race,” constantly fighting an uphill battle.
As a measure of the modern doctor–patient relationship that has evolved in
the era of Westernized managed care, a study was conducted to determine
doctors’ empathy for patients. Previous work suggests that exploration and
validation of patients’ concerns is associated with greater patient trust, lower
healthcare costs, improved counseling, and more guideline-concordant care.
The study by Dr. Ronald Epstein and colleagues included 4,800 patient sur-
veys concerning doctor visits, and 100 covertly recorded visits by actors posing
as patients. The results showed that only 15% of the doctors voiced empathy. In
the study, published in the Journal of General Internal Medicine, the research-
ers analyzed the patient surveys and actor visits and characterized the responses
by type, frequency, pattern, and communication style, and correlated them
with patient satisfaction ratings. Empathy was associated with higher patient
ratings of interpersonal care.

“The best physicians are empathic. They show neither sympathy nor dis-
dain. Empathy does not develop as naturally as sympathy or disdain. We
must nurture this emotion, allowing it to blossom. True empathy greatly
helps the doctor–patient relationship.”
—Robert M. Centor, 2005

A key element to Dr. Weil’s vision of integrative medicine is for the practi-
tioner to return to the roots of medicine by fostering partnerships with patients.
We know that the stronger the doctor–patient relationship, the more powerful
the healing response. This is called the placebo response by researchers, but is
underutilized in today’s version of “hit and run” medicine. The restoration of
10 INTEGRATIVE GASTROENTEROLOGY

faith and trust in the treating practitioner by the patient is an essential element
to healing.
At Johns Hopkins, the first physician-in-charge was Sir William Osler
(1849–1919), who was the father of modern medicine. In his writings and
teachings, Sir William Osler emphasized humanity, compassion, observing
and listening to patients with an open mind and heart, and to minimize the
use of pharmaceutical medications. Following are some excerpts from many of
his famous quotations.

“Observe, record, tabulate, and communicate. Use your five senses. Learn
to see, learn to hear, learn to feel, learn to smell, and know that by practice
alone you can become expert.”
“It is much more important to know what sort of a patient has a disease
than what sort of a disease a patient has.”
“The good physician treats the disease; the great physician treats the patient
who has the disease.”
“Teach young physicians to care more particularly for the individual patient
than for the special features of the disease.”
—Sir William Osler (1849–1919)

The integrative practitioner should strive to:

• Humanize healthcare: Combine old-fashioned caring with superb medical
care
• Prevent disease and promote health
• Listen to and communicate effectively with patients and their families in
order to form partnerships
• Appreciate and bridge cultural differences, so that care plans are under-
stood by their patients
• Share decision making with patients and their families as partners
• Emphasize the necessity of a team approach in caring for each patient
• Integrate the best medical knowledge into healthcare that is accessible,
patient friendly, and high quality
• Act as an advocate for patients and the health needs of society
• Act as a steadfast guide and source of support to patients, no matter where
they choose to seek specialty care
• Raise awareness that book-smart doctors can lack emotional intelligence,
and appreciate how a disease affects a patient’s daily life

Sir William Osler followed in the footsteps of the ancient Greek physician,
Hippocrates (460–377 B.C.). These quotations by Hippocrates reflect his
 Why Integrative Gastroenterology? 11

philosophy of the body’s natural healing force and the importance of proper
nutrition and exercise to good health. There is also a message to young physi-
cians to guide the patient’s healing, that it is better to do nothing than to harm
the patient.

“Everyone has a doctor in him or her; we just have to help it in its work.
The natural healing force within each one of us is the greatest force in
getting well.”
“To do nothing is sometimes a good remedy.”
“Walking is man’s best medicine.”
“If we could give every individual the right amount of nourishment and
exercise, not too little and not too much, we would have found the safest
way to health.”
—Hippocrates

Conclusions

Digestive diseases are responsible for a major economic burden in the United
States and worldwide. Preventive care, education about the influence of diet
and lifestyle on digestive disease development and treatment, and research
support, all lag behind in meeting the need to correct the economic burden
and to provide future generations of scientists in the digestive sciences. Given
the American digestive disease epidemic, there is a need for governments to
readdress this shortcoming and to review its methods of support, as well as for
physicians to adopt an integrative approach to the prevention and treatment of
digestive disease.

“The doctor of the future will give no medicine, but will interest her or his
patients in the care of the human frame, in a proper diet, and in the cause
and prevention of disease.”
—Thomas A. Edison, U.S. inventor (1847–1931)

NOTES

I. The term iatrogenic is defined as “induced in a patient by a physician’s activity,

manner, or therapy. Used especially to pertain to a complication of treatment.”
II. Sources: Vital Statistics of the United States—1970, National Center for Health
Statistics, Table 1-26, “Deaths from 281 Selected Causes, by Age, Race, and Sex:
United States, 1970”; death certificates from 31 states, reported in “Mortality of
Dentists, 1968 to 1972,” Bureau of Economic Research and Statistics, Journal of the
12 INTEGRATIVE GASTROENTEROLOGY

American Dental Association, January 1975, pp. 195ff; death reports collected by the
American Medical Association, reported in “Suicide by Psychiatrists: A Study of
Medical Specialists Among 18,730 Physician Deaths During a Five-Year Period,
1967–72,” Rich et al., Journal of Clinical Psychiatry, August 1980, pp. 261ff.;
Vital Statistics of the United States—1990, National Center for Health Statistics,
Table 1-27, “Deaths from 282 Selected Causes, by 5-Year Age Groups, Race, and
Sex: United States—1990”; National Occupational Mortality Surveillance data-
base, reported in “Mortality Rates and Causes Among U.S. Physicians,” Frank
et al., American Journal of Preventive Medicine, Vol. 19, No. 3, 2000.
Discovering Diverse Content Through
Random Scribd Documents
 CHAPTER XII.
A PLOT THAT FAILED.

Secrets often leak out of a country post office, just how no one
knows, but still they do, and when Mark called upon Judge Miller
after arriving in B——, and escorting Virgene home, that gentleman
said:
“Well, my young friend, I suppose I am to congratulate you upon
receiving an appointment to the naval school, and I am glad of it.”
Mark stood aghast, and the judge continued:
“Mr. Clemmons told me his son Scott had received an appointment,
and that a like official looking document had come through the mails
for you, and he supposed it was also a cadet midshipman’s berth in
our navy, though he wondered how you had obtained, without
influence, what he had found no easy task to secure for his son.”
“Yes, sir, I have orders to report for examination, but I wished to
keep it secret, for I may fail, you know, sir.”
“Not you; but I suppose you won yours from having saved a
schooner from being wrecked some half a year ago, and which made
quite a hero of you, I remember.”
Mark saw that the judge was on the wrong track, so he did not
correct him as to how he had gotten his appointment.
“Well, Mark, you came to see me for some purpose, so out with it,”
said the judge.
Mark told of his seeing the little schooner adrift at sea, and going
out in his boat had found her abandoned, so sailed her into port.
He had taken from his meager savings enough to advertise her in
Boston, Portland and New York, but no claimant had come, and so
he wished to know if the vessel belonged to him.
“You have a claim upon her, Mark, and can get salvage, should her
owner turn up; but there is just such a craft needed, or will be
within a couple of months, for running around the islands with
parties, and my advice to you is to secure a skipper and a couple of
men and let them run the trips for you, for it will bring in a snug
income to your mother, while, should her owner appear, you have
the vessel to give up to him upon the payment of salvage. Now,
what do you think of my advice, Mark?”
“I thank you for it, sir, and shall take it.”
“And your skipper can report to me, if you wish, while you must tell
your mother to come to me, if I can in any way serve her, for I
suppose she will move up to B—— when you go?”
“No, sir, my mother will remain at Cliff Castle.”
“What, alone?”
“No, sir, she has old Peggy.”
“It is a dreary, weird place to dwell, Mark.”
“She likes it, and she prefers to remain, for we have talked it over,”
answered Mark.
Soon after making a few purchases for home, he went on his way to
his boat just as the sun was setting.
As he passed the tavern, Virgene Rich called to him, and said:
“Mark, I have just learned that Scott Clemmons has also an
appointment to the naval academy. You must beware of him, Mark,
for he is your bitter foe now, and mine, too, since I testified against
him.”
“He is not dangerous, Miss Virgene,” replied Mark indifferently.
“You mistake; for all snakes are dangerous, as they strike from
cover. I will see you before you go, will I not?”
“Yes, miss, and I hope you will ride down to see my mother, as you
promised.”
“I certainly shall,” was the answer, as Mark walked on.
At his boat stood Silly Sam, who said:
“See here, Mister Mark, I hain’t no bullfrog to croak, but I seen a
gang o’ fellers sail downstream an hour ago who hain’t no friends o’
your’n.”
“Thank you, Sam, but it’s catching before hanging, you know.” And
with a light laugh Mark sprung into his skiff and sped away just as
twilight fell.
He had to beat down the inlet, and as he stood over toward a point
of land in the darkness, running on the port tack with the wind
blowing fresh, his little craft suddenly gave a lurch and the next
instant went over, throwing him into the water.
As he rose he heard the sound of oars, and in the darkness saw a
large boat rowing toward him, while he heard voices say:
“That rope settled him, as you said it would.”
“Yes, and we laid it just right; but do you see his boat?”
“Yes, there she lies upset, and she’ll drive out to sea with him on
her, so that ends him.”
“But he is not on the boat.”
“Then he has drowned, for Silly Sam said he could not swim a
stroke.”
“Let us take up the net.”
“Oh, no, leave it down, for his boat seems caught in it, and that will
tell the whole story.”
The boat, a large fishing yawl with sails down, was rowed up to the
capsized skiff, and every eye was turned over the dark waters, while
several hailed to see if a swimmer was near.
The surf-skiff was caught in the net, which had been stretched to
accomplish just what it had done, and, confident that their victim
had perished, sail was set on the fishing yawl and it sailed away
toward the town.
Then from out of the shadows swam Mark Merrill, and going to his
upturned boat he removed the slender mast, righted the skiff,
clambered in, and with his hat threw the water out.
Then the mast was stepped once more, the wet sail spread, and the
surf-skiff held on her way homeward, while Mark mused aloud:
“I know two of the three who were in that boat; but I’ll not tell on
them—oh, no! I’ll just keep my secret for future reference.”
 CHAPTER XIII.
STUMBLING BLOCKS.

From a hint given him by Commodore Lucien, Mark had devoted

himself to certain studies, so that there should be no chance of his
failure to enter the academy through ignorance.
His mother had helped him greatly, and in her mind there was no
doubt of his passing the examinations, both physical and mental,
severe though they might be.
As he had told Judge Miller, his mother had decided to remain at
Castle Cliff with old Peggy.
They had talked it all over, and as, for some reason, Mrs. Merrill
wished to shun the world, to live the life almost of a recluse, they
had all agreed that it was best for her to remain where she was, and
Peggy was equally as content with the arrangement.
When Mark returned from his visit to B——, which, but for his being
a splendid swimmer, would have been fatal to him, he did not tell his
mother of the plot he knew had been concocted to put an end to his
life.
He simply told her that he had run upon a fishing net where he had
never expected to find one, and going very rapidly, with a fresh
breeze blowing, the surf-skiff had capsized, throwing him and his
purchases out. His papers were all wet, but Peggy quickly dried
them.
“But about this check, Mark, which Commodore Lucien so kindly sent
you?” asked his mother.
“I answered the letter at once, mother, returning the check, and
accepting the outfit, for which I shall pay him at some future day.”
“That was right, my son.”
“Mother, I went to see Judge Miller about the schooner, and he made
a suggestion which I think it would be well to follow. You know
Jasper Crane has no smack now, and is in hard luck, while he and
his two sons are the best seamen on the coast, so we can put them
on the schooner, as a crew, the old gentleman being skipper. As it
will also cost considerable for me to reach the Naval School, I can
make a cargo of the raft that came ashore and run it to Norfolk,
thence going up the Chesapeake to the Naval Academy, while
Captain Jasper Crane brings the schooner back and follows the
advice of Judge Miller about putting her on as a packet among the
islands.
“He is very kind, my son, and I believe the plan is a good one, as
well as yours to run the lumber to Norfolk, only you must give
yourself ample time, so we will begin preparations to-morrow.”
This was done, for Mark sailed down the coast to the home of
Captain Jasper Crane, who dwelt near where the Merrills had first
lived when coming to the coast, and the old sailor and his sons were
delighted with a prospect of getting work to their liking.
Two weeks after the Venture, for such was the name of the derelict
schooner, set sail for Norfolk, Captain Crane declaring that he would
serve as first mate while Mark was on board.
The run south was made in good time, and the lumber brought
sufficient to pay the crew liberally and return to Mrs. Merrill several
hundred dollars, while Mark took sufficient for his own needs, and
enough to pay his debt to Commodore Lucien.
The rush of the Venture up the Severn River in a gale, with Mark at
the helm, whose masterly work won the admiration of the middies,
and we will now follow the young sailor into the new world he had
entered.
Mark had politely given his name to the cadets, and asked the
question as to how he would find the commandant, expecting a civil
response.
But here was a novelty for the fun-loving cadets.
Against all custom a new man had arrived in his own craft by sea.
He had given them ocular demonstration that he was not a
greenhorn on the deck of a vessel, whatever he might be in other
things.
He came dressed as gorgeously as Ralph Rackstraw of H. M. S.
Pinafore, and he had not been abashed in the presence of their
marine highnesses.
This was all wrong, very wrong, in their eyes.
What right had a new man to know the stem from the stern, the
forecastle from the quarter-deck of a vessel, when entering the
academy?
He came there to find out, to be taught, and he must start on even
terms with all other verdant youths.
He attacked the academy from the sea, boarded, as it were, the
sacred grounds over their marine stone bulwarks, giving the sentry
at the gate the go-by, ignoring the existence of the officer of the
day, and, confronting them with a natty tarpaulin set upon the side
of his head, with spotless duck trousers, a sailor shirt with
embroidered collar, and a sash about his slender waist, had coolly
said that his name was Mark Merrill, and he wished to be directed to
the quarters of the commandant.
This was too much for Winslow Dillingham, who took it upon himself
to play the part of “Smart Aleck,” and he looked the stranger over
with a cool, insolent stare, and said, in a drawling way:
“Beg pardon, but you said your name was Jack Hayseed, I believe?”
“I said that my name was Mark Merrill, and asked to be directed to
the quarters of the commandant,” and Mark kept his temper
admirably.
“Well, Mr. Pork Barrell, for such, I believe you said your name was, I
will answer for the commandant that he wants no fish to-day.”
“Ah! then you are the commandant’s cook, so should know; but as I
never argue with servants, I’ll seek your master.”
And Mark Merrill started on his way, when with a bound Winslow
Dillingham confronted him, his face livid with rage.
 CHAPTER XIV.
FACING THE MUSIC.

The quick retort made by Mark Merrill to Winslow Dillingham’s

insulting words brought a general laugh, for the cadets were quick
to appreciate wit and sarcasm, even if directed at one of their
number.
Cadet Dillingham had offered the insult gratuitously, and he had
gotten a reply that offended him deeply.
The laugh of his comrades angered him the more, and stung by the
words of the stranger and their enjoying them, he lost all control of
himself, and sprang before Mark Merrill in a threatening attitude.
Mark had not advanced a step since landing.
He stood upon the wall where he had stopped upon ascending from
his boat, and he simply paused to ask a polite question, and
received an insulting response.
The first insult he had accepted in silence, but the second one he
had been stung to reply to.
He saw at once that he would have to fight his way—that whatever
the “future admirals” might be considered by outsiders, they were
merciless to a stranger who came into their midst.
Quickly over the crowd he had run his eyes, and he discerned with
intuition that his retort had put him in favor with some of those who
were lovers of fair play.
He had turned the laugh upon Midshipman Dillingham, and he was
satisfied and content to drop all ill-feeling.
But not so with the irate cadet.
His own attempt at smartness had gotten him worsted thus far, and
he must turn the laugh to protect himself from his own comrades.
He knew well the position he held, that many stood in awe of him on
account of his brute strength and admitted courage.
Now he was angry, and he intended to resent physically what he felt
he could not do in a war of words.
So he squared himself before Mark Merrill, and hissed forth, while
his eyes blazed with anger:
“Retract your insulting words, sir, or I shall chastise you right here!”
“Do you mean it, mate?” Mark asked, in an innocent way.
The crowd smiled audibly at this, and Winslow Dillingham grew
whiter with fury, while he savagely said:
“Yes, I do mean it. Ask my pardon, or take the consequences, sir!”
“What are the consequences?”
“A thrashing.”
“Well, I don’t wish to be whipped, so if you retract your insult to me,
I’ll ask pardon for what I said.”
“I retract nothing.”
“And you will insist upon thrashing me?”
“Yes.”
“What with?”
This was too much for Cadet Dillingham, and he aimed a savage
blow at Mark’s face.
It was cleverly caught, and quicker than a flash Mark Merrill had
seized the cadet in his arms and hurled him into the water with the
words:
“You are too hot to argue with, so cool off!”
With a splash Cadet Dillingham went beneath the surface, when the
cry arose:
“He cannot swim a stroke,” and the laughter on every lip was
checked.
“Is that so that he cannot swim? Then I’ll haul him out as I threw
him in.” And with a bound Mark Merrill went over the sea-wall and
seized the drowning youth in his strong arms, while he struck out for
a landing, with the words:
“All right, mate, the ducking has cooled off the temper of both of
us.”
Winslow Dillingham made no reply then; but as he was hauled out
by Herbert Nazro, a dark-faced, handsome fellow of the first class,
he said, as he turned to Mark Merrill:
“I humbly ask your pardon, my friend, and will escort you to the
commandant and report my own rude behavior and its just
punishment.”
“I thought there was manhood in you, mate, but there is no need of
reporting anything. I have a dry suit aboard my craft, and will soon
rig up and return ashore, when maybe some of these gentlemen will
show me my course.”
“We’ll march you there in force, sir, for somehow you’ve caught on in
great shape with us baby tars,” said a cadet, stepping forward and
offering his hand, while he added:
“My name is Herbert Nazro, a first-class man.”
“And here’s my hand, sir, as a friend,” said Cadet Captain Byrd
Bascomb.
“Don’t overlook my extended grip,” cried Cadet Sergeant Neil Carrol.
And so it went on until Cadet Lieutenant Frank Latrobe seemed to be
suddenly inspired with a thought for he asked, eagerly:
“I say, my friend, are you not the youth who was appointed by the
President?”
“I was appointed at large, sir, yes.”
“And it was for services rendered, was it not?”
“It was from the kindness of the Secretary of the Navy and
Commodore Lucien, rather.”
“You are the man we have been told of. Go aboard your flagship, put
on your dry togs, and we’ll march you to the commandant at a quick
step.”
The cadets showed that this advice chimed in with their humor, and
springing into his boat, Mark sent it flying back toward the schooner,
while the dripping Dillingham was surrounded by a squad of friends,
to hide his condition, and marched off to his room to also get on dry
clothes.
“Keep him there, Nazro, until I can get ready, for I wish to be in the
procession,” said Winslow Dillingham, as he dove into his room to
change his clothes, glad to escape the argus-eyed officers about the
buildings and grounds.
 CHAPTER XV.
BOARDING THE VENTURE.

To Mark Merrill his salt-water bath with his clothes on was nothing to
speak of. He had lived so much in his skiff, been overboard so often
that he thought nothing of it, though he did regret losing his temper
with Winslow Dillingham, who had shown himself such a good fellow
after all.
Of course he did not suppose that he would have drowned, for there
were too many manly fellows upon the wall who could swim to allow
that.
But, having placed his life in jeopardy himself, he was the one to
prevent any fatality therefrom.
The idea that the youth could not swim had never entered his mind,
for swimming like a fish himself and never remembering when he
could not do so, he supposed it was the most ordinary
accomplishment, and, as he had said, he merely wished to cool the
temper of the one who had set upon him as a butt to be made fun
of.
“What’s the trouble ashore, my lad?” asked Captain Jasper Crane,
who was about to launch the schooner’s yawl to come to the shore
when he saw Mark returning.
“Oh! nothing to speak of, sir, only I had to stop some funny business
one of the boys played on me, and finding he could not swim I
leaped in after him.”
“Just like you, Master Mark, just like you,” said Captain Crane,
following the youth into the cabin.
“And I tells yer, lad, you’ll find more hard knocks to put up with
among them brass-buttoned gentry ashore than you’d get as a
foremast hand on a merchant craft.
“My advice to yer would have been to stick to your little craft here
and make money; but then you is high-minded and I knows it’s in
yer to make a name for yerself, if yer sets about it, only the course
are a rough one to sail. Maybe me and one o’ the boys better go
ashore with yer next time, for we is some handy with our flukes
when we is run afoul of.”
Mark laughed heartily, for it came into his mind how he had seen the
skipper and his sons run afoul of, as he expressed it, one day in
Portland, by a gang of roughs, and had a fair demonstration of how
“handy they were with their flukes.”
To see him go ashore under an escort amused him greatly, as he
pictured the cadet-midshipman being knocked about by the trio of
salts from the Kennebec.
But he thanked the captain for his offer, and went on with his toilet.
Meanwhile the skipper was called upon deck.
A boat had come alongside with a middy in command, sent from the
man-of-war, to have the skipper of the strange schooner give an
account of his seeking an anchorage where he had.
Having heard of the trouble Mark had met with ashore, Captain
Crane gazed upon the spry young middy with no friendly eye.
“Are you the sailing-master of this craft?” asked the midshipman
pompously.
“I am the mate, very much at your service, young officer.”
“Where is the master?”
“The capting is down in his cabing; but if you wish to see him I’ll
send yer keerd, and maybe he’ll see yer, maybe he won’t.”
The face of the youth flushed at this, and he asked sternly:
“Is this a yacht on a pleasure cruise, my man?”
“Now, see here, my boy, I hain’t your man. I’m my old woman’s
man, and nobody else has a claim on me, for I am o’ age.”
“Answer my question, sir.”
“Yes, it are a yacht on a cruise, but leetle pleasure I’m thinking it will
bring her capting by coming into this port.”
“I wish the name of your vessel, her owner, and why she is here.”
“I suppose ef I don’t tell yer, you’ll tarn yer big guns on the craft;
but as I said, I am only the mate, and the captain will be on deck in
a minute, for he is down below changing his clothes, having just
thrown a young admiral in the drink, and then had to jump in and
pull him out to keep him from drowning, so you better be
uncommonly polite to him, as the water are handy and real wet,
too.”
The midshipman felt that he was being made fun of.
He saw the smiles on the lee side of the faces of his boat’s crew, and
he knew that they saw that he was getting worsted.
His orders were simply to board the schooner and ascertain her
name and business in the anchorage she had chosen.
That was all.
Much breath had been consumed thus far in conversation, and he
had discovered nothing.
He was getting angry, and yet it came to him that disciplining
himself was one of the first things taught at the Naval School.
If he could not command himself, he certainly could not expect to
command men.
He saw that he had struck a rough old hulk, one that could be
towed, but not rowed, and he decided to change his manner of
attack by demanding to see the owner or captain of the vessel.
 CHAPTER XVI.
UNDER CONVOY.

Just then out of the cabin came Mark Merrill, dressed as before, in a
very natty sailor costume.
He had heard all that had passed, and suppressing a smile, politely
saluted the midshipman, for he certainly wished no more trouble
upon his début as one of Uncle Sam’s middies.
“There’s the capting now, Officer Buttons,” growled Skipper Jasper
Crane to the midshipman, pointing toward Mark Merrill, as he
stepped on deck.
“That!” exclaimed the middy, as he beheld a lad not as old as
himself, rigged up in a dandy style.
“Yes, that, and he’s more of a sailor to-day than half your men-o’-
war trained jim-cranks,” and turning to Mark, the old skipper
continued:
“Capting Merrill, this is a young gent from the big gun craft yonder
who sprung his catechism on me until I got weary, so I tarns him
over to you.”
“How can I serve you, sir?” asked Mark, with extreme politeness.
“Do you own this schooner, sir?” asked the middy, somewhat
amazed at finding so youthful a skipper.
“I may say that I do, sir.”
“You are her captain?”
“At present, yes, sir, Mark Merrill, at your service; but I expect to
relinquish my vessel to good Captain Crane here within an hour or
so.”
“May I ask why you sought an anchorage here in the Naval Academy
harborage?”
“I am a stranger, sir, in this port, but came under orders to report as
a cadet midshipman, so ran my vessel here to anchor. I trust I have
broken no law, sir?”
The polite manner of Mark, his pleasant smile, quite disarmed the
young officer, while he was surprised at his words that told he had
come under orders as an appointee to the academy.
“No, sir, you have broken no set law, only it is uncommon for other
than government vessels to run in here. But I shall report who you
are and the reason of your coming.”
“Permit me also to say, sir, that my schooner will put to sea to-night,
so that she will remain here but a couple of hours at the farthest.”
The midshipman bowed, then did the manly thing, for he extended
his hand and said:
“Allow me to welcome you to the academy, Mr. Merrill, and hope that
you will pass the ordeal of entrance with flying colors. My name is
Ernest Rich.”
The name recalled the sweet face of Virgene Rich to Mark, and he
grasped the extended hand with real warmth, while he said:
“I thank you for your kind wishes, Mr. Rich.”
Then he escorted the midshipman to his boat, told him he was just
going ashore to report, and soon after the gig of the vessel of war
pulled away he went over the side into his surf-skiff.
“Don’t yer think we’d better go ashore with yer, Master Mark?” asked
Captain Crane dubiously.
“No, indeed, thank you.”
“These young fellers all seems practicing to scare ordinary folks; but,
Lord love ’em, they is a clever lot o’ young sea cubs arter all, and in
war times they can outfight a shark.”
Leaving good skipper Crane moralizing upon cadet midshipmen in
general, Mark let fall his oars and sent his skiff shoreward.
It was an off-duty time at the academy, and the cadets were there
whom he had left, with more who had been summoned to swell the
procession. It had leaked out just who Mark Merrill was, for
Commodore Lucien had been on a visit to the commandant, and had
told of the pluck of the boy pilot of Hopeless Haven.
Then, too, the Secretary of the Navy had written a personal letter to
the commandant, so of course it went the rounds that the “new man
from Maine was a hero.”
Having made the discovery, Cadet Captain Byrd Bascomb and his
clique meant to give the sailor lad a welcome, especially as they had
found in him one who was a square good fellow.
When Mark landed he was somewhat nonplussed at the intention of
the cadets to honor him.
They welcomed him with a hurrah, and Winslow Dillingham was on
hand, as he expressed it:
“As dry as a ship on the ways.”
He offered his hand cordially, and said:
“We are quits now, aren’t we?”
“Do not speak of it,” was the ready reply, and as he could not help
himself Mark’s arm was locked in that of Cadet Captain Byrd
Bascomb, who gave the command as he took the head of the
column:
“Column forward! march!”
Up to the commandant’s quarters they marched, a line was formed,
and the “great mogul,” as the lads facetiously called their chief,
supposed when he saw them that they had some grievance to
complain of.
When the commandant appeared the cadets saluted, and waited for
him to speak, Mark meanwhile, his face flushed with
embarrassment, standing by the side of Byrd Bascomb and inwardly
regretting that he had ever decided to come to the Naval Academy.
“Don’t skedaddle at the first sight of the enemy,” whispered Cadet
Captain Byrd Bascomb, realizing how Mark Merrill felt at such an
introduction to the commandant of the academy.
Under this advice Mark braced up, while the commandant asked in
his pleasant way:
“Well, Cadet Captain Bascomb, may I ask why I am honored with
this visit?”
This appealed to the young cadet officer, who prided himself upon
his speech-making, and was always glad to get a chance to display
his oratory, saluted, and responded:
“We are here, most respected commander, to present to you one
who boarded the academy grounds by way of the harbor and over
the sea wall.
“He asked the way to your quarters, and discovering in him the
young hero who won his appointment to the service, which is more
than any of us were guilty of, we came as a convoy to conduct him
to your presence, and I beg to introduce Mr. Mark Merrill.”
 “‘We come as a convoy to conduct him to your
presence, and I beg to introduce him as Mr. Mark
Merrill.’” (See page 69.)
 CHAPTER XVII.
JACK JUDSON’S MEMORY.

When the little schooner Venture was seen driving up the bay and
into the Severn River, the cadet midshipmen ashore were not the
only interested watchers of her progress.
She had swept around the bluff, where now stands the popular
resort known as Bay Ridge, in a manner that at once attracted every
sailor’s eye who saw her.
The little fleet of stanch craft that found a safe harbor in Annapolis,
were anchored snugly in a sheltered nook, all ship-shape to ride out
the gale.
Each vessel had its crew on board in case there should be dragging
of anchors, and they were compelled to get up sail, which all
devoutly hoped would not be the case.
Then ashore there was an interested crowd on the oyster docks
gazing with admiration upon the beautiful craft driven along like the
very wind, carrying an amount of canvas which appeared foolhardy
in the extreme.
Over at the fort, on the opposite side of the river, were groups of
soldiers also observing the schooner’s rush up the harbor, and
officers were braving the fierce wind to have a look at her.
The reviewing ship, and training ship for the middies, also had their
quota of observers, while upon the stately vessel of war anchored in
the stream the large crew were riveting their gaze upon the Venture,
while the tars were commenting upon the manner in which she was
being handled in a manner most complimentary to the helmsman,
though with a belief that they would see him come to grief before he
reached an anchorage.
Upon the quarter-deck of the vessel-of-war her officers were
chatting over the flying craft, and various criticisms were made as to
the skill and recklessness of the helmsman.
They, of course, had their own ideas as to what was good
seamanship, and expressed them accordingly.
But it is forward, among the men, the bone and sinew, the human
machinery of the navy, that I will ask my reader to accompany me.
Among a group of over a score of sailors leaning over the port
bulwarks forward was one who was gazing with more than usual
interest upon the schooner.
“Mates, I have seen that craft before,” he said decidedly, making a
glass of his two hands to look through.
“When, coxswain, and whar?” asked an old salt, with gray hair and a
complexion like the hide of an elephant.
“It was when I was on leave some months ago and took a run in my
brother’s schooner that trades on the coast of Maine.
“I saw that craft, I am dead certain, come into the port of B——,
and she came then in a living gale, and had only two men and a boy
on board of her.
“The boy was at the helm, and ran her up to the dock in great
shape.
“I was told that he carried the mail between some of the ports on
the coast, and generally went in a surf-skiff in any kind of weather,
but sometimes came up to the town with a load of fish, which he
had that day.
“Several days after he came up to town in his surf-skiff and I made
his acquaintance, and if that’s his craft then he’s the one as has the
tiller.
“I’ll get my glass and take an observation,” and Coxswain Jack
Judson went below, but immediately returned with a very handsome
glass, which had been presented to him by his brother of the trading
schooner.
He took a steady look, and said decidedly:
“Mates, that’s the craft, for a month’s pay it is, and it’s the boy at the
helm for another!”
“Waal, what is he doin’ in these waters, coxswain?” asked a seaman.
“I don’t know, but did you ever see a craft better handled?” All
admitted that they never had, while an old sailor growled forth:
“He’s trying to show off, and he’ll carry his sticks out of the craft yet
before he can drop anchor. These young sailors is allus fools.”
“No, he won’t hurt her, and he isn’t any fool, either, for he knows the
craft and what she’ll do when he puts her to it.
“I don’t think he’s trying to show off, for that isn’t like him, only he’s
running under what sail he had up when the gale struck him.
“You see now there are four men aboard, counting the boy as a
man.
“Every rope is where it belongs, the crew are at their posts and they
are not at all uneasy, from their looks, while there is a gray-head
among ’em.
“They all seem to be enjoying the run, looking at the scenery and
unmindful that they have got everybody watching them.
“Mates, I’ll tell you a story of that lad, for I know him now without
looking through my glass.
“His name is Mark Merrill, and I saw him stand to fight a gang of five
young roughs who set upon him,” and Jack Judson told the story of
how Scott Clemmons and Ben Birney had smashed the toy ship
which Mark Merrill had taken up to sell in B——, to get money to pay
the doctor for going to see his mother.
As he was talking the schooner swept by in splendid style, winning a
murmur of admiration from all on board the vessel of war, and when
she came to an anchorage Jack Judson said with enthusiasm:
“He’s let go his mudhooks, and didn’t carry a stick or inch of canvas
away, either.
“Yes, he’s my lad, and I’m going to ask leave to go and see him,
too.”
 CHAPTER XVIII.
STRANGELY MET.

When Mark Merrill was presented to the commandant of the Naval

Academy he felt deeply embarrassed at the publicity which had been
given to his arrival.
He had sailed up to the academy from Norfolk to save money on the
railroads, and then he saw that Shipper Crane and his sons had a
lurking desire to see where he was going to anchor for the next few
years, while cramming his head with all the cargo of learning
necessary to make a skilled naval officer.
And Mark had been anxious to have the skipper tell his mother when
he returned that he had left him at his destination, and what he
thought of his future home.
He certainly had not intended to attract attention by his arrival, but
greatness had been forced upon him by a combination of
circumstances which he could not avoid.
Although when the commandant had entered the navy, back in the
“Forties,” there had been no naval school, except aboard ship, he
had been a middy, and was well aware that they had not changed
much since those days.
He understood that Cadet Captain Bascomb and his mates had in
some way gotten wind of the coming of Mark Merrill, and had at
once seized upon him as a hero, the fact of his saving the yacht
Midshipman having leaked out.
There were a number of officers at headquarters, and they, as well
as the commandant, looked on with interest at the introduction of
the newly appointed lad.
Mark, though his face was flushed with embarrassment, had doffed
his tarpaulin and stepped forward toward the commandant, and
said:
“I am ordered to report to you, sir, but did not know that I was
breaking any rule in coming as I did by water.”
“I am glad to meet you, Mr. Merrill, and to welcome you to the Naval
Academy, while I do not know of any law against a cadet coming by
water.” And the commandant smiled, while, turning to the cadets, he
continued:
“You may leave Mr. Merrill in my charge now, Captain Bascomb, and
I am glad that you gave him the welcome you did, as, from all
accounts, he is deserving of it.”
The cadets saluted, and were marched off by their captain, while the
commandant, in a kindly way, invited Mark into his quarters.
To his surprise Mark beheld in the room, standing by the window
where he had seen all, no less a personage than Scott Clemmons.
The latter had just arrived, and reported to the commandant.
He was most fashionably attired, wore a spotless white silk tie
around his standing collar, and held in his hand a high hat,
presenting a perfect specimen of the youthful genus dude.
His face was pale, and his eyes had an angry look as he turned them
furtively upon Mark.
“Here is also a young gentleman from your State; in fact, I believe
you are neighbors, as you both hail from B——. Mr. Merrill, Mr.
Clemmons,” said the commandant, introducing them.
Scott Clemmons, in a nervous way, half-stepped forward with
extended hand, but Mark simply bowed, ignoring the hand, a fact
which the keen eyes of the commandant took in, and rather set
down against Mark, who said:
“Yes, sir, I have met Mr. Clemmons before.”
There was something in the tone and manner in which it was said
that convinced the commandant that their meeting had not been a
pleasant one, and Scott Clemmons remarked in a supercilious way:
“Yes, commandant, but this young man does not move in my circle
at home, being only a fisher lad.”
The commandant almost gave a start, and his kindly face changed
so suddenly to a look of sternness that even Scott Clemmons saw
that he had made a mistake.
Had he not seen it, he was instantly made cognizant of the fact, for
the commandant turned directly toward him, and said in a distinct
way:
“Mr. Clemmons, I believe your father is a man of great wealth and
comes of an aristocratic family, but you must distinctly learn at once
that here, in this Naval School, neither politics, riches, nor family
connections hold the slightest influence.
“There are no cliques; all who come here come as young gentlemen,
and though many are from the lowest walks of life they must be
gentlemen here.
“Mr. Merrill may have been a fisher lad, but I have it from the best of
authority that he made an honest living and supported his mother,
and he was appointed here for having nobly risked his life to save
the lives of others.”
“I never heard of that, sir, and wondered how he got appointed,”
blustered out the confused Clemmons.
“You never heard how he saved the yacht Midshipman from being
wrecked, with the Secretary of the Navy and other distinguished
gentlemen on board?” asked the commandant, with some surprise.
“No, sir, it was not known in our town.”
“Then, sir,” was the very decided answer, “Mr. Mark Merrill is as
modest as he is brave, not to have told of his daring deed,” and he
glanced at Mark, who replied with a quiet dig at Scott Clemmons:
“I move in no social circle, sir, so had no one to tell it to.”
The commandant turned his head away to hide a satisfied smile,
while Scott Clemmons felt that he had made a sad mistake in his slur
at Mark for being only a fisher lad.
 CHAPTER XIX.
A THREAT.

Scott Clemmons was a remarkably politic young man for one of his
years.
He had seen the gathering of the cadets, and recognized Mark
Merrill in their midst, and it had made him envious and hateful.
One whom he hated was coming under flying colors, it seemed.
Wondering how Mark had gotten his appointment, and angry
because he had done so, he saw that he was made a hero of from
the start, or else why this popular demonstration in his favor.
“Of course he will never pass the examinations, for he is too
ignorant for that,” he said to himself.
Then had the commandant re-entered with Mark Merrill, and the
vain youth had sneered at the sailor-boy appearance of the lad, and
thought what a far greater impression he would make in his fine
clothes and polished manner.
It was in a pitying way he had referred to Mark’s being a fisher lad,
and he meant to condescend to shake hands with him when
introduced, but got the cut in this from the one he intended to
patronize.
Seeing that he had made a mistake, from the commandant’s severe
reproof, the cunning youth meant to atone from policy, to give his
actions an air of manliness, so he quickly said:
“I really intended no slight, commandant, but something occurred
once of an unpleasant nature between Merrill and myself, in which I
am free to admit I was at fault, so I frankly offer my hand now in
friendship, if he will accept it.”
The commandant seemed pleased at this, and glanced at Mark.