There is a river arising in the Appalachian Mountains and flowing through the Piedmont of North Carolina (from the Latin pedemontis meaning foot of mountains) before continuing to the Atlantic Ocean. Native Americans called this river Yattken or Land of Big Trees in reference to the forest blanketing the river’s drainage basin. As settlers with European ancestry pushed westward out of Pennsylvania and Virginia, the trails and paths that Cherokee and Siouan tribes tribes etched through the forest became roads. The preeminent route being The Great Wagon Road. For centuries prior, the Indians of the Piedmont were familiar with a species of tobacco plant having a high nicotine content and a bitter taste, Nicotiana rustica. The tobacco produced from this plant was smoked ceremoniously in pipes, inhaled as snuff or deployed as a topical medicant for wounds. English settlers used tobacco differently, for enjoyment, and found the taste of tobacco from Nicotiana rustica unpleasant. In the South, it might be said - but isn’t- that the newcomers didn’t cotton to Nicotiana rustica. They preferred tobacco from Nicotiana tabacum, a plant that led to milder tobacco possessing a lower content of nicotine. With the influx of settlers, the Native American population was decimated by disease and conflict. The surviving Indians were displaced; some Cherokees still reside in the Appalachian Mountains of western North Carolina. While this debacle was occurring, the newcomers cleared the forest and used the timber for dwellings. The land where the trees once stood became cropland and the main crop grown by the settlers was Nicotiana tabacum. In time, the Piedmont region of North Carolina came to dominate world tobacco production. 

Aided by innovation and savvy marketing, two mighty tobacco companies emerged in the region. The first innovation was the serendipitous discovery by a slave in Caswell County North Carolina, Stephen Slade, of a method to flue-cure Nicotiana Tabacum thereby creating bright leaf tobacco, a product having a mild, sweet taste that became immensely popular. The second innovation was the invention of the Bonsack machine for rolling cigarettes. Automation allowed cigarettes to be produced 50 times faster than cigarettes rolled by hand. An early adopter of the technology was the pater familia of a family that was to become the namesake of one of the two Piedmont tobacco dynasties and uncoincidentally the namesake of a highly regarded University.  Soon cigarettes were plentiful, inexpensive, and convenient.  Consequently, the amount of tobacco consumed by smokers of cigarettes soared past the amount of tobacco consumed by users of pipe, chew or snuff. An ambitious tobacco grower whose farm and distribution center was located on land in the watershed of the river whose name had been anglicized and textualized to Yadkin had the idea of blending bright-leaf, burley and Turkish tobaccos plus sweetener into a cigarette. The resultant cigarette, Camel, was a tremendous success and secured the fortune of the second tobacco dynasty in the Piedmont. 

Around the time the Camel cigarette was introduced, an executive with the company that produced it bought a 1400-acre tract of land east of the Yadkin river and south of a river crossing known as Shallow Ford. The purchased land became the tobacco executive's country estate. The estate was given a grandiose name that was an apt descriptor of the surrounding ecosystem; something like Woodland Knoll Estate. A lake was created by damming a tributary of the Yadkin River. A functioning mill house with a boathouse and guest rooms was built on the lake. The family’s primary residence, a 24 room Georgian style mansion, was built nearby. The road through this early 20th century version of Xanadu meandered 3.5 miles. The estate lasted precisely one generation. Descendents of the original owners divided the property and sold it off in parcels. Today, the new growth rising from the former estate is mainly the subdivision. Trees and other flora have generally been subtracted from the landscape. The tobacco executive’s surname is memorialized in the name of the lake, the mill house, and the two-lane blacktop road that winds around the subdivisions. 

Due to the historic importance of tobacco and cigarettes to the region, the prevalence of smoking is high in the Piedmont of North Carolina.  Throughout my career, I was, apart from a small number of cases, forbearing toward patients who were cigarette smokers. This was an easy position to take. As a surgeon engaged in emergency general surgery, I had little sway over my patient’s habits.  I suppose during an encounter with a patient whose viscus had perforated I could have persuaded the patient to swear off smoking... with the patient’s promise having the sincerity of a confession extracted by torture. While I denounced smoking, I had some sympathy for the cigarette smoker. For one thing, the more frequent annoying habit of the patients I treated was gluttony. My typical patient arrived with a surfeit of abdominal adiposity.  When it comes to opprobrium, compared to cigarette smokers gluttons get a pass. As recently as the 1990s smoking was permitted everywhere; on planes, on buses, in restaurants and in theaters. Now smoking is restricted to outdoors, personal vehicles, and homes; and outdoors in a public space, the smoker is often silently scorned. 

I became less sympathetic toward the cigarette smoker when a utility project closed the main road through the subdivision in which I live, a subdivision built on land once part of what I am calling Woodland Knoll Estate. Four to six times a week, I had been running a 5K - or sometimes a 10K route- along the streets of the subdivision. With the main road impassable, to continue running the same distance, I was forced to alter my route. The new route, a curvilinear closed loop, took me outside of the subdivision. The portion of the loop outside the neighborhood caused me to run along Tobacco Executive Road.  The litter on the shoulder of this road exceeded what I was accustomed to running through. Not wanting to jog through a cloaca, I decided if I was going to stick to this course I would need to collect the litter. The idea came to me that it would be efficient to collect the litter during my runs; like the mythological Atalanta slowing to collect golden apples except instead of gathering golden apples I would be collecting litter.  It did not matter to me if stopping and starting added a minute or two to my pace. My daily runs are for well-being, not personal records. I proceeded to put my plan into action. For disposing of the bulkier items of trash, for example, a Styrofoam clamshell carryout food container, I identified accessible Waste Management trash receptacles along the route. A reliable one was located at the mouth of a narrow gravel road that led to a house that was unable to be seen from the road. Another trash bin was situated on the parking lot of a small rural Baptist Church. To reach these trash depositories, I had to leave my jogging path. To minimize this, in the pocket of my running shorts I kept a one-quart plastic freezer bag with a sliding lock that I purchased in bulk from one of America’s largest retailers. In this baggie, I inserted smaller pieces of litter or litter such as aluminum cans or plastic bottles that I could crumple with my hands while still running. When I returned home, I tossed the freezer bag of trash in the bin at my house.  

It was while collecting litter along Tobacco Executive Road that I had an epiphany. The shoulder of a road attracts cigarette butts the way spilt sugar attracts ants in summertime. Adding the distance out and back, I was only running along the road for one mile, yet there wasn’t a day that I did not collect multiple cigarette butts. After running the alternate course for a month, I had collected more than 120 of the rascals and they were not hard to find.  The discarded cigarette butts lay in the grass or weeds inches from where the paved edge of the road ended. No doubt, tossed from cars. An online search revealed the magnitude of the problem. Keep America Beautiful, a non-profit organization with the mission of improving the environment, estimated that 9.7 billion cigarette butts were littered in 2024 far exceeding the second most common item of litter; food wrappers. This suggests far too many cigarette smokers are in the habit of flicking cigarette butts out car windows with impunity; behavior I had not previously laid against the typical smoker. 

For most people, including myself, the impetus to collect trash along roads that skirt community property or private property in which the residence is far from the road is not great. Litter collection depends on altruistic volunteers, or volunteers provided by the city or county responsible for maintaining the road. Those latter volunteers can sometimes be identified by their uniform, the orange jump suit. There are just not enough volunteers of either type. Maybe in the future small, lightweight drones will do the job by zipping alongside roadways to hooverup cigarette butts.  

Considering the rise of the cigarette from the Piedmont of North Carolina and the problems linked to cigarettes but unknowable at the beginning of the 20th century when the mass-produced cigarette burst forth, I am reminded of the famous quote from a Nobel Prize winning Southern writer, “The past is never dead. It isn’t even past.”

Bruce Harris MD FACS is a retired General Surgeon who practiced in North Carolina. Dr. Harris earned a BS in Physics at Harvey Mudd College in 1977, and is a graduate of the University of Missouri-Columbia School of Medicine in 1981. He enjoys running, reading, writing, snowboarding, and rafting.