HISTORICAL VIGNETTES IN VASCULAR SURGERY Norman M. Rich, MD, Section Editor
Alexis Carrel’s historic leap of faith Sheldon Marvin Levin, MD, San Francisco, Calif
In 1894, Francois Carnot, the popular president of France, was assassinated in Lyons. He was stabbed in the abdomen, and when surgeons were unable to stop the massive hemorrhage, he died on the operating table. The wound had divided his portal vein, a problem at that time beyond anyone’s ability to solve. Carnot was delivering a political speech. In the audience was Alexis Carrel, a 20-year-old medical student. The horrifying event was an epiphany that changed his life. With a leap of faith, he believed he could solve such a problem and was determined to do so. What gave him this confidence? He would employ a revolutionary operating technique. Lyons was the world’s center of the lace industry. Carrel’s mother owned a lace factory, where women produced exquisite lace, using tiny needles and fine silk threads. Carrel was familiar with the technique and was convinced that it could be applied to sewing blood vessels. While completing his medical studies, he practiced embroidery with his mother until he became a proficient lacemaker. He graduated in 1900 and joined the Lyons’ anatomy department, where he obsessively carried out animal experiments. He divided and repaired major arteries and veins, using fine needles and threads. He achieved remarkable, unique results, which were published. Physicians in Europe and the United States were fascinated by his articles, and in 1904, he accepted an offer to work at the University of Chicago. There he expanded the scope of his endeavors, working closely with Dr Charles Guthrie, a physiologist. Dr Guthrie saw potential in Carrel’s vascular techniques and introduced the idea of performing kidney transplants. Exchanging kidneys in animals was successful. From the Department of Surgery, School of Medicine, University of California, San Francisco. Author conflict of interest: none. Reprint requests: Sheldon Marvin Levin, MD, Department of Surgery, School of Medicine, University of California, San Francisco, San Francisco, CA 94121 (e-mail: [email protected]). The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2015;61:832-3 0741-5214 Copyright Ó 2015 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.09.012
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Kidneys produced urine for several days before shutting down. Dozens of articles were written, some with Guthrie as the first author.1-3 The articles evoked considerable attention in the medical community. In 1906, Carrel moved to the Rockefeller Institute in New York, where he widened his horizons further, transplanting other organs; the stomach, the liver, even the heart!4-6 In 1912, he was granted the Nobel Prize in Medicine, recognizing the potential of his brilliant achievements in blood vessel surgery and in organ transplantation. Some observers felt that Guthrie’s contributions were ignored, and he should have at least shared the prize. Carrel returned to France in 1914 when World War I began. As a major in France’s medical service, he worked closely with Henry Dakin, a British chemist, and devised the widely accepted technique of using Carrel-Dakin’s solution in the treatment of infected war wounds.8 After the war, he returned to the Rockefeller Institute, and, utilizing special solutions, successfully kept an embryonic chicken heart beating for 30 years! In 1935, Charles A. Lindbergh, the famous pilot, was concerned that his sister-in-law suffered from rheumatic heart disease with severe mitral valve stenosis. He believed that developing a heart-lung machine could allow surgeons to repair her mitral valve. He enlisted help from Carrel, who was working on a preliminary pump, and together they experimented with improving pump function. Carrel’s book “The Culture of Organs” described the implications of their research. Carrel wrote a best-selling book called “Man the Unknown,” expressing controversial views on eugenics.7 In the mid-1930s, there was growing concern in this country about the fascist regimes of Germany and Italy. There was a segment of our society organized as the America First Committee that took an opposite view. Charles Lindbergh admired aspects of Hitler’s Germany and was a member of the Committee. Carrel identified with Lindbergh, who became a close friend; they opposed support for England in its struggle against the Nazis. Lindbergh, Joseph P. Kennedy, and others believed that the Nazis would crush England, and the US should learn to do business with them. In 1939, Carrel returned to France after the beginning of World War II and, after the fall of France, worked closely
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Fig 2. Carrel stitch (http://sterileeye.com/2008/09/25/ triangulation/).
Fig 1. Alexis Carrel (www.nobelprize.org).
In 1953, Dr John H. Gibbon in Philadelphia performed the first successful open-heart operation using a heart-lung machine. In 1954, early understanding of the rejection phenomenon gave Dr Joseph Murray in Boston the courage to perform the first human kidney transplant in identical twins. It worked! Dr Murray received the 1990 Nobel Prize for his accomplishments. By creating the groundwork for the new fields of vascular surgery and organ transplantation, the genius of Alexis Carrel has saved millions of lives. His techniques are used daily in hospitals throughout the world.9 The achievements of his early years greatly benefitted mankind. REFERENCES
with the Vichy government. In 1944, he was accused by the free French as a Nazi sympathizer and collaborator.8 He died before his case came to trial. Medically, he was clearly decades before his time. One challenge he could not solve was finding a suitable graft to replace the aorta. Advances in anesthesia, antibiotics, and blood transfusions culminated in the 1950s to allow clinical applications of his work. In 1952, using a preserved human aorta as a graft, Dr Chares Dubost in Paris was the first to replace an aortic aneurysm. In 1953, Drs Arthur Voorhees and Arthur Blakemore in New York successfully used a synthetic plastic graft to replace an aortic aneurysm. This innovation was timely, because the human tissue grafts degenerated in a few years and had to be replaced.
1. Carrel A. The transplantation of organs: a preliminary publication. JAMA 1945;45:1645. 2. Carrel A. Surgery of blood vessels and its application to the changes of circulation and transplantation of organs. Johns Hopkins Hosp Bull 1906;17:236. 3. Carrel A, Guthrie CC. A new method for the homoplastic transplantation of the ovary. Science 1906;23:591. 4. Carrel A. Heteroplansplantation of blood vessels. Science 1910;25:740. 5. Carrel A. Experimental surgery of the aorta by the method of Meltzer. JAMA 1910;54:28. 6. Carrel A. On the experimental surgery of the thoracic aorta and the heart. Ann Surg 1910;52:83. 7. Carrel A. Man the Unknown. New York and London: Harper and Bros; 1935. pp 299-303. 8. Edwards S. Alexis Carrel, Visionary Surgeon. Springfield, Ill: Chas. C. Thomas; 1974. 9. Deterling RA. Alexis Carrel, the man and his contribution to vascular surgery. J Cardiovascular Surg 1961;2:81. Submitted May 1, 2013; accepted Sep 11, 2013.
Alexis Carrel’s historic leap of faith Sheldon Marvin Levin, MD, San Francisco, Calif
In 1894, Francois Carnot, the popular president of France, was assassinated in Lyons. He was stabbed in the abdomen, and when surgeons were unable to stop the massive hemorrhage, he died on the operating table. The wound had divided his portal vein, a problem at that time beyond anyone’s ability to solve. Carnot was delivering a political speech. In the audience was Alexis Carrel, a 20-year-old medical student. The horrifying event was an epiphany that changed his life. With a leap of faith, he believed he could solve such a problem and was determined to do so. What gave him this confidence? He would employ a revolutionary operating technique. Lyons was the world’s center of the lace industry. Carrel’s mother owned a lace factory, where women produced exquisite lace, using tiny needles and fine silk threads. Carrel was familiar with the technique and was convinced that it could be applied to sewing blood vessels. While completing his medical studies, he practiced embroidery with his mother until he became a proficient lacemaker. He graduated in 1900 and joined the Lyons’ anatomy department, where he obsessively carried out animal experiments. He divided and repaired major arteries and veins, using fine needles and threads. He achieved remarkable, unique results, which were published. Physicians in Europe and the United States were fascinated by his articles, and in 1904, he accepted an offer to work at the University of Chicago. There he expanded the scope of his endeavors, working closely with Dr Charles Guthrie, a physiologist. Dr Guthrie saw potential in Carrel’s vascular techniques and introduced the idea of performing kidney transplants. Exchanging kidneys in animals was successful. From the Department of Surgery, School of Medicine, University of California, San Francisco. Author conflict of interest: none. Reprint requests: Sheldon Marvin Levin, MD, Department of Surgery, School of Medicine, University of California, San Francisco, San Francisco, CA 94121 (e-mail: [email protected]). The editors and reviewers of this article have no relevant financial relationships to disclose per the JVS policy that requires reviewers to decline review of any manuscript for which they may have a conflict of interest. J Vasc Surg 2015;61:832-3 0741-5214 Copyright Ó 2015 Published by Elsevier Inc. on behalf of the Society for Vascular Surgery. http://dx.doi.org/10.1016/j.jvs.2013.09.012
832
Kidneys produced urine for several days before shutting down. Dozens of articles were written, some with Guthrie as the first author.1-3 The articles evoked considerable attention in the medical community. In 1906, Carrel moved to the Rockefeller Institute in New York, where he widened his horizons further, transplanting other organs; the stomach, the liver, even the heart!4-6 In 1912, he was granted the Nobel Prize in Medicine, recognizing the potential of his brilliant achievements in blood vessel surgery and in organ transplantation. Some observers felt that Guthrie’s contributions were ignored, and he should have at least shared the prize. Carrel returned to France in 1914 when World War I began. As a major in France’s medical service, he worked closely with Henry Dakin, a British chemist, and devised the widely accepted technique of using Carrel-Dakin’s solution in the treatment of infected war wounds.8 After the war, he returned to the Rockefeller Institute, and, utilizing special solutions, successfully kept an embryonic chicken heart beating for 30 years! In 1935, Charles A. Lindbergh, the famous pilot, was concerned that his sister-in-law suffered from rheumatic heart disease with severe mitral valve stenosis. He believed that developing a heart-lung machine could allow surgeons to repair her mitral valve. He enlisted help from Carrel, who was working on a preliminary pump, and together they experimented with improving pump function. Carrel’s book “The Culture of Organs” described the implications of their research. Carrel wrote a best-selling book called “Man the Unknown,” expressing controversial views on eugenics.7 In the mid-1930s, there was growing concern in this country about the fascist regimes of Germany and Italy. There was a segment of our society organized as the America First Committee that took an opposite view. Charles Lindbergh admired aspects of Hitler’s Germany and was a member of the Committee. Carrel identified with Lindbergh, who became a close friend; they opposed support for England in its struggle against the Nazis. Lindbergh, Joseph P. Kennedy, and others believed that the Nazis would crush England, and the US should learn to do business with them. In 1939, Carrel returned to France after the beginning of World War II and, after the fall of France, worked closely
JOURNAL OF VASCULAR SURGERY Volume 61, Number 3
Levin 833
Fig 2. Carrel stitch (http://sterileeye.com/2008/09/25/ triangulation/).
Fig 1. Alexis Carrel (www.nobelprize.org).
In 1953, Dr John H. Gibbon in Philadelphia performed the first successful open-heart operation using a heart-lung machine. In 1954, early understanding of the rejection phenomenon gave Dr Joseph Murray in Boston the courage to perform the first human kidney transplant in identical twins. It worked! Dr Murray received the 1990 Nobel Prize for his accomplishments. By creating the groundwork for the new fields of vascular surgery and organ transplantation, the genius of Alexis Carrel has saved millions of lives. His techniques are used daily in hospitals throughout the world.9 The achievements of his early years greatly benefitted mankind. REFERENCES
with the Vichy government. In 1944, he was accused by the free French as a Nazi sympathizer and collaborator.8 He died before his case came to trial. Medically, he was clearly decades before his time. One challenge he could not solve was finding a suitable graft to replace the aorta. Advances in anesthesia, antibiotics, and blood transfusions culminated in the 1950s to allow clinical applications of his work. In 1952, using a preserved human aorta as a graft, Dr Chares Dubost in Paris was the first to replace an aortic aneurysm. In 1953, Drs Arthur Voorhees and Arthur Blakemore in New York successfully used a synthetic plastic graft to replace an aortic aneurysm. This innovation was timely, because the human tissue grafts degenerated in a few years and had to be replaced.
1. Carrel A. The transplantation of organs: a preliminary publication. JAMA 1945;45:1645. 2. Carrel A. Surgery of blood vessels and its application to the changes of circulation and transplantation of organs. Johns Hopkins Hosp Bull 1906;17:236. 3. Carrel A, Guthrie CC. A new method for the homoplastic transplantation of the ovary. Science 1906;23:591. 4. Carrel A. Heteroplansplantation of blood vessels. Science 1910;25:740. 5. Carrel A. Experimental surgery of the aorta by the method of Meltzer. JAMA 1910;54:28. 6. Carrel A. On the experimental surgery of the thoracic aorta and the heart. Ann Surg 1910;52:83. 7. Carrel A. Man the Unknown. New York and London: Harper and Bros; 1935. pp 299-303. 8. Edwards S. Alexis Carrel, Visionary Surgeon. Springfield, Ill: Chas. C. Thomas; 1974. 9. Deterling RA. Alexis Carrel, the man and his contribution to vascular surgery. J Cardiovascular Surg 1961;2:81. Submitted May 1, 2013; accepted Sep 11, 2013.
