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 November 11, 1864 in Ohio, United States
 January 7, 1943
 American
 surgeon
Crile, George Washington (Nov. 11, 1864 - Jan. 7, 1943), surgeon, was born near Chili,
Ohio, the fifth of eight children of Michael Crile, a prosperous farmer, and Margaret
(Dietz) Crile. His father was of mixed Scotch-Irish and Dutch ancestry, his mother of
Dutch background. Both families had settled in America before the Revolution and both
had lived in Ohio for two generations. Crile attended district schools near his home and
then worked as a teacher while studying at Northwestern Ohio Normal School (later Ohio
Northern University), where he received the B.A. degree in 1884. Although both parents
were English Lutherans, Crile, after reading Paine, Ingersoll, and Voltaire in his college
years, became a lifelong atheist, devoted to the concept of intellectual freedom.
Entering the University of Wooster Medical Department (later absorbed by the Western
Reserve University School of Medicine) in Cleveland in the spring of 1886, he received
the M.D. degree in 1887 and served a year as an intern at University Hospital in
Cleveland. His interest turned to the study of surgical shock when a close friend, a
student assistant in the hospital, was injured in a streetcar accident and died in profound
shock after the amputation of both legs.
Crile's subsequent career was characterized by ambition, industry, and an intense
curiosity regarding the role of physiology and emotional factors in successful surgery, a
relationship that at the time was not generally recognized. The years following his
internship were occupied with establishing a busy practice; with animal experimentation
into the nature of surgical shock; with teaching at the Wooster Medical School (1889-1900); and with several trips for study in Europe, then almost a necessity for
success in medicine. While abroad he worked (in 1895) with Britain's eminent
neurosurgeon Victor Horsley on the problems of surgical shock, performing experiments
to observe the effects of hemorrhage, anesthesia, and physical stresses such as traction
on the peritoneum in the production of shock. Crile's first monograph, AN EXPERIMENTAL
RESEARCH INTO SURGICAL SHOCK, was awarded the Cartwright Prize by Columbia University in
1897 and was published two years later. Primarily a description of animal experiments,
many of them crude by later standards although advanced for their day, the monograph
represents an important pioneer attempt to delineate the causes, the nature, and the
treatment of shock.
In 1900 Crile became clinical professor of surgery in the Western Reserve School of
Medicine, and in 1911 professor of surgery. His research efforts during these years
continued to focus on shock and related problems in surgery, and by 1914 he had
published monographs on BLOOD-PRESSURE IN SURGERY (1903), on HEMORRHAGE AND
TRANSFUSION (1909) and ANEMIA AND RESUSCITATION (1914), and on anesthesia
(ANOCI-ASSOCIATION, 1914). Many of his conclusions were ahead of their time, and their
importance was insufficiently appreciated. Crile saw the need for monitoring blood
pressure in surgical patients and helped popularize the use of the Riva-Rocci
sphygmomanometer (introduced into America by Harvey Cushing [Supp. 2]) for this
purpose in 1901. Crile saw that the prevention of shock was of far greater importance
than its treatment, and to this end he advocated atraumatic and bloodless surgery
combined with safe anesthesia. Through animal experiments he demonstrated the
importance of measuring the peripheral and central venous pressures and studied their
relationship to cardiac output, hemorrhage, and to replacement of blood volume. He
learned that blood becomes acidotic in shock and suggested the use of bicarbonate
solution to combat the condition. He devised and used clinically an ingenious "pressure
suit" which was capable of restoring blood to the circulation by the application of external
pressure. He also used epinephrine for the same purpose and recognized that the drug
exerted its effect by constricting peripheral vessels.
Although Crile was an acute and accurate observer of the shock phenomenon, his
theories of its cause were incorrect. He recognized the importance of avoiding loss of
blood and the value of fluid therapy, but seemingly he did not perceive that fluid
depletion, i.e., loss of blood or shift of other body fluids, is the chief etiologic agent of
surgical shock. He postulated instead a "kinetic theory" based on changes which he
believed to originate within the nervous system. Since untreated shock led to death, Crile
went on to study methods for resuscitation of the dying. He successfully used saline
solutions and epinephrine to treat patients seemingly in extremis. He soon came to
realize that the brain imposed a time limit, and that if the brain was deprived of oxygen
for more than a few minutes, all attempts at resuscitation were useless.
By 1903 Crile had realized that saline solutions were of limited benefit in the prevention
and treatment of shock, and he was one of the first to use blood transfusions regularly in
surgery. (In 1901 Karl Landsteiner [Supp. 3] had distinguished the four basic blood
groups.) Initially he sutured the donor's artery painstakingly to the recipient's vein for
transfusion (1905); later he devised a cannula to be used for this purpose. He
recognized the dangers of overtransfusion, which he saw as "cardiac dilatation," and the
risks of using incompatible blood, and by 1909 he had adopted methods for
cross-matching blood. By 1914 he was able to state that "the ideal treatment for surgical
shock [is] the direct transfusion of blood." By the end of World War I, Crile saw
blood-banking techniques developed for military surgery, although two more decades
were required before banked blood became available in civilian practice in this country.
Photo: Courtesy of the National Library of Medicine.
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