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(continued)
Crile developed a "shockless" method of anesthesia ("anoci-association") by which he
attempted to isolate the operative site from the nervous system, where he believed
surgical shock to originate. Anoci-association made use of generous premedication with
morphine and atropine, regional (procaine) block, and anesthesia by inhalation of
nitrous oxide and oxygen administered by trained anesthetists. His "kinetic theory" of
shock on which he based anoci-association was without foundation, but his methods were
excellent and foreshadowed today's use of trained anesthetists and balanced
anesthesia.
Crile's clinical experience was enormous, and he made many contributions to clinical
surgery. He early became interested in surgery of the head, neck, and respiratory system
and in 1892 performed what may have been the first successful total laryngectomy in this
country. He recognized the need for complete excision of lymph nodes in cancer of the
head and neck and devised a technique of radical dissection comparable to the radical
operation of W. S. Halsted [q.v.] for carcinoma of the breast. Crile pioneered in surgery
for goiter and was able to compile a very large series of successful operations (25,000 by
1936) on patients with hyperthyroidism. He also wrote extensively on other surgical
diseases, such as cancer, peptic ulceration, and diseases of the biliary tract.
Military surgery interested Crile throughout his life. He served as an army surgeon in
Cuba and Puerto Rico during the Spanish-American War, and during World War I he
aided in the organization of the Army's Medical Department. He was appointed director of
clinical research for the American Expeditionary Forces, and while in France taught the
need for whole blood transfusion, safe anesthesia, wide debridement, and adequate
drainage for wounds. He also urged that the "moratorium wards" where soldiers were
taken to die be redesignated "resuscitation wards," where soldiers would be given whole
blood to resuscitate them instead of morphine to ease their deaths. He experimented
with means of resuscitation even for apparently hopeless conditions. His methods were
often imaginative, and included the administration of oxygen under pressure for gas
casualties, epinephrine for patients in shock, and diluted sea water infusions to support
victims of massive trauma.
On Feb. 7, 1900, Crile married Grace McBride of Cleveland, who actively shared and
encouraged all of his interests. Their children were: Margaret, Elisabeth, George, Jr.
("Barney"), who also attained distinction as a surgeon, and Robert. Crile's chief interests
outside of his profession were big-game hunting and horseback riding. He went on a
number of safaris in Africa and made several family trips to the American West.
In 1924 Crile was sixty, the age of mandatory retirement from the surgical chair at
Western Reserve, but retirement was unthinkable for a man of his energy. In 1921, with
several colleagues, he had founded the Cleveland Clinic, where he subsequently acted as
chief surgeon. His interest in research now included the comparative anatomy of the
neuroendocrine system. He made trips to Florida, the Arctic, and Africa, where he
collected some 4,000 species of animals for his dissections; the results appeared in his
book, INTELLIGENCE, POWER AND PERSONALITY (1941). He became engrossed in a "radio-electric
theory of life," and believed that the autonomic nervous system and the endocrine
glands controlled energy release within the body, and that a number of disease states
resulted from overproduction and release of energy. Unfortunately he projected his
theories into clinical practice and attempted to cure such diverse conditions as
hypertension, "neuro-circulatory asthenia," and epilepsy by "de-kineticizing" operations.
These included adrenal gland denervations and removal of the celiac ganglion, a large
nerve plexus deep within the abdomen. Crile performed many hundreds of these
operations, probably with little real benefit to his patients. He also continued to operate
during the later years of his life when age and its infirmities (including the loss of one
eye and diminishing vision in the other) should clearly have disqualified him from active
surgery. Despite these failings of his later years, Crile's place in American surgery is
secure. His honors and accomplishments make an impressive list. He was a founder of
the American College of Surgeons and served as its president (1916-17) and on its
board of regents (1913-41). He became a consultant to the Air Force in 1941 and saw his
pressure suit revived to prevent blackout in the fighter pilots of World War II. He also
served as the president of the Cleveland Clinic from 1921 to 1940.
Crile remained active until a few weeks before his death. In 1941 he survived a plane
crash in Florida, despite his age and in spite of serious injuries. During the last weeks of
1942 he developed bacterial endocarditis. He improved at first on penicillin (just then
introduced) but succumbed to the disease in Cleveland early in 1943. His remains were
cremated and the ashes were interred in the Highland Park Cemetery in Cleveland.
Crile was a man of great energy, imagination, curiosity, and organizational ability. His
best work was done during the golden age of American surgery -- roughly, from 1885 to
1915 -- when surgery evolved from a crude and chancy art to an applied scientific
discipline. His greatest contributions were to surgical physiology, a field that has become
of the highest importance to surgery during the decades since his death.
-- A. Scott Earle
Further Readings
[The chief source of biographical information, with several excellent photographs, is GEORGE CRILE: AN AUTOBIOG., ed. by Grace Crile (2 vols., 1947). To this may be added obituary material from: the CLEVELAND CLINIC QUART., Apr. 1943; The BULL. OF THE AM. COLLEGE OF SURGEONS, Feb. 1943; the ANNALS OF SURGERY, Apr. 1944 (by William E. Lower); and the AM. PHILOSOPHICAL SOC., YEAR BOOK, 1943 (by Evarts A. Graham). A contemporary popular evaluation of Crile's place in American surgery is to be found in his obituary in the N. Y. TIMES, Jan. 8, 1943. For Crile's role in popularizing the determination of blood pressure in surgery, see John F. Fulton, HARVEY CUSHING: A BIOG. (1946). Crile's DISEASES PECULIAR TO CIVILIZED MAN (1934) and THE PHENOMENA OF LIFE: A RADIO-ELECTRIC INTERPRETATION (1936) illustrate his later medical beliefs. Dr. George Crile, Jr., was most helpful in answering questions and commenting on this brief biography.]
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