Innovators & Pioneers
George Washington Crile
Born: November 11, 1864 in Ohio, United States
Died: January 7, 1943
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.
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
[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.]
Source: From DICTIONARY OF AMERICAN BIOGRAPHY, Supplement 3: 1941-1945. American Council of Learned Societies, 1973. Reprinted by permission of the American Council of Learned Societies.
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