I saw a Historic Blood Transfusion
By FRANK P. CORRIGAN, M.D.
The
famous surgeon, George Washington, Cyril is remembered for many things, among
them his Cleveland Clinic—one of the outstanding institutions in its kind—and
the huge veterans’ hospital in Cleveland which bears his name. But to me his most enduring monument will
always be the extraordinary operation he performed one hot August night in
1906.
It
heralded a new era in surgical history by showing that blood transfusion was
facsimile. And it came about almost by
accident.
I was
house officer on duty at Cleveland’s St. Alexis Hospital when the first-floor
nurse called me. The patient in 106 was
sinking fast, she said. When I got to
his bedside I found that the nurse had not exaggerated. The patient, Joseph Miller, who had been
admitted to the hospital that morning with a badly bleeding kidney, was a dying
man. I felt his pulse—weak and thread;
respiration, rapid and shallow; lips, blue.
Immediately ordering some stimulation and a saline infusion, I located
the St. Alexis staff surgeon, Dr. Crile, who came to the hospital at once.
When he
arrived he was dressed in a dinner jacket, and I knew I had interrupted a
dinner party. Dr. Crile had a
personality that could light up any room and that height he was in
exceptionally fine sprites. He examined
the patient and found him slightly improved by stimulation I had administered,
but it was clear that Joseph Miller had only a short time to live. Dr. Crile turned to me and said, “Corrigan,
I’m going to transfuse him.”
I was
astonished. Although I knew in theory
what he was talking about, I had only a vague idea of what he meant to do and
how he planned to do it. Doctors had
dreamed for centuries of devising a dependable means of putting human blood back
into circulation. In the 17th
century Jean Denys, in France, had injected the blood of a lamb into the veins
of a boy, who miraculously survived, although we know today that interspecies
transfusion is ineffective and dangerous.
Other
efforts included attempts in the 19th century to inject blood into
the abdominal cavity of hemorrhaging women during childbirth. But such experiments had few practical
results and often ended in disaster.
One prime obstacle, it was eventually recognized, was the coagulation of
the donor’s blood when drawn from the body into a receptacle, with the
resulting danger of introducing a clot into the recipient’s blood stream.
During
the first years of the present century, great strides had been made in Chicago
by the brilliant French surgeon and physiologist. Alexis Carrel, later to be awarded Nobel Prize for his pioneering
work in surgery of blood vessels.
Combining his theoretical knowledge of the circulatory system with his
remarkable skill as a surgeon, he had succeeded in joining the blood vessels of
live dogs.
Dr.
Crile now proposed to perform the daring operation on a human being. He would transfuse Joseph Miller by uniting
his blood vessels with those of his brother.
Sam
Miller at his dying brother’s bedside.
Dr. Crile turned to him and asked, “Would you give some of your blood to
save your brother’s life?”
Sam
answered without hesitation, “Yes, of course.”
‘All
right, “Crile said to the nurse. “Tell
them to get ready in surgery. Prepare
the patient’s arm from the shoulder down.”
Then to the healthy brother: “Come along with me, Sam.”
In the
operating room, Sam and Joseph were laid parallel, head to foot, on adjoining
tables. A local anestic was
administered to each of them. Joseph
was by then sinking fast.
It began
to appear, however, that the operation might never begin; Dr. Crile announced
that all our surgical needles were too large for the delicate work of sewing
together the small blood vessels to join the two circulatory systems. Then one of the nuns produced a tiny
needle—almost hair-thin—which used in sewing delicate linen.
A second
snag arose when it became evident that regular surgical thread was too
large. In order of get a thread thin
enough, he unraveled the finest silk twist available in the hospital and used
one of its three strands.
We then
brought together the wrists of the two men and dr. Crile made his
incisions. He exposed the artery near
the surface of Sam’s wrist and a vein in the wrist of the patient. Each of these was sealed off with rubber
clamps, and then severed. Next, threads
were inserted at three points at the mouth of each vessel and drawn sauté,
changing the normal circular shape of each to a triangle. The mouths of the severed vessels were then
brought together, with the interior coating—the intimae—of each vessel in
direct contact with that of the other.
Without perfect contact the blood would clot instead of passing freely
through the junction.
Now Dr.
Crile could begin sewing the vessels together to form a “watertight” joint. Their triangular shape gave him three flat
surfaces to work with. But they were
tiny; each one a their of the circumference of a blood vessel which was no more
than an eighth of an inch in diameter.
Along each of these minute surfaces he would have to take a dozen
stitches.
The
intense summer heat had fallen like a pall over the brightly lit operating
room. Everyone present realized that at
any moment there could be a fatal slip in this delicate operation. With his miniature needle and cobweb thread,
Crile began the crucial job.
God
gives the gift of true surgery to few men; fewer still develop it in to the
utmost. Joseph Miller was fortunate in
having one of those favored few operating on him that night. When the two vessels were completely sewn
together, we released the clamps, and the blood from Sam’s artery began to
course into Joseph’s vein. With each
new spurt of blood, we knew that the union would hold.
The
effect of fresh blood flowing into the dying man’s system was like a
miracle. He recovered consciousness and
his skin became a lovely pink; he opened his eyes and smiled and began to take
notice of his surroundings. We were
lost in wonder and admiration at the sight of this dying man coming back to life,
until the head nurse said, “Doctor, the brother has fainted.”
No one
has been paying any attention to Sam and he had passed out. He looked almost as pale as his brother had
short while before!
We
immediately terminated the operation.
The vessels were sited off again to stop the flow of blood, the junction
was cut away and the severed ends of Sam’s artery and Joseph’s vein were
rejoined. Then the outer skin was
sutured. Although the blood had flowed
from Sam’s body into Joseph’s fir only a few minutes, the entire operation had
taken over three hours. We were
exhausted, but exhilarated by the conviction that we had crossed a new frontier
in medicine.
Thanks
to later developments, blood transfusion no longer requires such surgery. Today blood is drawn front the donor into a
receptacle containing an ant-coagulant, and the transfusion is administered
through direct intravenous injection so easily as to be a medical commonplace.
In 1906,
of course, we had no knowledge of blood types and the Rh factor and the many
other things we have learned since then.
Dr. Crile had used the blood of Joseph Miller’s brother in the belief
that a brother’s blood would be most likely to resemble the general
characteristics of the patient’s. In
Miller’s case, the two more transfusions were needed before he was firmly on
the road to recovery; for those dr. Crile used the blood of another brother and
a sister. After Joseph’s recovery, Dr.
Crile published the data he had collected to demonstrate the feasibility of
transfusing human blood safely. It
caused a sensation in the medical world.
By stimulating renewed interest in transfusion, it made possible the
developments, which are taken for granted today. Both Joseph Miller, and his brother Sam, had full, long lives and
lived until nearly 90 years of age.
