Courtesy: Medical Miracles, from Readers Digest 1981.
November.
From the frontiers of science and the far horizons of
personal courage, these stories of medical triumphs and miracles will reaffirm
your faith in the awesome powers of the human spirit. Dramatic victories and
human triumphs.
Selected and edited by the editors of Readers Digest
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.
