Early days

George Crile was an exceptional man, a skilled surgeon who lived at a time when American medicine was emerging from its horse and buggy period and was embracing the principles of aseptic surgery and scientific medicine. Always full of new ideas, he was first to carry out a human-to-human blood transfusion. He made many innovations in surgery and was instrumental in founding the Cleveland Clinic.

He was born in 1864 on a farm four miles from Chili, a sleepy Ohio village with one general store, a blacksmith’s shop, a shoemaker, a tanner, a flour mill, and a school. His ancestors were conservative and adventurous Dutch and Irish-Scots men. One of them, believed to have been named Groyle or Gryle, settled in Maryland then moved to Ohio. For young George Crile, as he describes in his autobiography, working on a farm was discipline and education in itself, “cutting thistles, pulling out mullen stalks, shearing sheep, cradling oats and wheat, and hauling hay.”¹ It also served as an introduction to the general sciences as he would witness the mating, gestation, birth, and raising of animals. He learned to unsex farm animals and he noted that castrated animals never fought with each other and were easier to handle, thus showing the effect of sex hormones on behavior. The school was open only six months a year and when the boy ordered a Webster’s Unabridged Dictionary, on arriving the book caused a sensation by its size.

In 1879 Crile left the farm to teach at the district school where, by 1882, he became the principal, a position he held for four years. At fifteen he entered Wooster Medical School (later to become Western Reserve). To graduate from medical school, students had to first study under a preceptor, an established physician. Crile paid two hundred dollars for the opportunity of seeing patients with him, hearing him discuss the symptoms, and observing the treatments he recommended. He could use the library of his preceptor, who directed his reading, made him responsible for the accounting in his drugstore, and taught him how to make pills and compound medicines. Medical school itself, as often before the Flexner report, was conducted in an inadequate building that twenty years earlier had been abandoned as unfit for an elementary school.

After graduating in 1887 at age twenty-three, Crile worked for Dr. Frank Weed, a medical practitioner and dean of the school, first as an intern and later in his practice. There he was also able to carry out experimental work and develop his lifelong interest in the causes and treatment of shock, leading him to devise methods of measuring blood pressure and eventually using treatments such as fluid replacement and the preoperative administer of atropine and cocaine to prevent it. He lectured on histology, for which he cut this own microscopy slides, and worked on diphtheria, developing a better method to intubate patients with upper respiratory obstruction. By 1897 he had carried out research in cancer, developed an interest in genito-urinary and abdominal surgery, with particular emphasis on the surgical treatment of appendicitis. Medical practice in those days was highly demanding but it also offered an opportunity to acquire vast clinical experience. By the turn of the century, Crile had experience with over 10,000 accident cases he had attended.

Wars and innovations

At the outbreak of the Spanish-American War in 1898, Crile served with distinction as a brigade surgeon with the rank of Major. While waiting with his regiment to join the war zone, he acquired a splendid uniform, a beautiful sword, and a handsome black horse he named Sam. He also performed an emergency splenectomy on a cavalryman from New York who had been kicked by a horse. He took part in the landing in Cuba, later went to inspect the Army Hospital in Guantánamo, and found that yellow fever was raging on the island. He then participated in the campaign to conquer Puerto Rico. Here too were all kinds of infectious diseases, in particular yellow fever, which at the time was not known to be transmitted by mosquitoes, and also “tropical fever,” dysentery, and even smallpox.

After the war, he returned to surgical practice and research and developed a technique of skin grafting. One of his particular interests was the better treatment for surgical shock, an interest that went back to his earliest days in medicine. He became interested in the possibility of transfusing blood from one human to another, developed special apparatus and needles to do so, and carried out the first attempt of transfusion in 1905. His first patient, a wasted patient with thyrotoxicosis in thyroid crisis did not survive; however, his second patient, a twenty-three-year-old Russian who had a secondary hemorrhage following nephrectomy for a diseased kidney was a great success. He continued research into using blood transfusions, and was years ahead of its general adoption and use in medicine. He also attempted to use transfusion to cure many other conditions such as malignant disease and infections.

Around 1908 Crile became aware of the deleterious effects of chloroform and ether anesthetics and began to explore the possibility of performing complex operations under oxygen-nitrous oxide anesthesia. Being of the opinion that women would make better anesthetists because of their “natural intuition” he recruited a nurse to develop a new program. He trained her to anesthetize rabbits and dogs, later babies, and eventually patients for major operations. By 1911 he was able to report that she had given 575 anesthetics and eventually developed a school of anesthesia where students would come from all over the world.

In addition to his busy surgical practice, his interest in science was never assuaged and he continued an academic career, rising to professorial rank with a great reputation as investigator and surgeon. He made innovations in the surgical treatment of appendicitis, intubation for laryngeal obstruction, laryngectomy for cancer, abdominal surgery, surgical treatment of goiter, gallbladder disease, genitourinary surgery, cancer and ulcer of the stomach, and cancer of the colon. He traveled widely, attending the great medical centers in London, Paris, and Berlin, and met famous surgical figures such as Lord Moynihan, Theodore Billroth, Almroth Wright, and Alexis Carrel, also Metchnikoff. In 1912 he was one of the twelve men appointed to set up and organize the American College of Surgeons and became its second president in 1916. He received many awards and was in high demand as a lecturer on new surgical methods.

When World War I broke out in 1914, Crile sailed on the Lusitania to France with the purpose of taking medical supplies for the war effort. Visiting the front lines, he saw the abysmal manner in which injured soldiers were being cared for and became involved in developing better methods for dressing burns and treating “shell shock,” frostbite, and neurasthenia (the psychological effects of trench warfare). Later in the war, he returned to France and with his surgical associates from Cleveland, organized and managed an American base field hospital—applying methods he had used in America including blood transfusions, and later treated the victims of gas warfare. By the end of the war, his hospital had treated over 80,000 wounded soldiers. He returned to Cleveland with the rank of colonel.

The Cleveland Clinic

After the war, he continued his surgical practice and academic pursuits. But growing dissatisfied with the restrictions, inefficiency, and lack of organization of university medicine, he founded in 1921 with three other colleagues a private clinic and hospital that became the Cleveland Clinic. He based this on his wartime experience and eschewing the traditional academic university model of separate departments, he envisaged the clinic as a cooperative effort where all the doctors worked as one team. The physicians were salaried, their performance reviewed by a board committee, and salaries adjusted accordingly. Doctors would treat patients in the clinic and in the hospital. In the clinic every specialty had its own “desk,” allowing patients to be seen in consultation without delay. Committee work and teaching exercises were carried out after working hours, while grand rounds and other formal exercises were held on Saturday mornings.

In the decade after its foundation, the Clinic was shaken by a terrible fire in 1929 when 160 people lost their lives, including patients, employees, and the very founding physician of the clinic. Recovery was aided by the help of the community, and in the ensuing decades, the Clinic expanded greatly. In the late 1940s, academic departments were established, including a unit under Dr. Irvine Page studying hypertension and a department of artificial organs under Dr. Willem Kolff developing the first disposable dialyzer, pioneering cadaver kidney transplantation and the development of the artificial heart. There were many firsts in medicine at the Cleveland Clinic and the spirit of combining education, research, and excellence in patient care has continued to this very day.

Conclusion

Dr. Crile continued his work to devise new methods to treat and prevent infection and surgical shock, and for his efforts was awarded the Distinguished Service Medal. At age 74, in 1936, he performed a celiac ganglionectomy for hypertensive disease, and the procedure was widely carried out at the Clinic but eventually abandoned as not being effective. During World War II, he was an honorary consultant to the Medical Department of the United States Navy. In his retirement, he became interested and conducted research in marine animal physiology. A man with an indomitable spirit, he died in 1943. He is remembered as one of the great innovators in American medicine.

Further reading

1. George Crile: An Autobiography, edited by Grace Crile. JB Lippincott Company 1936.