CARREL—MENDER OF MEN.

Oamaru Mail, Volume XXXVII, Issue 11811, 21 December 1912, Page 3 (Supplement)

CARREL—MENDER OF MEN.

(By Curl Syndor.) l)r Carrel began V2 or 13 years ago. when lie was prosector in the hospital of his native Lyons. It was with an amazingly simple thing—just a stitch! But it was for that stitch and all that it enabled Dr Carrel to do that he was given the Nobel Prize, and not for the work which he is doing now. richly fruitful as that work promises to be. But did you ever stop to think how practically every step of human progress and, for that matter, every tiny advance of human intelligence has depended upon some often slight mechanical or physical thing? . Consider the question of surgery. Suppose 1 that you were out somewhere away from any help dtad that a friend had cut a vein or artery and that his life depended upon your binding it together again—how. would you go about it? Very much as a seamstress would mend a patch or join together two pieces of cloth. And the degree of your success would more or less depend upon your familiarity with the seamstress' ., art.' . •'.'"

Now everyone knows Low deftly expert some seamstresses are, and how they will put together the edges of a piece of fabric so closely and with such a fine whipstitch that it is sometimes difficult to see the seam. Consider now that surgeons, ready-made and other, have been binding* up severed veins, probably for thousands and quite possibly teiiis of thousands of years. There is good evidence that the aborigines of both hemispheres practised the art of trepanning, or boring a little hole in the skull, to extract an embedded arrow, long before they were able to work in me-tnls—that is", when they were still using stone implements. This could not have come until long after they had been able to sow up wounds. Now the'amazing part of all this is that through all these thousands of years the surgeons never gained the same dexterity with the needle that almost any housewife could show! When Dr Carrel began his work he was inspired with the idea that if one. 1 could transplant the organs of the body and change them about, .this would mean not only a great advance in surgery, but perhaps lend a great insight into the workings of the human machine. But every one of the organs, as we call them —the liver, the kidneys, the spleen, and so on —have large veins and arteries, sometimes several, leading to and from them, and it somehow seemed an extremely difficult (thing to join arteries which hud been cut. Ido not know if Dr C'arrc-1 had a mother who was wonderfully expert with her needle, but he must have known some one, for the method he worked out was beauti-'|

fully ingenious. The veins, as you know, are rather elastic little tubes, and if, in the circular opening which a cut vein would make, you made three thrusts of a needle at equally separated points, you would have what as school children we learned to call an isosceles triangle, or one with equal sides; and if each of, these sides was formed., by a single thread with extended; ends so you could pull on them, then you could pull the vein itself into this triangular shape, and then by doing the same thing with the end of the other vein, you could put these together, end to end, and sow along a straight line. It sounds a little complicated to de-

scribe, but it is fairly simple in practice, and the sewing together is with the same overhand stitch that every housewife knows. But notice the result.

In pulling out the little tubes of the arteries so that their ends take on this triangular shape, the tissue is considerably stretched. Now if you use the finest needle and the finest and smoothest silk thread that you can get. and make this thread still smoother bydrawing it through vaseline, the holes which the needle and thread make will be so minute that when the tension is relaxed 'they will close up of itheiii' own accord and you will have a nearly seamless union.

This is precisely what Br Carrel did. and the result was that his "sutures," to use the surgeon's parlance, offered no anchorage uuon which blood might clot —one of the deadly dangers of arterial surgery. And so quickly and smoothly did tlie tissues knit together that in an astonishingly short time the effect and often even"the trace of the operation had disappeared. It was with this simple but marvellously effective piece of technique that Dr Carrel has performed a" large part of all his subsequent niiracles. But do not imagine thatrit is quite as easy as it looks. Dr Carrel described" his method and its advantages in a French medical jourual more than 12 years ago. It was adopted very quickly by other surgeons all over the world, and has quite revolutionised the especial part of surgical practice with which it deals. And with it many others have attempted the same feats that Dr Carrel has seemed to achieve with such apparent ease. But somehow it has only been he, and' not those whom he has shown, who has done the new things. Some of this is due obviously to a quite unusual skill and. still obviously, some of it to a wonderful patience and perseverance. But nil of these even would count for little were it not for ono further tiling. If you read Dr Carrel's papers, even the more recent you will note a curious insistence upon "what he and other physicians term a rigid asepsis—in plain parlance, avoidance of contamination by microbes. Here, indeed, in the'most vivid sense is the siir{rje»n'.s "blar'k beast" —h'js deadliest foe. So long as the living tissue, like the skin or the mucous luting of the mouth and alimentary canal, is inthct, the bacterial life cannot penetrate, and even the bacterial poisoning from the outside is largely excluded. But cut it, puncture it in any way. either with the surgeon's knife or a bullet, or the vicious little jigger of the mosquito or the fie a. and the door is open for infection. AH this has been known now for going on half a century. It is very suggestive that after all this time Dr Carrel should find it worth while to insist so stronglv upon this elementary precaution. It is evident that in his own mind a considerable measure of his success has been the extreme care that he has taken to keep out the bacterial hosts. How important this is was brought home to him in only the present rear, in the new work of which I shall tell in a moment, that of making seemingly "dead" tissue grow. In this work Dr Carrel used only microscopic bits—often only a few cells at 5 time—yet even here, working with these cells which are themselves but a little larger than manv of the bacteria, he found that his work was blocked incessantly by these same marauding hosts of destruction. . Here, again, was required the most rigid asepsis." Here, again, the tremendous importance of the slightest details.

Using this technique, this patience, this caution. Dr Carrel lias been able to plav with the animal machine almost as if it wore made of tubes' and rods of brass and iron. He has taken important organs from one animal—the kidneys for example—and transported them into another with no evil effect. ' He has taken a leg of one dog and grafted it on another in place of one taken away, and with no outward evidence of the change. He has taken the heart of a little doc and introduced it into the neck or a larger dog and linked it ud witlrthe coronarv circulation of the fatter, and thus done literally probably what has never been done before, all poetry and fancy to the contrary—made two hearts to beat as one! And these are but a few of his bewildering.feats. Verv justly, though, one may inquire :* What's tho good of it .all? A phvsician would • answer: The greater the freedom with which we can change or control the bodily processes the greater the possibility of curing every manner of human defect. But Dr Carrel's work would have a tremendous significance if we were not so astonishingly myopic in our ideas about human life. Consider for a.moment this question: Every year, with no great hindrance on the part of any legislative or other authoritv. our railways kill something like 10.000 persons. Thev injure something like 150.000 more. We have no very reliable figures as to factory and similar accidents, but you may make a guess at the total from the fact that about 5000 coroners' cases are reported nnnallv in the Borough of Manhattan, and that this 1-itter is somewhere around ]-loth of the population of the Union. If you count in from five to

tea thousand murders a year and per- ! haps nearly as many suicides, and ali the people who are killed on trolleys or run over by the ruthless automobile, it seems probable that the yearly number of violent deaths in the United States from more or less avoidable causes runs from 50,000 to 100,000. And the number of. maimed and crippled must be at least ten times this —certainly far over half a million. Now supposing we looked at this in a way that Dean Swift might have done. Obviously, the-se 50.000 or 100,000 factory employees, trainmen, children in the streets, and the like, slaughtered thus ! with hardly a qualm, were just so much human chaff—worthless or very near it. Else would not the men who make our laws, sit upon the bench or upon juries, do something radical to stop it? w» know that thev do practically nothing. Well, if these 50,000 lives are worth little or nothing, why should we be so horribly squeamish about them/ . Depending upon the degree of mutilation — whether the bodies are blown to pieces, or chewed up, or.merely punctured by a bullet or killed electrically, here, ata i modest, calculation are at least. 50,000 «ood arms, as many legs, and perhaps 1 slightly less number of lungs, livers, hearts, and other organs. Why lam sure Dean Swift would'ask: Should all this enormously valuable material be thrown- away? Why should it not be out in cold storage m central stations from which ' the surgeons could draw at will in patching up and remaking the half a million or more unfortunates who are maimed and mutilated—have an arm torn off or something—without b Tam'Lwa're- that this idea will seem very shocking to some people, and Specially to people s„lLimgma- ; tions; who are duly horrified when 1500 people are drowned like so many rats when n Titanic races against an,icebere but will not contribute _a solitary dollar, an hour of time, or a single vote fdr way law which will in any way tend to lessen the daily butchery of human beings in this country, which. mak.es the 3aily industrial mortality m America greater than that of any war that was ever waged. , . . , Meanwhile the actual application ot Dr Carrel's methods has actually begun in a small way, and we may reasonably expect tliat" what may be called plastic surn-ery, on a broad scale, will be one of the'developments of the future. _ It was for this work largely that'Dr Carrel received' the Nobel Prize, not for the spectacular things which he is doino- now. The very latest of these he described at a meeting of •physicians recently in New York City. He called it a "visceral machine." It was in effect simply the vital organs of an animal, the lungs, liver, kidne'vs, stomach, and alimentary tract, etc., separated from the body and from the'nervous system. And for ahout eleven hours, or until assistants tired of blowing a bellows in this machine, tolerablv normal respiration., circulation and digestion were maintained; the heart was kept beating, the lungs expanding and contracting, the stomach secretin"- and digesting its food, and the blood, pulsing through the arteries and back through the veins almost as if it were consciously alive. The thing was so unbelievable that had the announcement been made hy any other than a man of Dr Carrel's standing, it would have been contemptuously dismissed as a'monstrous fake. How" was it done?

If you open, most nny school physiology, even, the best, yoti -will there read, all were taught, that the various; functions of the body are more or less under the control of the ■ nervous svstem and that the proper co-ordina-tion of the bodily functions (long and difficult words se?m dear to most scientific writers) is thus brought about. But the difficult part of any growing n.nd expanding science, such as physiologv, is that what seenis quite firmly established one day is shown to be quite untrue or, in largo part, baseless tho next. Tho nervous control and regulation of tho human machine is a case in point. Within the last five years a quantity of new work has shown that a large part at least of tho bodilv functions ar,e> noarlv automatic, mid that even tho "co-ordination" of their functions is not effected by means of the nerves, but bv substancFs secreted by the different orgr.ns and distributed to points, often verv distant, through the circulation of the' blood. The?.a substances Professor Starling has called hormones or "exciters." A typical one is the substance secreted by the little suprarenal capsulrs. which ara about as bitr a.s the l end of your little .finger. This substance travelling about in th? blood stream controls among other things the blood pressure. Another regulates our breathing, another tho opening and closing of the stomach, and probably others the- beat of the heart, though this latter is not yet clear. But .noto how all the advancement of knowledge''is exactly like the movement of the cogs of a machine. Before this new knowledge had como no on© would have dreamed of attempting to isolate the various organs and try to keep them going without th? aid of any brain or nervous system. It would havH been perfectly clear and demonstrable that tho thing could not be dene.

So you see that Dr Carrel, with his fine technique and his patience and'his daring", comes just in the nick of time. His work makes one tooth in the cogs; tlui work of Professor Starling and others on the hormones forms another tooth. Tlie two fit perfectly, and ber hold the time machine grinding out a new marvel! Eleven hours, it is true; is not a. long time to keep the bodily functions going, but there ' seems no good reason why this .should not be kept up indefinitely under proper conditions, and machinery toward this end. which, is mainly a little mechanism for blowing up the lungs rhythmically as in ordinary respiration, is now under construction.

When this is attained, then the physiologists can Perform their experiments, many of them, with the greatest case, and without the slightest suggestion of giving pain. May we, then, hopo that the dreary whine of the antivivisectionists will be stifled? But all these achievements of Dr Carrel's, spectacular as they are, pale in scientific interest before his latest preoccupation, which is little less than an inquiry into the mystery of life and death. • •

Perhaps that fact is natural phenomena, at the present time shrouded in the deepest obscurity, is tho mechanism or, if you- please, the cause of growth. How arid under what conditions can a, single bit of microscopic living matter multiply itself, and at the same time fo transform itself that it may-become, for example, an elephant, .an oak, an orchid, .or a human being? . This is the problem which has so deeply becunied another member of the, Rockefeller Institute, Professor Jacques Loeb,' and with results of far-reaching .importance. It was another- side of the question which engaged the attention of-Dr Carrel. If wo snip off a sprig of plant and put it in the ground, it will ofton grow. In sohio of the lower animals the power of'reproduction of parts is oftentimes considerable, extending even to the renewal of the lens-of the eye. This latter is one of the 'most highly specialised bits of living tissue we know of. Why should this not be true of apes and other humans?

Taking up a -method devised .by Professor Harrison, Dr Carrel •'has-already-been able to produce some astonishing results. ■'■'-.''-'

Tjle " lias bsen ■ able, for example, t<> take bits of cold-storage chicken arid set them growing again! . Of course, this growth is as yet.only of : 'microscopic dimensions, but it is none the less real and wonderful. What is more,' it seems as if tbis growth under "proper, conditions, could be kept up indefinitely. Dr Carrel has already kept some bits crowing for months, is nothing now to indicate that ther? is any term to their activity. In other words, he offers the possibility of achieving immortality for individual living tissue!

Is it anv wonder tbat a man so gifted with manipulative power and imagination should have, a heart on fire with the thoughts of what might do if only lie can liv? long cnoutrh? —any wonder that to siieh a man the allure of earning an income of £IO,OOO or £20.000 a year from his skill as a surgeon is no temptation—to whom even such a. prize as the Xobsl award brings probably as many worries in the way

of inane interruption of his work as it. did of satisfaction —any wonder that such a man finds it hard to understand why one should wish to be a typical money-grubbing American? You have a natural curiosity to know something of the personal side of such si. man? He is rather short of stature, with a finely rounded head, a smiling face, and those lovely continental manners which seem io difficult of reproduction in this country. Although he has been in this country only seven years, he both speaks and writes excellent English. He lias something of a tasfo for philosophy, is an admirer, though hardly a follower, of the French writer, M. Bergson, and, by way of an avocation, has spent some, of his vacation time in studying at first hand the miraculous happenings, at Lourdes. But that great philosopher and; teacher whom he. most deeply reveres was"" the French physiologist, Claude Bernard. He is of the latter a ~fcrue disciple; he is more, he seems almost a reincarnation. -At any rate, it is not. too much to say that he is quite the greatest experimental genius in the field of "physiology that France has prodticed since Claude Bernard closed his richly fruitful life. .