Blood and Guts

by Richard Hollingham

  The doctors who had now gathered around the president concluded that the dagger had missed his heart, but one of his major blood vessels 'in the region of the liver' had been punctured. The blood pouring from his wound told only part of the story: most of the blood was being lost inside the president's body.

  They did their best to stem the flow with towels and bandages, and at 11.30 the surgeons issued an optimistic statement in which they stated that the condition of the president was 'alarming but not hopeless'. The bulletin went on to suggest that the haemorrhage had ceased. The surgeons were wrong. The president was bleeding to death and there was nothing anyone could do. At 12.45 the president of France was declared dead.

  French justice was swift. A little over a month after the assassination the president's murderer was tried, convicted and executed. The Lyon surgeons concluded that Carnot had died from blood loss caused by a wound to the portal vein – the major blood vessel from the intestines to the liver. Even if they had attempted to operate on him, they would have had little chance of success. No one had managed to mend a broken blood vessel before; the only option open to surgeons was to tie off blood vessels completely. This was fine in a limb, although cutting off the blood supply inevitably ended in amputation. When it came to a major internal vein or artery, the procedure was out of the question.

  The whole affair was deeply shocking, particularly for a young doctor at the hospital, Alexis Carrel. In his autobiography Carrel wrote how the president's life 'left him with his blood, in the midst of the holiday crowd. I can still hear it flowing drop by drop fifty years later.'* Carrel was appalled that the surgeons had been unable to save the president. The death set him on a path that would lay the foundations for modern transplant surgery. It would lead Carrel to a Nobel prize, a partnership with the world's most famous aviator, and into collaboration with the Nazis.

  * It is very unlikely that Carrel was at the bedside of the dying president, but in later years he seems to have convinced himself – and everyone else – that he was. There is also some debate over exactly where the president died. Some historians claim it was at the hospital, whereas reports in newspapers of the time say it was in the city préfecture.

  Alexis Carrel was an odd-looking young man. He had the countenance of someone who thought about things a lot, whether it was the death of a president, the latest surgical advances or the future of humanity. Carrel was intense, self-absorbed and somewhat distant. It was as if he were observing the world from a higher intellectual plain. Physically, he was also quite unusual. Anyone meeting him for the first time found it difficult to identify what it was about his appearance that was so unsettling, until they peered into his tiny eyes. Behind his pince-nez, which he wore for his chronic short-sightedness, you could see that one of his eyes was brown and the other one blue.

  Throughout his life Carrel collected enemies, usually power ful ones. And where better to start his collection than with his superiors at the hospital in Lyon – those surgical butchers who considered themselves such experts, but who had so impotently failed to save the life of the president. They said saving him had been impossible; Carrel thought they were wrong, said as much and set out to prove it.

  First he needed to develop his sewing skills, but not the brutal, clumsy sewing he was used to seeing during operations in the hospital (he sometimes wondered if surgeons took pride in the grotesque size of the scars they left behind). If Carrel wanted to sew together delicate blood vessels, he needed to learn how to do minute, delicate, precise stitching. So he headed to Lyon's silk district and acquired the services of the city's finest embroiderer, Madame Leroudier.

  Carrel was a driven and conscientious pupil and, with the smallest of needles and finest silk thread, he worked tirelessly to perfect his technique. Just trying to thread the microscopic eye of an embroidery needle takes considerable patience and determination but Carrel worked night after night, much to the derision of his macho medical colleagues. Within months, he had not only mastered the stitches, but was almost as good as Madame Leroudier herself. It was said that Carrel was so proficient that he could place five hundred tiny stitches in a single piece of cigarette paper. Now all he had to do was apply his beautiful embroidery technique to some veins.

  Blood vessels are circular, slippery and easily damaged. Cut one and it resembles a damp, floppy drinking straw. Clamp a vein or artery with forceps and it is left crushed and bruised; sew a vein back together again and it will almost certainly leak or clot – either way, it will be all but useless. Carrel had to overcome all these problems if he was to sew blood vessels together successfully, so he headed back to the laboratory with his tiny curved embroidery needles and fine silk thread and set to work.

  The first thing he worked out was how to stop the flow of blood without damaging the vessel. Using bands of cloth, he would gently squeeze vessels shut and successfully hold back the blood. If he rolled back the edges of a cut vessels so that they resembled cuffs, he could sew the cuffs together without the usual leaks or damage that led to clots. But it was Carrel's final discovery that was his most masterful. He called it the 'triangulation method' of suture.

  First, he joined the ends of the blood vessel together by placing three stitches equal distances apart around its edge. For each stitch he left a short piece of silk thread attached. The blood vessel was thus joined at three points. Now here's the clever bit: when he pulled tight on all the threads at the same time he created a straight line between each one. He had turned the circular vessel into a triangle. He could then sew along the straight lines between the threads. It was a remarkably simple idea, but extremely effective. He had overcome the problem of trying to sew around a circular vessel by doing away with the circle. Once he had sewn along the first line, he moved on to the second and the third. When he released the threads, he was left with a neat sutured join in the blood vessel. It was such a simple technique that even the surgeons he held in contempt would be able to manage it.

  It was no great surprise to anyone when Carrel failed to receive promotion at the hospital in Lyon, and it was probably best for all concerned when he left for the United States to pursue his research. In Chicago he teamed up with Charles Guthrie, a similarly obsessed medical researcher, and together they improved Carrel's technique with ever finer needles and thread. They stitched severed veins and arteries, and joined the two together. Usually the veins and arteries belonged to a dog, sometimes a cat, or occasionally a guinea pig. Some animals survived the procedures, some didn't. Carrel was unsentimental about any creatures that might suffer in the name of medical progress.* Armed with his new surgical techniques, he had a much greater purpose in mind: transplantation.

  * The animals would have been anaesthetized, and there is no evidence that they were mistreated. Whether the experiments themselves amounted to mistreatment is a matter for debate.

  INSIDE THE LABORATORY OF ALEXIS CARREL

  Rockefeller Institute for Medical Research,New York, June 1938

  * * *

  Dr Alexis Carrel was now considered one of the world's most eminent and famous scientists. Surgeons, politicians and celebrities came to seek his advice or expert opinion. This month he was even on the front page of Time magazine. The reporter had been lucky to secure an interview – Carrel was usually hidden away in his laboratory, guarded by his protective secretary, as devoted to his work as ever. Since winning a Nobel prize in 1912 for his work on 'Suture of Blood Vessels and Transplantation of Organs', Carrel had conducted thousands of transplantation experiments. He had transplanted limbs from dogs, kidneys from cats and testicles from rabbits. He had taken lungs from guinea pigs, heads from dogs, ovaries from cats and thyroids from kittens (the attrition rate of kittens was particularly high). He had swapped the leg of a black dog with the leg of a white dog and replaced the head of one dog with the head of another.* He had grafted kidneys, livers and lungs; he had transplanted organs, glands and legs. He had swapped skin, rearranged veins and added hearts. No animal, it
seemed, was safe from Carrel's increasingly bizarre research.

  * Carrel wasn't alone. In 1954 a Russian transplant surgeon, V.P. Demikhov, went even further, transplanting the head of one dog on to the back of another to create a monstrous twoheaded creature. This disturbing experiment was brought to an end after the two heads started fighting each other.

  Carrel's laboratories were every bit as sinister as the experiments. Built on the top floor of the Rockefeller Institute, they were reached from an anteroom by a narrow spiral staircase. Here Carrel's fanatical team of researchers worked in sterile windowless labs. They were lit by roof lights and electric bulbs in the plainest of shades. Everything else was in varying tones of black – from the matt black floors to the bare grey walls. Even the cloths on the operating tables were black. There was no colour, no dust and no reflections. Dracula couldn't have conceived a more suitable lair.

  The outfit the scientists wore might have been designed by a fetishist. The researchers were known as the Black Gang. They worked in black gowns and black trousers. Their heads were covered in black linen balaclavas. The headgear was square in shape – like a welder's helmet – with only a narrow slit for the eyes. On their hands the scientists wore thick, black rubber gloves. These shadowy, featureless men would be the last thing most of their experimental animals ever saw.

  There was a good reason for all the black. Carrel had designed the labs to minimize reflection and glare from the lights – vital, he believed, to help the researchers see what they were doing, particularly when they were working on such tiny bodies (such as those of kittens, rabbits and guinea pigs). The all-enveloping outfits were designed to minimize infection. Joseph Lister would have been proud of the lengths to which Carrel had gone to keep the place aseptically clean (see Chapter 1), although Lister might have preferred a cheerier colour. The odd thing was that the only one who wasn't dressed entirely in black was Carrel himself. He had taken to wearing a peculiar white hat that resembled a bandage stretched over his bald head.

  In the late 1930s most of Carrel's laboratory was devoted to his 'perfusion' experiments. He had gone beyond simply transplanting organs to removing them altogether. His aim was to keep organs – eventually human ones – alive and functioning in a totally artificial environment. For the last three years he had been working with his close friend, Charles A. Lindbergh, the first man to fly across the Atlantic. Although it might seem an odd partnership, the celebrity aviator and eccentric French scientist had much in common. Lindbergh shared many of Carrel's political views, they were similarly driven, and both were ambitious to advance medical science.

  In 1938 Carrel and Lindbergh were celebrating the publication of a book they had written together, The Culture of Organs. In it they outlined the 'cultivation' of organs using the Lindbergh pump. The pump was designed to bathe living tissue in nutrients to keep it alive, and looked exactly like the sort of thing a scientist working in a sinister black laboratory would devise. The contraption consisted of a series of pumps, bottles, gauges, valves and odd-shaped glass flasks all connected with lengths of rubber tubing.

  The pump, the culmination of years of effort, was really an early type of heart-lung machine – it kept organs alive, nourishing them and providing them with oxygen. At around the same time, surgeon John Gibbon (see Chapter 2) was also developing a heart-lung machine, only his aim was to keep entire organisms alive – eventually humans – while life-saving surgery was carried out. By the late 1930s Gibbon could sustain the life of a cat. In comparison, Carrel's motives were far more scientifically detached. He was able to sustain the life of a disembodied cat's heart. Improving treatments or saving people's lives wasn't enough for him. He had far loftier ambitions.

  For a start, the Lindbergh pump was to be used to study organs outside the body. It allowed Carrel to examine the nutritional requirements of a particular organ, or study the chemical processes taking place. He could assess the production of insulin in the pancreas, urine excretion in the kidneys or the life cycle of cells. With the techniques he developed, Carrel took the creation of 'cultures' of living tissue to a whole new level. On one bench in his black laboratories he grew cells taken from the heart of a chicken embryo. So far he had managed to keep successive generations of these cells alive for twenty-six years.

  This was all very well, but it was only incidental to his life's work on transplants. Carrel planned to remove damaged organs from a patient's body – a diseased kidney, for instance – place the organ in the pump apparatus and treat it in this artificial medium until it healed. Once the organ had been cured, he would replace it in the patient using the techniques he had first developed in Lyon. It didn't even need to be a kidney – it could be a leg, an arm or even a brain. If Carrel's laboratory was nightmarish now, imagine what it would be like lined with bottles of bubbling glass jars filled with dismembered limbs, diseased hearts and cancerous lungs.

  But even this wasn't enough for Carrel. In what he called his 'new era' of surgery he foresaw a time when human organs could be grown in the lab and used to manufacture drugs such as insulin. He never made it clear who might provide these organs, but the ethics of his work always came second to scientific progress. As the reporter from Time magazine suggested, Dr Carrel was 'looking for the fountain of abundant, replaceable age'. But probably not for everyone.

  Carrel's collaboration with Lindbergh underlay a much deeper moral purpose. The two men were out to change the human race. Three years before, in 1935, Carrel had published his philosophical treatise Man, the Unknown. It was widely read and drew acclaim from scientists, statesmen and intellectuals around the world. In it Carrel outlines his views on everything from future scientific progress to the role of women in society. He was convinced that man was in a state of physical, mental and moral decline and needed to be 'remade'.

  'For the first time in the history of humanity, a crumbling civilization is capable of discerning the causes of its decay,' Carrel wrote. 'For the first time, it has at its disposal the gigantic strength of science.' The recent political and economic turmoil had demonstrated the failings of democracy; he wanted to see a new social order. Countries should be run by a ruling elite, their standing in society determined by biological worth. Man had the power to transform himself, to control his genetic destiny. Only the strong should be genetically perpetuated.

  The irony that a short, balding, myopic Frenchman (with different-coloured eyes) should be calling for the creation of a master race was lost on Carrel. But his call for the introduction of eugenics was well received. The idea that only the genetically 'superior' should be allowed to breed (or encouraged to breed) was something that many in power had been thinking for some years. At various times everyone from Winston Churchill to George Bernard Shaw and H.G. Wells had flirted with the philosophy of eugenics. In six American states laws had been in place for decades to allow the forced sterilization of the insane and 'mentally deficient', and in Germany Carrel's scientific standing added credibility to the philosophy of the Nazi government. In the German edition of his book, he even went so far as to endorse Nazi policies.

  Carrel probably had little knowledge of what was really going on in Nazi Germany, despite having travelled and lectured there in 1936. By the mid-1930s eugenics was at the heart of German government policy. Hitler was oppressing opposition groups, people of Jewish faith, ethnic minorities, homosexuals and gypsies (among others). The government had set up concentration camps, as well as secret extermination centres where the mentally and physically disabled were being killed. At the same time women of Aryan descent were being encouraged to have as many children as possible.

  However, while Carrel advocated preventing the criminal or insane from breeding, he shied away from destroying 'sickly or defective children as we do the weaklings in a litter of puppies'. Instead he felt the only way to 'obviate the disastrous predominance of the weak is to develop the strong'. Among his suggestions was the proposal to remove the sons of rich men from their families so that t
hey could 'manifest their hereditary strength'. And although he believed childless women were 'not so well balanced', unlike many misogynists he was a firm believer that women should be highly educated, 'not in order to become doctors, lawyers or professors, but to rear their offspring to be valuable human beings'. As for his treatment of criminals, those who couldn't be conditioned with a whip should be 'humanely and economically disposed of in small euthanasic institutions supplied with proper gases'. You can see why the Nazis were so taken with his views.

  Not everyone was impressed. There were rumours that 'occult practices' were taking place in Carrel's black laboratories. Even that Lindbergh was planning to have his heart removed so that it could be replaced by a mechanical device of Carrel's creation. This wasn't so far from the truth: the two men were operating in a scientific hinterland. Lindbergh was fascinated by questions of life and death, and had contemplated immortality. Carrel was a believer in clairvoyance and telepathy, and an advocate of the power of prayer (he even wrote an article about it for the Reader's Digest).

  On 28 June 1938 Carrel was sixty-five years old and the strict rules of the Rockefeller Institute meant that he was forced to retire. For someone so passionate about his work, this was incredibly frustrating, but perhaps now was the time to realize his life's ambition and set up his own institute devoted to the study of man. An institute that would build on his theories outlined in Man, the Unknown. An establishment that would set mankind on a triumphant path to the future.

  Carrel's opportunity came in February 1941 (some ten months before the United States entered the Second World War) when he joined a relief mission to take food and medical aid to occupied France. Quite what Carrel's motives were for joining such an endeavour is unclear, but it wasn't long before he'd offered his services to the Vichy government. He saw the downfall of France as evidence for his theories on society. France had been 'crushed because of our corruption, vanity and weakness'. Now he had the opportunity to help in 'remaking' the country.