Biography of Alexis Carrel
The embroiderer Nobel laureate
Something as female as embroidery was of great importance to Alexis Carrel’s rise to fame in the masculine environment of surgeons. He was the eldest son of Alexis Carrel-Billiard, a textile manufacturer, and his wife, Anne-Marie Ricard, both from bourgeois Roman Catholic Families. Carrel made his first acquaintance with the life saving dextrousness when he was four years old, when his father died. To supplement her income, his mother undertook embroidering to support her three children. Alexis was very impressed by her skill with the tiny needles employed. Alexis was sent to a Jesuit day school and college near his home in Lyon. As a schoolboy he showed an interest in biology by dissecting birds. Encouraged by an uncle, he conducted experiments in chemistry.
After taking his baccalaureat he entered medicine at the University of Lyon in 1890. When the French President Mare-François-Sadi Carnot (born 1837) was assassinated by an Italian anarchist in Lyons on June 24, 1894, he was already specialising in surgery, and he was advised that the surgeons could not repair the president’s portal vein which had been severed by the assassins knife. Such wounds could not at that time be successfully repaired.
A student of embroidery
From that time on Carrel became interested in techniques of suturing blood vessels and went to one of the finest emboriderers in Lyons, Madame Leroidier, to learn to use the tiny needles and thread which they employed. He developed an extraordinary skill in using the finest needles and practiced sewing with a needle and thread on paper until he was able to make stitches that would not show on either side. He used these skills in experiments on animals with vessel anastomosis, and devised a method of turning back the ends of cut vessels like cuffs, so that he could unite them end-to-end without exposing the circulating blood to any other tissue than the smooth lining of the vessel. By this device and by coating his instruments, needles and thread with paraffin jelly, he avoided blood clotting that might obstruct flow through the sutured artery or vein. He avoided bacterial infection by a most exacting aseptic technique.
Carrel was attached to hospitals at Lyon from 1893 to 1900, from 1896 as an interne, except for a year as surgeon in the French army’s Chasseurs Alpins. In 1900 he was conferred doctor of medicine at the University of Lyon.
His talent for anatomy and operative surgery became apparent when in 1898 he was attached to the laboratory of the celebrated anatomist Jean-Léo Testut (1849-1925) at the faculty in Lyon. He was prosector under Testut until 1902. That year he began publishing his results on suturing of blood vessels, but despite his undoubted clinical skills he was not popular with members of his faculty. This was enhanced by his often espousing mystical views.
A surgeon healer?
In 1903 Carrel took a pilgrimage to Lourdes and was impressed by the recovery of a young woman with tuberculous peritonitis. He strongly suggested a controlled study of the healings of Lourdes. This made him more unpopular with the faculty and he realized that he would not achieve any clinical advancement if he remained in Lyons. His brilliant achievement did not spare him from difficulties, brought on partly by his critical attitude toward what he considered the antiquated traditions and political atmosphere of the Lyon medical faculty. Finding a university career blocked by local opposition, he left Lyon and after a year of advanced medical studied in Paris, decided to migrate to Canada and left France «to forget medicine and raise cattle».
A new career in North America
When he arrived in Canada in 1904, Carrel met with two physicians who encouraged him to continue his medical career in North America, and he gave a paper at the French Language Congress in Montreal in 1904 which greatly impressed the chairman of physiology at the University of Chicago. He was offered a teaching position in Chicago and accepted, and arrived there in September 1904. In Chicago he worked in the physiological institute of George Neil Stewart (1860-1930). Here he commenced his experimental work on vessel surgery and soon had authored publications on anastomosis of blood vessels and transplantation of a kidney. In 1905 he transplanted a puppy’s kidney to the carotid and jugular of an adult dog and watched the kidney function for several hours. In 1908 he was able to present a dog that had lived for 17 months with a transplanted kidney.
Carrel and his seven years younger collaborator, Charles Claude Guthrie, performed a number of surgical heterografts and homografts with kidneys and thyroids and commenced the study of rejection problems. A major part of the work that became the foundation for Carrel's receiving the Nobel Prize was performed jointly by Carrel and Guthrie during two 3-month periods in 1905 and 1906 at the Hull Laboratory at the University of Chicago, resulting in the publication of 21 jointly written papers.
Carrel's growing reputation for surgical skill, bold experimentation, and technical originality rapidly gained the attention of a number of leading scientists of that time, in particular the neurosurgeon Harvey Williams Cushing (1869-1939), the surgeon William Stewart Halstead (1852-1922) from Johns Hopkins and the pathologist/bacteriologist Simon Flexner (1863-1946), who was the director of the recently established Rockefeller Institute. Both Johns Hopkins and Rockefeller offered him positions and he chose the Rockefeller, which signalled the commencement of a long and happy association. This choice was probably largely due to Simon Flexner, a brilliant Jew from Louisville, Kentucky, who had little formal education, but understood the importance of so orthodox a mind as Carrel’s to a faculty interested in making quantum leaps in medical research.
French-American transplants becomes Nobel laureate
Carrel was with the Rockefeller Institute of Medical Research, New York City, from 1906 to 1939, a full member from 1912. Here he resumed his surgical experimentation. Subsequent progress in surgery of the heart and blood vessels and in transplantations of organs has rested upon the foundation he laid down between 1904 and 1908. In 1910, he demonstrated that blood vessels could be kept in cold storage for long periods of time before transplanting them (Journal of the American Medical Association, Chicago, 1908; 51: 1662), and he was the first to cultivate tumour tissue in vitro. In this he had seized upon the work of Ross Granvlle Harrison (1870-1959) of Yale University, who announced in 1908 the cultivation of frog's cells in vitro.
On January 17, 1912, he removed a minute piece of heart muscle from an unhatched chicken embryo and placed it in fresh nutrient medium in a stopperd Pyrex flask of his design. He transferred the tissue every forty-eight hours, during which time it doubled in size and had to be trimmed before being moved to its new flask. Twenty years later, longer than the lifetime of a chicken itself, the tissue was still growing. Every January seventeenth, the doctors and nurses at the Rockefeller Institute would celebrate with Carrel, singing “Happy Birthday” to the chicken tissue.
The replacement of diseased organs with sound ones and the restoration of amputated limbs had long been prevented because the surgeon did not have a reliable technique for re-establishing circulation in the transplanted or restored part without the danger of haemorrhage or thrombosis. It was Carrel who perfected the anastomosis of blood vessels in 1902 and, in doing so, provided the method which would revolutionize vascular surgery and make it possible to transplant organs and restore amputated limbs.
In 1912 Alexis Carrel won the Nobel Prize for physiology or medicine “in recognition of his work on vascular suture and the transplantation of blood-vessels and organs.” He was the first person from North America to win this prize.
Happiness and war
In 1913, on a visit to France, Carrel married Anne de la Motte de Meyrie, widow of a marquis, and a devout Roman Catholic with one son. The couple had no children of their own. In France Carrel found that there was a great deal of resistance to him and his ideas. Once again it was the Rockefeller Institute which came to his rescue and financed a hospital, the Rond-Royal which was directed by him and in which, with Théodore Tuffier (1857-1929), he carried out cardiac valvotomies.
When the First World War broke out, he received orders to mobilise with the French Army. Carrel conducted a hospital and research centre near the front lines, where Mme. Carrel assisted him as a surgical nurse. With the aid of an American chemist, Henry Drysdale Dakin (1880-1952), he developed the irrigation method of treating severely infected wounds, which although often effective was too complicated for general use and has been supplanted by the use of antibiotics. This work earned him the Legion of Honour. His hospital was destroyed at the end of the war by air attack and he finished the war in laboratories near Paris.
Carrel returned to the United States immediately after the war, resuming his work at the Rockefeller Institute in 1919.
The Nobel laureate and the aviator
On November 28, 1930, Alexis Carrel was approached by Charles Lindbergh at the Rockefeller Institute of Medical Research in New York. Lindbergh’s visit was occasioned by the heart disorder of his sister-in-law, Elizabeth Morrow, and had been arranged for by the anaesthesiologist Dr. Paluel Flagg. Her doctor had informed that an operation to repair the heart could not be done, because the organ could not be stopped long enough for the surgery to be performed. Lindbergh asked why a mechanical pump could not circulate the blood during an operation and was "astounded" that an eminent doctor could not answer the question. "Knowing nothing about the surgical problems involved," Lindbergh recalled, "it seemed to me it would be quite simple to design a mechanical pump capable of circulating blood through a body during the short period required for an operation.
"The prospect of this "artificial heart" spawned a new series of questions: "Why could not a part of the body be kept alive indefinitely if a mechanical heart was attached to it – an arm, or even a head?”
At that time Carrel was undertaking a far-reaching experimental program, aimed at the cultivation of whole organs; however, with little success. Carrel patiently explained that a mechanical pump could not be used to circulate blood through the body while surgeons operated on Elizabeth Morrow because "blood soon coagulated in contact with surfaces of glass or metal . . . and its delicate cells could not withstand the hammering of mechanical valves."
Carrel showed Lindbergh an apparatus he had built in his laboratory several years earlier. It was a perfusion pump – for circulating the nutrient media over tissue cultures, which was necessary to keep them alive. The problem, Carrel said, was infection. Nobody had been able to build an operable perfusion pump that did not induce infection.
Lindbergh felt he could improve on Carrel's contraption of glass tubes, electric wires, magnetic coils and valves. Carrel said that if Lindbergh wished to design a new pump, he could have complete access to his facilities. The offer of working with "a great surgeon and biologist, a man overflowing with ideas and philosophical concepts, in a laboratory far better equipped than any I could dream of establishing in the basement of my New Jersey home" was irresistible to Lindbergh.
The following night Lindbergh made sketches of a Pyrex perfusion pump. It was a simple design, which Carrel passed on to Otto Hopf, an extraordinary glass blower with a workshop in the basement of one of the Institute buildings. Carrel first experimented with this pump by inserting a section of a cat's carotid artery in the petri dish organ chamber, "We were for the first time in the history of experimental perfusion, able to avoid infection," Lindbergh proudly recalled.
Lindbergh now put in long weeks in Carrel's laboratory, Carrel putting each new apparatus designed to the test. Carrel, impressed with Lindbergh's industry and ingenuity, once said, "My friends, the world will hear from this young man some day."
In late 1934 Lindbergh had designed pump "by which a pulsatile circulation of nutrient fluid, properly oxygenated, could be maintained through an organ." Using Lindbergh's machine Carrel performed surgeries that showed that circulation, even in such vital organs as the kidneys, could be interrupted for as long as two hours without causing permanent damage. On April 5. 1935, after Lindbergh had perfected the machine, a whole organ was successfully cultivated in vitro for the first time. Carrel bled an etherized cat to death, removed its thyroid gland, and placed it in the organ chamber. It was perfused for eighteen days, permitting for the first time an entire organ to live outside the body. The idea dating at least as far back as 1812 – when French physiologist Jean Julien César Legallois (1770-1814) wrote of "artificially circulating a fluid through an organ" – had, thanks to the Lindbergh pump, at least been realized.
The cover of Time magazine, June 13, 1938, shows Charles Lindbergh and Alexis Carrel with the perfusion pump.
A writer for the Time cover story described the pump this way:
- "Looking like a twist of vitrified bowel oozing out of a clear glass bottle, the Lindbergh perfusion pump consists of three chambers one above the other. The organ to be studied lies on the slanting glass floor of the topmost. Nutritious fluid from the lowest or reservoir chamber is driven up a glass tube connected with the organ's artery, to and through the organ by pulsating gas pressure."
There was an instantaneous connection between the surgeon and the aviator, each of whom was favourably predisposed toward the other. Carrel believed in the psychological importance of heroes, for they played a role in "promoting the optimum growth of the fit." In Dr. Alexis Carrel the hero found a hero, and Carrel found a son. Lindbergh promptly recognized that he was sitting with a Renaissance man dedicated to both enlightenment and the occult, a scholar who accepted the existence of powers unknown. "Carrel's mind," Lindbergh would later state, "flashed with the speed of light in space between their logical world of science and the mystical world of God." To Lindbergh, Carrel’s laboratory was a refuge.
Lindbergh recognized that Carrel had a "blunt tactlessness that created many enemies." But he also found in this fifty-seven year-old doctor "character that attracted the love of those who knew him well." Nobody in Charles Lindbergh's adulthood affected his thinking more deeply than Alexis Carrel. Their relationship would intensify over the next decade; and Lindbergh would come to conclude at the end of his life that Carrel had "the most stimulating mind I have known."
Carrel’s naturally religious, even mystical temperament led him to speculate on the great problems of human destiny. In a widely read book, Man the Unknown (1935), he expressed the hope that scientific enlightenment might confer upon mankind the boons of freedom from disease, long life, and spiritual advancement, under the leadership of an intellectual elite. "Eugenics," Carrel wrote in Man, the Unknown, "is indispensable for the perpetuation of the strong. A great race must propagate its best elements."
As Simon Flexner was succeeded by Dr. Herbert Gasser as director of the Rockefeller Institute, the high profile Alexis Carrel was being nudged into retirement. Carrel's public image at this time became sullied by his political views. His great admiration of Mussolini for his "building up of a great nation," read differently after Mussolini had invaded Ethiopia. Other comments about civilization collapsing, modern nations saving themselves "by developing the strong," not "by protecting the weak," and his concern for the "salvation of the white races". During the summer of 1938, Carrel and Lindbergh carried on discussions delving into the subject of "race betterment."
Unfortunately, similar discussions were raging through the third Reich, a coincidence that would not be lost on future detractors of either Carrel or Lindbergh. His belief in “whiteness” is no less evident in his writing on the effects of light: “We must not forget that the most highly civilized races – the Scandinavians, for example – are white, and have lived for many generations in a country where the atmospheric luminosity is weak during a great part of the year. In France, the population of the north is far superior to those of the Mediterranean shores.
Upon his retirement from the Rockefeller Institute, Carrel would return to his native France, maintaining an apartment in Paris but preferring to live on Île Saint-Gildas, the largest of an archipelago off the Brittany coast. The Lindberghs bought one of the other islands in the archipelago, the Illiec, ten minutes by boat, a kilometre walk at low tide, from Saint Gildas.
When Carrel retired from the Rockefeller Institute in 1938 he was planning an institute devoted to "the study of man, but with the outbreak of war, he returned again to France, where in 1941 he estblished the Fondation pour l’étude des problems humains. His hope was to serve his native country by a grandiose program to safeguard and improve the population by scientific nutrition, public hygiene, and eugenics, creating the conditions that are "indispensable to the life of an elite.” He also intended to study the possibility of raising human intelligence above its present level, as well as the genetics of great leaders.
When the sixty-seven year old Carrel approached Pétain with his vision of an "Institute of Man," Pétain offered to subsidize it. Carrel accepted and went to work, despite the obstructions placed in his way by the medical profession. His acceptance of support from Vichy and his negotiations with the German command on behalf of his institute led to exaggerated charges of collaborationism. Carrel was observed one day at the German Embassy. He had arrived, in fact, to request help in feeding starving French children; but he happened to appear when a party was in full swing. Although the Carrels retreated as quickly as possible, rumours spread that the Germans had entertained them. Accused of being a collaborator, the septuagenarian's health deteriorated.
Carrel had a myocardial infarction in 1943 and another one immediately before the liberation. He was removed from all his offices, and he and his wife, Anne-Marie-Laure Gourlez de La Motte, were placed under guard in Paris as collaborators.
He died on November 5th, 1944, from a myocardial infarction, shortly after the French radio accused him of fleeing his guards to avoid trial and of being a collaborator. "Cold, privations and isolation," he had written to a friend, had brought suffering to him and his wife. Another friend of the Nobel laureate eulogized, "He died really of a broken heart; he could not stand the accusations made against him and his sensitive soul broke under them."
Although not a fully orthodox churchman, Carrel received the last rites of the Roman Catholic Church and was interred in a chapel at his home on the island of St. Gilda, off the coast of Brittany.
Carrel liked to display his boldness in everything he said, sometimes just for their shock value. According to one of his colleagues at the Rockefeller Institute, Carrel once kidded that "if he had to live his life over, he would have become a dictator in South America. In truth, Alexis Carrel was an elitist who believed in a disciplined society; but he was appalled by both genocide and anti-Semitism. He was simply alarmed by what he considered the rapid decay of the democracies of the world, which he attributed to a diminution of faith. "He had no love for Nazism, Fascism, or Communism," wrote a friend of Carrel," but he knew that their ideologies gave those nations an ever-flowing source of energy. By contrast, the democracies seemed to have discarded faith, and there lay the cause of their weakness and inefficiency."
A Carrel Foundation was later established at Georgetown University with the help of Charles Lindbergh. Its objective was "to promote the study and dissemination of the ideas expounded during his lifetime by the late Alexis Carel; to preserve manuscripts, records, apparatus, and other memorabilia left by or which relate to the late Alexis Carrel; to sponsor research projects which shall deal with subjects in which the late Alexis Carrel was interested; and the advancement and diffusion of knowledge concerning science, religion, and humanity.”
Alexis Carrel was indeed a remarkable, if rather controversial man, who made an extraordinary contribution to medical science. His political views, however, have hardly stood the test of time.
«A few observations and much reasoning leads to error; many observations and a little reasoning to truth.»
«He had certainly, along with Jaboulay, the best surgical hand that I ever witnessed in a career which allowed me to watch most of the great surgeons in the world.»
Stated by the great French surgeon René Leriche (1879-1955), who had worked with Carrel when he was in Lyon.
Certes les êtres humains sont égaux, mais les individus ne le sont pas.
We thank Holger Zorn, Germany, for correcting an error.