Cleveland Clinic constitutes the most visible legacy of George Washington Crile, an innovative surgeon who was among its co-founders.
But the prestigious research institution is only part of Crile's heritage. The former farm boy was a vanguard physician who helped to transform medicine from a crude and inconsistent field to one rooted in scientific principles and uniform standards.
Crile was among the first to wed science and clinical practice. He pioneered research in deadly shock. He co-founded the American College of Surgeons and helped to elevate its status. A prolific writer and popular speaker, he helped advance surgical techniques worldwide.
He took charge in times of trouble. In 1929, when 123 people died in a toxic blaze that nearly destroyed the clinic, Crile led rescue efforts and later sent handwritten letters to the families of each victim.
In keeping with his era, Crile was an adventurer whose interests included big-game hunting and horseback riding. He collected 4,000 species of animals for dissections.
Intellectual pursuits. Crile was born Nov. 11, 1864, the fifth of eight children in a prosperous farm family in central Ohio. His parents were Lutherans of Scottish-Irish and Dutch descent, but Crile became an atheist, devoted to intellectual freedom. According to a 1994 account in the Journal of Medical Biography by Robert Hermann, farm life inspired Crile's interest in biology and animal husbandry.
Crile's formal education was unimpressive. He earned a bachelor's degree at Northwestern Ohio Normal School, later Ohio Northern University. With encouragement from a local doctor, Crile pursued a medical degree at the University of Wooster Medical Department in Cleveland. Tuition was low and classes met in summer sessions, which allowed Crile to spend the winter working as an elementary-school principal. Crile graduated in 1886 after less than two years of study.
During an internship at University Hospital in Cleveland, the young physician watched helplessly as a friend, injured in a streetcar accident, died of shock after both legs were amputated. The incident changed the course of Crile's career.
He wrote: "I was overwhelmed by my lack of understanding of what was happening and baffled over the inefficiency of treatment. The cold sweaty skin and the pallor, the fading pulse, the high pulse rate, the sunken eyes and dilated pupils fixed themselves in my memory."
Crile took up animal experimentation to study shock. His curiosity led him to study physiology and eventually travel to Europe to work with leaders in the field. His first publication, An Experimental Research into Surgical Shock, which attempted to describe the causes, nature and treatment of shock, was awarded the Cartwright Prize for medical/surgical writing by Columbia University in 1897.
Advancing medicine. Crile established a busy Cleveland practice with surgeons Frank E. Bunts and William E. Lower. They attained academic appointments at the Western Reserve University School of Medicine and practiced at the city's top hospitals.
Crile, specializing in the removal of thyroid goiters, made numerous contributions to clinical surgery. He performed what might have been the nation's first successful total laryngectomy in 1892 and the first successful blood transfusion in 1906.
He recognized the need to monitor blood pressure in surgical patients. He also saw the importance of shock prevention and accordingly advocated atraumatic and bloodless surgery as well as safe forms of anesthesia. He used epinephrine to restore circulation and devised a "pressure suit" that was later adapted for use by fighter pilots in World War II.
Crile also saw the need for medical standards. He was among several young surgeons who, in 1903, founded the American Physiological Society, devoted to applying scientific principles in practice. According to the book Shock, Physiological Surgery and George Washington Crile, by Peter English, Crile and fellow surgeon Harvey Cushing proceeded with plans for the new organization after members of the well-established American Surgical Association frustrated their attempt to popularize a device to measure blood pressure.
A decade later, Crile co-founded the American College of Surgeons, which established standards for physicians and hospitals. The college bridged a gap between the American Medical Association, which recognized every medical school graduate as fit for all forms of practice, and the American Surgical Association, which accepted only a few leaders in surgery.
Crile served as the second president of the college from 1916 to 1917 and as a member of its board of regents from 1913 to 1940. World War I brought prominent roles for Crile and other college members in mobilizing the medical community, thus establishing the college as the voice of surgeons nationwide.
War and history. World War I also changed medical history, thanks greatly to Crile. Crile had noted the weakness of the federal government in organizing medical units during the Spanish-American War, when he served as an Army surgeon. Early in the war, Crile suggested to his friend, Myron T. Herrick, the ambassador to France, that teams from prominent medical schools and hospitals assume the job of staffing and supplying an American hospital near Paris. In 1915, a unit from Lakeside Hospital in Cleveland, where he was chief of surgery, became the first unit to serve a rotation.
Later, Crile, as director of clinical research for the American Expeditionary Forces, persuaded the government to extend the idea to field hospitals. Again, Lakeside physicians and nurses under his guidance led the way, embarking for Rouen, France, in May 1917. By July 1918, there were 42 field hospitals in France, 36 of them modeled on Crile's plan, according to English's account.
University-sponsored field hospitals ensured quality and cohesiveness. They also allowed scientists to accompany physicians to the front. Near the trenches, surgeons and physiologists worked in teams.
The experience encouraged physiologists to shift their emphasis to developing drugs rather than theories. According to English, research on the front established nitrous oxide as the safest anesthetic for severely wounded soldiers and blood transfusions as the best replacement fluid for shock patients, advancements that saved lives.
But the gains came at the expense of Crile's scientific reputation. By the end of the war, his theory on the cause of shock had been supplanted, and Crile bitterly refused to concede.
Founding the clinic. Still, the war allowed Crile and his partners to re-examine the practice of medicine. Crile, Bunts and Lower decided to carry ideas from their efficient wartime unit into a civilian medical institution. Crile's phrase "to act as a unit" was later used to describe the aim of the clinic.
The three physicians invited another Cleveland physician and academic, John Phillips, to participate. Borrowing some ideas from Mayo Clinic in Rochester, Minn., they established a not-for-profit foundation and obtained a bank loan to open a four-story clinic building, on Feb. 26, 1921.
The local medical community resisted the formation of the clinic. Solo practitioners viewed it as a threat-a bias against group practice that lingers today. Early opposition was so strong that the founders hastily opened a hospital in the first year for fear of being shut out of beds at other institutions, according to John D. Clough, M.D., chairman of the clinic's health affairs division and author of a history of the institution.
Crile served as the foundation's president from 1921 to 1940, when he retired because of failing eyesight. His later years of practice were profitable but controversial. Latching on to a new theory, Crile attempted to cure a variety of diseases with operations on the adrenal glands, which probably produced little benefit for patients.
Family tradition. Crile died in 1942. He and his wife, Grace McBride, had four children. His son George Jr., known as Barney, also became a renowned surgeon.
The Crile family continues to be involved in the clinic. Shortly before the death of Barney Crile in 1992, the clinic dedicated its Crile Building in honor of father and son.
The clinic was innovative in integrating services but remaining physician-driven. "The hospital isn't the tail that wags the dog. In the Cleveland Clinic, it's a tool," Clough says.
Mayo Clinic came first but didn't include a not-for-profit practice structure or a hospital until years later, according to Clough.
Clough says he doesn't think Crile would like the dominance of financial concerns in healthcare today. "I don't think he would have liked the sort of Wall Street imperative that drives the hospital chains and big for-profit physician groups."
But on Cleveland Clinic, Clough adds, "He probably would quibble with the details, but I think he would like the way that tradition has been maintained."