Blood and Guts (21 page)

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.

On 17 November, despite the fact that the French economy was
crippled by the German occupation and most ordinary people were
on a starvation diet, Carrel was awarded a generous budget to set up
his new institution. His foundation would study measures to 'safeguard,
improve and develop the French population'. Offices were
commandeered at the Rockefeller Foundation in Paris and, seemingly
oblivious to the suffering taking place around him, the selfabsorbed
little Frenchman resumed his experiments.

After Paris was liberated by the Allied forces in August 1944,
no one was sure whether or not Carrel should be arrested as a
collaborator. Although his work was backed by the hated Vichy
authorities and endorsed by the Nazi leadership, Carrel had
merely been getting on with his research. During the war he had
even spoken out against the inadequate rationing imposed by the
Germans, and counted members of the Resistance among his
friends. Some efforts were made to detain him, following press
accusations that he was a pro-Nazi racist (which was, strictly speaking,
true). The American ambassador was even asked to intervene
on his behalf. In the end Carrel died before anyone could decide
what to do with him. Sympathetic biographers have claimed that
he died of sorrow, devastated that people thought so ill of him.
Within a few years his public image had gone from scientific hero
to Nazi villain.
^*

^*
Charles Lindbergh almost suffered a similar fate. In 1941 he gave a speech in Iowa, during
which he called for appeasement with Germany. His anti-British and anti-Semitic views were
widely vilified, and many people, including Lindbergh's own mother-in-law, distanced themselves
from him. After Japan attacked Pearl Harbor in December that year, Lindbergh returned
to aviation, flying more than fifty combat missions in the Pacific and instructing many young
pilots. However, it was several years before his reputation was sufficiently rehabilitated for him
to once again be considered an American hero.

Alexis Carrel could have been a great medical hero; instead his
name has been all but erased from the history books. His enormously
popular text
Man, the Unknown
was removed from most
libraries, his perfusion experiments abandoned, his laboratories
shut down. Scientists and surgeons were embarrassed to have been
associated with him. The press that once sang his praises no longer
mentioned him. Everyone conveniently forgot that they had once
thought eugenics was a good idea. It was left to a few loyal
colleagues (including Charles Lindbergh) to try to put Carrel's side
of the story. As a result, the biographies are deeply divided. Some
are damning in their condemnation, others are obsequious in their
praise. But if you try to look beyond the man to his many achievements,
they are quite remarkable.

Carrel was the first doctor to work out how to sew blood vessels
together. This discovery alone helped save countless lives. When
arteries or veins were damaged, his efforts meant that they could be
successfully repaired. His technique made transplants possible
and opened up a whole new area of surgery. His pioneering
experiments with tissue culture gave scientists a much greater
understanding of organ and cell function. They also allowed the
investigation of conditions such as diabetes. His idea that limbs and
organs might be grown or repaired in the laboratory was decades
ahead of its time. Advances in stem cell research might one day
make this possible. As for his views on eugenics, it is hardly fair to
single out Carrel as a villain. In the first half of the twentieth
century his views on the future of humanity were shared by many
other influential people.

However, for all his achievements and technical advances, Carrel
kept coming up against a major problem. Transplants of an organ
between different parts of the same animal were invariably successful,
but almost every one of his hundreds of transplants between
different animals ultimately ended in failure. The operations had
gone well, the organs would function for a while and then, within
days (or occasionally weeks), they would fail. Carrel concluded he
was coming up against a biological force that he was powerless to
counteract. Despite fifty years of experiments, he failed to overcome
a major obstacle to successful transplantation: rejection – the body's
reaction to foreign tissue. In his battle with the body's immune
system, he was defeated time and time again.

The immune system is in a constant state of war and, as Carrel
discovered, a transplanted organ provides an easy target. Everything
alien to the body comes under attack, from transplanted tissue to
bacteria, fungi and viruses. The human body employs a whole range
of different cells and techniques to repel invaders, and the immune
system is continuously evolving to adapt to new threats. Transplant
an organ and the body will rapidly set to work to try and eliminate
the foreign tissue. The immune system even has its own distribution
network – the lymphatic system – and a series of lymph nodes where
the various immune system cells congregate.

The white blood cells form the core of the body's immune
response. Although they are called white blood cells, they are actually
transparent. Every single millimetre of blood has some ten thousand
white blood cells, all poised to take on invaders. The first line
of defence is made up of neutrophils, which can swallow up and kill
bacteria. These are backed up by the even more fearsome lymphocytes,
which come in two main forms: B and T.

B and T cells are manufactured in the bone marrow, found in
the long, flat bones of the body, such as the pelvis. B cells produce
fragments of protein called antibodies, which bind to the surface of
foreign invaders. These antibodies either disable the invader or
mark them out for destruction. T cells come in two different varieties
– helper T cells and killer T cells. The helpers work with the B
cells to produce antibodies and also assist the development of the
killer T cells. It is these killer T cells that are the really nasty ones.
They target anything identified by the B cells as alien, ambush the
invaders and destroy them.

Doctors know all this now, but fifty years ago the body's immune
response was still shrouded in mystery. For transplant surgery to be
successful, the formidable barriers of the body's own defences
would have to be studied, analysed and overcome. In the meantime,
some surgeons were prepared to carry on regardless.

Paris, 12 January 1951

Seven years after Alexis Carrel's death another Frenchman
was about to die. He was scheduled to be executed by guillotine
within the walls of the Santé prison in Paris. Not that many people
cared. Ever since the abolition of public executions in 1939,
interest in the death sentence had waned considerably. This was
merely another routine execution of a criminal that society could
probably do without.

It was a bitterly cold morning. The executioner's breath
mingled with the icy morning mist and choking smog of the city.
The guillotine stood in the courtyard, blocked in by the towering
brick walls of the prison. What a place to die.

The killing machine itself was once considered the height of
technology – a machine to end life efficiently and humanely. These
days it was beginning to show its age. The plank where prisoners
rested their bodies for the last time was worn, the high wooden
gantry was discoloured from age, and even the bucket for catching
the disembodied head was looking battered. The only part that still
appeared as good as new was the glistening steel blade, sharpened
the previous day.

The executioner examined the ropes on the machine and
checked the straps on the plank. He positioned the bucket of
sawdust where he judged the severed head would fall. With public
executions it used to be embarrassing to see a head bounce from
the basket and roll towards the crowd. It wasn't dignified. The least
an executioner could be was professional. He pulled on the rope
and hauled the heavy blade to the top of the gantry, then fastened
it before releasing a lever to let it go. Satisfied that it was working
properly, he hauled it up again. Now went to see how the prisoner
was getting on.

The condemned man had been given the last rites. The irony
of the situation sometimes made the executioner smile. It crossed
his mind that if the man – this criminal – had really believed in God,
he wouldn't have committed the crime in the first place. Still,
who was he to judge? He was only doing his job and the priest
was only doing his. It was best not to think about it too much,
particularly in this profession.

A guard tied the prisoner's hands together behind his back
and led him from the cell. The man shivered slightly as he was
taken into the courtyard. Some prisoners struggled, but this one
seemed as calm as could be. There was no point resisting the
inevitable; it achieved nothing and only made the whole thing
more unpleasant for everyone.

The prisoner was pushed forward on to the plank and his head
placed in the semicircular groove of the 'lunette'. The executioner
fastened the straps around him and instructed him to lie still. Two
men standing over by the wall turned their heads away, slightly
embarrassed witnesses. They had other thoughts on their minds.
The executioner checked once again that the bucket was in place
and the prisoner was positioned correctly. He told his colleague to
stand clear and moved towards the lever. Everyone was silent.

There was a click. The blade dropped so rapidly that its movement
was barely perceptible. The head dropped into the bucket
with a soft thud – eleven pounds of brain, bone, muscle and skin
gently oozing into the sawdust. It steamed in the cold air. Where
the neck had been severed a great arc of blood spurted out. The
fountain gradually subsided to a gentle trickle, congealing on
the frosty ground.

The two men who had been waiting and trying not to look
(although in truth it was almost impossible not to) took this as their
cue. The headless corpse was carried inside to a table and its clothes
cut off. The men put on their masks and gloves and, working quickly,
sliced open the warm body. They weren't too careful with their
incisions – the prison would clear up the mess afterwards. However,
they needed to be sure not to damage the kidneys they were trying
to remove. Within minutes, they had what they wanted. Dousing the
organs in fluid designed to keep them alive (similar to the fluids
Carrel used in his experiments), they wrapped them in towels and
headed for the hospital. These two men – surgeons Charles Dubost
and Marcel Servelle – planned to make transplant history.

In the operating room their first patient was being prepared for
surgery. The forty-four-year-old woman was lying anaesthetized on
the operating table, cloths draped across her, nurses ready with trays
of instruments. The bright light and pristine surfaces were in
marked contrast to the shabby conditions at the prison. When the
surgeons arrived with the dead man's kidneys the organs were
doused in more fluid to wash them and prevent them deteriorating.
While Dubost and Servelle scrubbed for surgery, one of the kidneys
was brought to the operating theatre for transplant.

The surgeons implanted the kidney into a cavity in the woman's
pelvis – connecting it into the pelvic blood vessels. The ureter – the
tube leaving the kidney, which normally carried urine to the bladder
– was passed through a hole in the skin. On the same day, they
carried out an identical operation on a twenty-two-year-old woman
using the other kidney from the executed prisoner.

At first both operations appeared to have been successful.
Within two hours of receiving the transplant, the older woman
began to excrete urine from her new kidney. Over the next few days
the volume of urine increased. The second patient seemed to be
recovering equally well. Perhaps Carrel was wrong; perhaps they
could overcome the body's defences? The surgical team was
cautiously optimistic, even allowing themselves a low-key celebration.

The forty-four-year-old woman died seventeen days after the
operation. The younger woman died suddenly after nineteen days.
In both cases the transplanted kidneys had been destroyed by the
immune system. The Paris surgeons went on to perform a total of
eight transplant operations. They used kidneys from living donors;
they washed the kidneys before transplant; they used the best available
medication and provided round-the-clock intensive care.
Despite all their efforts, every one of the eight patients died
(although one lasted more than a month). In each case the new
organs seemed to be incompatible. The biological force Carrel had
warned about continued to defeat them. But there was every reason
to keep trying. The patients the Parisian surgeons operated on were
all in the final stages of kidney, or renal, failure. Without functioning
kidneys they would certainly die slow, unpleasant deaths.

Kidneys act as filters to the blood. They remove waste products
from the body to produce urine. They also help to maintain the
right balance of fluids and regulate blood pressure, hormones,
minerals and red blood cells (among other functions). The first
symptoms of kidney failure include lethargy, nausea and swelling of
the ankles as a result of a build-up of fluid. Without treatment, symptoms
progress through nausea and breathlessness to confusion,
seizures, blindness and eventually coma. It's not called 'end stage'
renal failure for nothing.