Organ transplantation owes much to this 19th-century French sticker

On June 25, 1894, French President Marie François Sadi Carnot attended a banquet at the Chamber of Commerce in Lyon. Crowds lined the streets as he walked in and were still there after 9 p.m. when his carriage pulled up to pick him up. One man present, Sante Geronimo Caserio, had studied the President’s itinerary and, with the rolled-up newspaper under his arm, blended into the crowd. Moving so fast that Carnot’s guards couldn’t stop him, Caserio shot out of the crowd, out of anonymity, and slipped past the police. He dropped the newspaper and revealed a dagger, which he thrust deep into Carnot’s back. The President dropped, sank into his seat, and the carriage went in search of the best doctors in Lyon while the unrepentant anarchist was arrested.

Puncture wounds were then treated by identifying and ligating severed blood vessels and tying sutures around them to stop the bleeding. However, the assassin had severed the president’s portal vein – the vessel that carries blood from the intestines to the liver – and the panicked surgeons were helpless. Along with his esteemed colleague Anton Poncet, Louis Xavier Édouard Léopold Ollier examined the wound and decided, hoping for the best, to put an iodine bandage on it.

In the riotous aftermath of the President’s death, Italian businesses were looted and destroyed. Mobs rallied to burn down the Italian consulate as well, but were stopped by soldiers and police. Like his compatriots, surgical trainee Alexis Carrel was appalled by the assassination, but he directed his anger not at the Italian but at the impotence of his profession. Carrel believed that if only Carnot’s doctors had possessed the skills, they would have been able to save the President’s life.

In 1901, the same year that Karl Landsteiner developed the ABO blood group system, Carrel was given a place in a laboratory with access to surgical equipment and dogs. He soon found that despite recent advances in surgery, the threads used by surgeons were too thick for tiny blood vessels that would rupture easily. The needles were also too bulky, especially around the eye, which not only caused additional damage but also caused blood to clot around the eye, further compromising the delicate veins and arteries. If he was going to try sewing vessels together, he needed something better. Since nothing very fine was then available from surgical suppliers, Carrel turned to the famous embroiderers of Lyon. Through his family connections – his mother owned a textile factory – he had good contacts in this area. It was at a local haberdashery he found thinner, thinner, “No. 13 Kirby needles from Birmingham, UK and ‘Coton d’Alsace, No. 500’ for his thread. To make it easier for the needle and thread to slide through the vessels, he covered both with paraffin gel.

Carrel went to embroiderers not only for the needle and thread, but also for the technique. Vessels repaired with existing techniques tended to become infected. If a patient was lucky enough to escape infection, their aging repair would sometimes buckle and eventually rupture. It was clear that Carrel needed to develop a new method for repairing blood vessels that took into account their special material properties. He had a head start with his mother’s tutelage, and he used his contacts to secure tuition in Lyon’s famous Croix Rousse textile district, known by locals as ‘the hill that works’.

The woman he sought out was called Marie-Anne Leroudier, one of the best embroiderers in Lyon. Leroudier is not always mentioned in Carrel’s biographies. Even those who do name her tend to move on to something else at the end of the paragraph, dismissing her as the “seamstress” he happened to “saw” and was “inspired by.” But if you bother to look up her work, it’s inscrutably complicated. She made chasubles and cloth crosses with devotional scenes and embroidered the gold thread that dresses the curtains in the Opera House in Paris. She won the gold medal at the 1885 Amsterdam World’s Fair and exhibited some decorated panels in the Woman’s Building at the 1893 Chicago Columbian Exposition.

An embroiderer of such caliber is an unusual teacher for a surgeon. Most surgeons of the time learned to sew from their mothers, sisters, and wives. But a surgeon need not depict the Last Supper as a thread in a patient’s body. So what exactly did she teach him that he couldn’t get anywhere else? Fleur Oakes, former Embroiderer in Residence at the Department of Vascular Surgery at St Mary’s Hospital in London, explains what Leroudier could have imparted to Carrel – knowledge he could not have acquired elsewhere. This ranged from what she called “thread management” (guiding the thread where you want it) to methods of working with one hand and methods of achieving the complexity needed to work on tiny ones structures like veins and arteries to work.

Thanks to Leroudier’s invaluable teachings, he also learned how to puncture only part of the blood vessel wall, minimizing the chance of blood clotting around the suture.

In 1902 he presented his technique at scientific conferences in Lyon and published a paper on his findings. Being able to sew blood vessels together in the manner described by Carrel would revolutionize trauma surgery. Had his technique been available when the anarchist assassin slashed President Carnot’s portal vein, the surgeons treating him could at least have made a good attempt to save his life (although a wound like his would still be considered a challenge today). And at the end of his article, he shared the news that he was using the technique to transplant thyroid, kidney, and pancreas, but these experiments were “not advanced enough to draw any conclusions.”

Courtesy of St. Martin’s Publishing Group

Carrel later modified the technique further and it became the basis for much of vascular surgery, including bypass surgery. Vascular anastomosis—the sewing together of blood vessels—is why people today consider Alexis Carrel not only the “father” of vascular surgery, but of transplant surgery itself. He is therefore the first person mentioned in a historian’s chronicle of organ transplants, the name being checked in introduction after introduction.

Transplants predated Carrel by centuries, of course, but it was the use of embroidery techniques — and particularly the uncredited Marie-Anne Leroudier — that made internal organs no longer off-limits for aspiring transplant surgeons.

From the book SPARE PARTS by Paul Craddock. Copyright (C) 2022 by Paul Craddock. Reprinted with permission from St. Martin’s Publishing Group.