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Early Practices

Transfusions

The following is excerpted from BLOOD PROGRAM IN WORLD WAR II by Douglas Blair Kendrick (pgs. 1-5).

Chapter I: Historical Note

Transfusion Before World War I

Although the concept of the therapeutic value of blood dates back to antiquity, transfusion in the modern sense of the term was a practical impossibility until William Harvey, in 1616, announced his discovery of the circulation of the blood.1 This discovery opened the way for serious experiments on the infusion of various substances into the bloodstream and eventually led to the use of whole blood for transfusion.

Claims to priority are various and confusing. It is clear, however, that Richard Lower, inspired by the previous experiments of Sir Christopher Wren in infusion techniques, performed the first successful animal transfusion in 1665, when he transferred blood from the carotid artery of one dog to the jugular vein of another. In November 1667, Lower transfused Mr. Arthur Coga, "a mildly melancholy insane man," with the blood of a lamb. Mr. Coga, according to Pepys, described his experience in Latin before the Royal Society of Medicine and stated that he was much better. He impressed Pepys as "cracked a little in his head."

The next animal-to-human transfusions were also performed on generally the same indications, by Jean Baptiste Denis, physician to Louis XIV. When Denis' fourth attempt ended fatally, he was charged with murder. He was eventually exonerated, but, 10 years later, the procedure was prohibited by law in France as well as in Italy and was also forbidden by the Royal Society of Medicine in England.

For the next 150 years, there was little interest in transfusion, but it is significant that Nuck in 1714 and Cantwell in 1749 declared that this procedure would be of value in severe hemorrhage. When interest in transfusion was revived by James Blundell (5-7) in 1818, it was on the basis of replacement of lost blood in puerperal hemorrhage and after a series of experiments in which he had demonstrated that human blood loses none of its "vital properties" by passage through transfusion equipment. Blundell failed in his first four desperate attempts to save women on the point of death from postpartal hemorrhage, but he succeeded in five of the next six attempts.

1The following brief historical account of the development of blood transfusion is necessary for an understanding of the medicomilitary employment of this measure, a use not suggested up to World War I. The material included, unless otherwise indicated, is derived from (1) the detailed historical account in Kilduffe and DeBakey's THE BLOOD BANK AND THE TECHNIQUE AND THERAPEUTICS OF TRANSFUSIONS (1), which has an appended list of 207 (183 numbered) references, and (2) Lewisohn's (2,3) and Ottenberg's (4) accounts of the contributions of Mount Sinai Hospital in New York to this therapeutic technique.


In 1875, Landois (10), in a comprehensive monograph on transfusion, collected 347 cases in which human blood had been used and 129 cases in which animal blood had been used. By this time, important studies on the physiology of the blood were being performed by a number of qualified observers, and some physicians, such as Fordyce Barker, advocated transfusion " ... not exclusively in those desperate cases where favorable results are hardly looked for but ... before patients have arrived at, and fallen into, this desperate condition."

Techniques in use included transfusion with defibrinated blood, mediate transfusion with pure blood, immediate transfusion from vein to vein, and immediate transfusion from artery to vein.

Although the indications and rationale of blood transfusion were by this time apparently quite well understood, the indications during the last quarter of the century again became vague and irrational, the procedure was employed indiscriminately, and the number of severe reactions and fatalities increased. As a result, transfusion again began to be considered as a hazardous, and even a disreputable, procedure, to be employed only as a last resort and in desperation.


From BLOOD PROGRAM IN WORLD WAR II (SUPPLEMENTED BY EXPERIENCES IN THE KOREAN WAR) by Douglas Blair Kendrick. Washington, D.C.: Office of the Surgeon General, Department of the Army, 1989. (Provided by the Office of Medical History, Office of the Surgeon General/US Army Medical Command.)



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