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(continued)
Special Problems
 During the first years of the 20th century, a blood transfusion was frequently
a more difficult technical procedure, and sometimes a procedure fraught with greater
risks, than a major operation. Its development as an effective and safe therapeutic method required the solution of a number of special problems:
1. Blood coagulation. First efforts to overcome this difficulty were
made in 1835, with the use of defibrinated blood by Bischoff, and
terminated in 1914, with the successful use of sodium citrate by Hustin,
Weil, and Lewisohn (2, 3)
(p. 218).
2. Agglutination and hemolysis from admixture of incompatible bloods.
The way was opened to the solution of this special problem in 1900,
when Landsteiner (11) published his
epochal work on the identification of blood groups, based on his previous
demonstration of the presence of isoagglutinating and isoagglutinable
substances in the blood. Jansky in 1907 and Moss 3 years later, without
knowledge of Jansky's studies, worked out the reciprocal agglutinating
reactions of the four blood groups and classified them accordingly.
The confusion that arose because of differences in nomenclature was
eliminated after World War I, when the numbers previously used to
designate blood groups were replaced by the letters A, B, AB, and
O, each group thus being designated by the agglutinogens in Landsteiner's
original scheme.
Communications in the early years of the 20th century were often slow,
and foreign medical literature had only a limited circulation in the
United States. No practical use, therefore, was made of Landsteiner's
work until 1907, when Ottenberg (4),
at Mount Sinai Hospital in New York, first matched donor and recipient
before giving blood and thus made transfusion a safe procedure from
the standpoint of compatibility. The validity of Ottenberg's work
was not immediately realized; his offer to perform compatibility tests
for the surgeons at his own hospital had no general acceptance for
almost 5 years because such tests were considered unnecessary or misleading.
In 1911, Ottenberg demonstrated that it was safe to use as a donor a person whose serum agglutinated the recipient's red cells but unsafe and dangerous to use one whose red cells were acted upon by the recipient's serum. This demonstration eventually led to the widespread employment of group O donors as universal donors, since the red blood cells of this blood group are not agglutinable by the serum of any other blood group.
3. Technical difficulties. Until 1913, direct transfusion was used
to the exclusion of any other technique. This was a difficult and
time-consuming method, requiring a specially trained team to carry
it out and totally unsuited for use in sudden emergencies. In 1892,
von Ziemssen of Munich had performed transfusion by the syringe technique,
but his report attracted no attention and when Lindeman (12)
described it in 1913, it was, for all practical purposes, a new method.
With this technique, no dissection of blood vessels was necessary
in either donor or recipient, and the exact quantity of blood transfused
was known. The technique, however, required a trained team of at least
four persons and the use of a large number of expensive syringes.
Also, rapid injection of the blood was mandatory. In 1915, Unger (13)
introduced an apparatus based on the principle of the two-way stopcock,
which overcame many of these difficulties. Dozens of variations of
this apparatus were introduced during the next 15 years.
4. Infection. Infection ceased to be a major problem after first antiseptic, and then aseptic, techniques came into general use and as long as transfusion was employed only in hospitals and on what amounted to elective indications. The open containers originally used to collect blood for indirect transfusion first became impractical, and then a real source of danger, when indications for transfusion were extended.
References
1. Kilduffe, Robert A., and DeBakey, Michael: THE BLOOD BANK AND THE TECHNIQUE AND THERAPEUTICS OF TRANSFUSIONS. St. Louis: C. V. Mosby Co., 1942.
2. Lewisohn, R.: "The Development of the Technique of Blood Transfusion Since 1907; With Special Reference to Contributions by Members of the Staff of the Mount Sinai Hospital." J. MT. SINAI HOSP. 10: 605-622, January-February 1944.
3. Lewisohn, R.: "Blood Transfusion: 50 Years Ago and Today." SURG. GYNEC. & OBST. 101: 362-368, September 1955.
4. Ottenberg, R.: "Reminiscences of the History of Blood Transfusion." J. MT. SINAI HOSP. 4: 264-271, November-December 1937.
5. Blundell, J.: "Experiments on the Transfusion of Blood by the Syringe." M. CHIR. TR. 9: 56-92, 1828 (London).
6. Blundell, J.: "Observations on Transfusion of Blood. With a Description of His Gravitator." LANCET 2: 321-326, 31 June 1828.
7. Blundell, J.: "Successful Case of Transfusion." LANCET 1: 431-432, 3 Jan. 1829.
8. Benedict, N. B.: "Transfusion in Yellow Fever -- A Successful Case." NEW ORLEANS M. NEWS AND HOSP. GAZ. 5: 721-727, January 1859.
9. Benedict, N. B.: "On the Operation of Transfusion -- Being the Report of a Committee." NEW ORLEANS M. & S. J. 10: 191-205, September 1853.
10. Landois, L.: DIE TRANSFUSION DES BLUTES. Leipzig: F. C. W. Vogel, 1875.
11. Landsteiner, K.: "Zur Kentniss der antifermentativen lytischen und agglutinierenden Wirkungen des Blutserums und der Lymphe." ZENTRALBL. BAKT. 28: 357-362, 23 Mar. 1900.
12. Lindeman, E.: "Simple Syringe Transfusion with Special Cannulas. A New Method Applicable to Infants and Adults." Preliminary Report. AM. J. DIS. CHILD. 6: 28-32, July 1913.
13. Unger, L. J.: "A New Method of Syringe Transfusion" J.A.M.A. 64: 582-584, 13 Feb. 1915.
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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