The following is excerpted from BLOOD PROGRAM IN WORLD WAR II by Douglas Blair Kendrick (pgs. 5-7 and 11-12).
Chapter I: Historical Note
Blood Transfusion In World War I
The British Experience
In June of 1918, an editorial writer in the LANCET doubted that as
recently as 4 years earlier any surgeon could have been found to perform
"the operation" of transfusion in England (14). In the next issue, Sir Berkeley Moynihan (15) took exception to that statement: He and his associates in Leeds had been performing transfusion regularly for 10 years, first by the direct, and later by the indirect, technique.
The editorial writer's statement was, however, generally true. Blood
transfusion was not practiced by the majority of surgeons in Great Britain
before World War I, and its use in the last 2 years of the war was chiefly
derived from the work which had been done on it in the United States.
Techniques. -- Direct transfusion, as might have been expected, proved a
completely impractical method in military surgery. The elaborate preparation
required in the Kimpton-Brown technique makes one wonder how it could have been
employed at all in a busy casualty clearing station, but Fullerton and his
associates (16), using improvised equipment, employed the method in 19 casualties at the Boulogne base in 1916. The 15 deaths were not too
discouraging, since the blood was given only to patients whose condition was
considered desperate. In 1917, U.S. Army medical officers introduced the
standard Kimpton-Brown equipment into British hospitals, and numerous patients
were treated by this technique in casualty clearing stations of the British
In a series of reports between 1916 and 1918, Bruce Robertson (17-20), of the Canadian Army, explained the advantages of the syringe-cannula technique, which he had introduced into the British Second Army area. The method was far simpler than the Kimpton-Brown technique, but at that it was not simple, and it required a team of three persons to carry it out.
The use of preserved blood was introduced into a casualty clearing station in
the British Third Army during the battle of Cambrai in November 1917 by Capt.
(later Maj.) Oswald H. Robertson, MORC, USA (21, 22). His reasoning was that if blood had to be collected as casualties arrived, the number of transfusions given would necessarily be limited. The solution seemed to him to be the use of human red blood cells collected and stored in advance of the need.
Only group O (then termed group IV) blood was used. The 500 cc. taken from
each donor was collected in the Rous-Turner glucose-citrate solution ... and
stored in an icebox. After the blood had settled for 4 or 5 days, the cell
suspension contained no more citrate than would be used in ordinary citrated
transfusions. The majority of transfusions were given within 10 to 14 days after
the blood had been collected, but in some instances they were given with
26-day-old blood. The length of time the blood was kept did not seem to
influence the results. The blood arrived in good condition, with no evidence of
hemolysis, after transportation by ambulance for 6 to 8 miles over rough roads,
a demonstration later repeated by Capt. Kenneth Walker, who carried a bottle of
preserved blood with him during a journey from Arras to London. The 22
transfusions with preserved blood reported by Robertson in June 1918 were
carried out on 20 patients, of whom 9 died but all of whom, it was thought,
would have died unless they had received blood.
In 1918, transfusions were carried out farther forward than casualty clearing stations, chiefly due to the efforts of Captain Walker, Capt. Norman M. Guiou (23) of the Canadian Army, and Major Holmes-á-Court of the Australian Army (22). The syringe technique, Guiou claimed, could "easily" be applied in advanced dressing stations and in the average regimental aid post. If casualties were given blood in these areas, he continued, they would be kept alive until they reached the casualty clearing station, where they could be treated surgically.
The official history of the British Medical Service in World War I
concluded that whatever the merits of the various techniques of transfusion in
civil life, there was no doubt of the superiority of the citrate method in
wartime. It could be employed in circumstances in which other methods were
impractical. It was simpler than other methods. It permitted the
transportation of blood from donor to recipient without interrupting an
operation and further congesting an already overcrowded operating tent. A
skilled "transfuser," devoting himself entirely to the task of
drawing and citrating blood, could supply a dozen patients in need of blood,
leaving to anesthetists the "simple task" of administering the blood
Donors. -- There was no difficulty in procuring blood donors. Up to the middle of
1918, the spirit of comradeship was sufficient to supply them. Later, a 3-week
leave in England after the donation secured many offers from lightly wounded
men. Dental patients and soldiers with minor injuries, sprains, and flat feet
were also used as donors. Syphilitic and malarial subjects were rejected, as
well as those with other infectious diseases, such as trench fever. A healthy
donor, it was thought, could withstand the loss of 700-1,000 cc. of blood.
Blood grouping. -- Early in the war, the precaution of blood grouping before transfusion was frequently omitted because it was impractical. A number of reactions were attributed to this omission, and by June 1918, Bruce Robertson (19) had observed three cases of fatal hemoglobinuria in 100 transfusions. Later in the war, preliminary blood grouping became the rule, but, when there were no facilities for laboratory work, his suggestion of a test injection was generally used, particularly in emergencies. If no symptoms occurred within 1 or 2 minutes after the injection of 15 to 20 cc. of donor
blood, it was thought safe to proceed with the transfusion. ...
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.)