James Blundell, proponent of physiological concepts, teacher of the
conservative practice of obstetrics, and one of the first to practice
blood transfusion in humans, was an eccentric physician of Guy's Hospital.
Little is known of Blundell's early life beyond the cursory details
provided by Pettigrew 1
in his MEDICAL PORTRAIT GALLERY. He notes that Blundell was born in
London and received an excellent classical education under Rev. Thomas
Thomason. Blundell's medical education began at the United Southwark
Hospitals, where he studied anatomy and surgery under Sir Astley Cooper
and midwifery and physiology with his maternal uncle, Dr. John Haighton,
a dominant influence in his professional career. His medical studies
continued at Edinburgh, and, upon presentation of a thesis prepared
in Latin discussing the senses for music and hearing, he received
the MD degree in 1813. Returning to London, he began his academic
career with lectures on midwifery under Haighton, to which he added
shortly thereafter a course in physiology. He was admitted a licentiate
of the Royal College of Physicians in 1818; and in the same year succeeded
his uncle as lecturer in the united schools of St. Thomas' and Guy's
Blundell's experimental work was initiated and completed within a
decade. His important physiological contributions, investigations
of surgical management of the pelvic organs, and introduction into
clinical practice of the transfusion of whole blood have been attributed
to his intimacy with Haighton. Practicing vivisection, Blundell refuted
the arguments of the opposition and maintained that gains from physiological
knowledge justified the experimental exposure of animals in the laboratory.
The importance of blood transfusion was offered as an example which
carried direct implications from the dog to man. From the laboratory
facilities at Guy's Hospital, he presented in 1818 his findings associated
with the transfusion of whole blood, by means of the syringe, in a
series of dogs.2 The benefits
of rapid execution of the procedure to prevent coagulation of blood,
the importance of avoiding the introduction of air into the recipient's
veins, and the incompatibility of heterologous donors were discussed.
Although the possibility of transfusing whole blood from human to
human had been discussed in the literature for centuries, Blundell
made the hypothesis a reality. He completed four successful transfusions
out of slightly more than twice this number. As he pursued his experimental
trials in dogs, he performed, with a syringe, the first transfusion
in humans in 1818.2 Complicated
instruments were described subsequently. One device named an "Impellor"
provided blood under pressure to the recipient; the Gravitator, a
gravity feed apparatus, was described in the LANCET in 1829. The indications
for transfusion included postpartum hemorrhage, extreme malnutrition,
puerperal fever, cancer of the pylorus, ruptured uterus, and hydrophobia.
Since each of his patients was critically ill at the time of decision,
it is impossible to discover from the clinical notes whether a transfusion
reaction appeared as a complication in any. Excerpts from the LANCET
In the present state of our knowledge respecting the operation, although it has not been clearly shown to have proved fatal in any one instance, yet not to mention possible, though unknown risks, inflammation of the arm has certainly been produced by it on one or two occasions; and therefore seems right, as the operation now stands, to confine transfusion to the first class of cases only, namely, those in which there seems to be no hope for the patient, unless blood can be thrown into the veins.
Blundell's experimental investigations of the response of the peritoneum of animals to surgical interference held considerable interest because of the possibilities for surgical advances generally and for obstetrics and gynecology specifically. He accumulated convincing evidence that the abdomen was surgically approachable. Proceeding to implement these observations in humans, he gained experience in correcting intraperitoneal rupture of the bladder, relieving intestinal intussusception by passing the folds of the small bowel through the fingers after a small abdominal incision, dividing the Fallopian tubes at Caesarean operation to prevent further pregnancy, and alleviating severe dysmenorrhea by removal of healthy ovaries.
The object of the Gravitator is, to give help in this last extremity, by transmitting the blood in a regulated stream from one individual to another, with as little exposure as may be to air, cold, and inanimate surface; ordinary venesection being the only operation performed on the person who emits the blood; and the insertion of a small tube into the vein usually laid open in bleeding, being all the operation which it is necessary to execute on the person who receives it.
Although the description of the instrument must appear complex, its use is simple; in truth, when the transfusion is once begun, the operator has little to do; his principal cares are -- first, to see that the cup never empties itself entirely, otherwise air might be carried down along with the blood. Secondly, to make sure that blood which issues by dribbling, from the arm of the person who supplies it, may not be admitted into the receiver, as its fitness for use is doubtful. Thirdly, to watch the accumulation of blood in the receiver, and to prevent its rise above the prescribed level; and, lastly, to observe with attention the countenance of the patient, and to guard, as before stated, against an overcharge of the heart. This latter cause is of great importance.
In his obstetrical practice and teaching, Blundell urged against unnecessary
interference, differentiated between placenta previa and accidental
hemorrhage, advised late interference only in breech presentation,
was cautious in employing forceps, and treated eclampsia by venesection,
emetics, and purgatives. Vaginal or abdominal hysterectomy was recommended
for cancer of the cervix. His lectures in physiology and midwifery
appeared in the LANCET against his wishes but in accordance with a
policy practiced by Wakley, the editor. His treatise, entitled RESEARCHES
PHYSIOLOGICAL AND PATHOLOGICAL, INSTITUTED PRINCIPALLY WITH A VIEW
TO IMPROVEMENT OF MEDICAL AND SURGICAL PRACTICE, was prepared as three
essays.4 The second on generation
in rabbits proved that semen must have access to the rudiments for
reproduction, and that the corpus luteum develops unrelated to pregnancy.
His LECTURES ON MIDWIFERY, assembled as a text in 1832,5 was followed
by a larger volume on THE PRINCIPLES AND PRACTICE OF OBSTETRICY, edited
by Castle,6 which was superseded in 1837 by his OBSERVATIONS ON SOME
OF THE MORE IMPORTANT DISEASES OF WOMEN, also edited by Castle.7
This text was popular as judged by its several revisions and editions,
including printings outside of Great Britain.
Blundell was admitted a Fellow of the Royal College of Physicians in 1838, two years after he retired from Guy's Hospital in an irreconcilable dispute with the administration. The loss to Guy's and to future pupils who might have benefited from his research and teaching was great. He retired from these pursuits to full-time practice and eccentric hours of work. He arose at midday, saw patients in his office at home throughout the afternoon, and spent the evening making house calls in his carriage, which was fitted with illumination so that he could read between calls. Blundell's secondary retirement, this time from practice while in his late fifties, enabled him to devote his leisure to literary pursuits, especially the study of Greek.
1. Pettigrew, T.J.: BIOGRAPHICAL
MEMOIRS OF THE MOST CELEBRATED PHYSICIANS, SURGEONS, etc., MEDICAL
PORTRAIT GALLERY, vol. 1, London: Fisher, Son, & Co., 1840.
2. Blundell, J.: "Experiments on the Transfusion of
Blood by the Syringe," MEDICOCHIR TRANS 9:56-92, 1818.
3. Blundell, J.: "Observations of Transfusion of Blood,"
LANCET 2: 321-324, 1829.
4. Blundell, J.: RESEARCHES PHYSIOLOGICAL AND PATHOLOGICAL,
London: E. Cox & Son, 1824.
5. Blundell, J.: LECTURES ON MIDWIFERY AND THE DISEASES
OF WOMEN AND CHILDREN, London: Field & Bull, 1832.
6. Blundell, J.: THE PRINCIPLES AND PRACTICE OF OBSTETRICY,
T. Castle (ed.), Washington: D. Green, 1834.
7. Blundell, J.: OBSERVATIONS ON SOME OF THE MORE
IMPORTANT DISEASES OF WOMEN, T. Castle (ed.), London: E. Cox, 1837.
Photo: Courtesy of the National Library of Medicine.