Innovators & Pioneers
James Blundell
Born: October 18, 1899
Died: January 9, 1993
Nationality: British
Occupation: physiologist
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 hospitals.
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 report follow.5
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.
Source: From the BIOGRAPHICAL HISTORY OF MEDICINE by John H. Talbott, pgs. 507-509. Reprinted by permission of John A. Talbott, M.D.
