Wednesday, March 11, 2015

A Brief History of Blood Transfusion in the 19th Century


The use of blood as a product can be traced back to the 17th century, although the greatest advances in its therapeutic was prompted by the worldwide conflicts of the first half of the 20th century. Here, Anthony J Harding puts transfusion science into historical perspective.

There are numerous Biblical references to blood, which was considered as the very essence of life and synonymous with the same. Jehovah Witnesses quote Leviticus on the forbidding of eating (taking) blood from another as a key element of their stance against human blood transfusion.

One of the earliest accounts of the circulation of blood was by the Arabic scholar, mathematician and physician Ibn-al- Nafis who, in 1260 AD, described the 'minor circulation' of blood in the body. This was more than 250 years before William Harvey described the continuous circulation of blood around the body in 1616, which he published in 1628.

The advent of the understanding of human anatomy and the circulation of blood gave rise to experimentation in transfusion techniques involving animal-to-animal and animal-to-human procedures. This eventually resulted in human-to-human transfusion.

In 1657, Dr (later Sir Christopher) Wren, now better known as the renowned Architect, performed a series of experiments involving the injection of various fluids into the veins of animals, with mixed results. Subsequently, in 1665, at a meeting of the Royal Society of London – of which Wren was a founder member – he demonstrated the transfusion of blood from one animal to another.

Although Lower and King performed the first animal-to-human transfusion in England, the first ever transfusion was performed by the Frenchman Jean-Baptiste Denis, five months earlier in June 1667 in Paris. Amazingly, Denis had commented on the potential of transfusion not only to replace blood loss but also to treat disease.

More importantly, he also considered that transfusions "ought to be done with blood of the same species". However, owing to the perceived risk to the donor, he later rejected this policy in favour of using animal blood.

The resultant fatal reactions recorded by Denis led to the transfusion of blood to humans being prohibited in France and subsequently in England. Thus, blood transfusion fell into disrepute and neglect for 148 years.

Nineteenth century revivalists
James Blundell graduated from Edinburgh in 1813, became an obstetrician of note at Guy’s Hospital in London and is credited with reintroducing blood transfusion into medical practice. Blundell reported favourably on the benefit of transfusion in cases of post-partum haemorrhage in 1828. He was clearly influenced by, and generously acknowledged, the earlier work of John Henry Leacock, also a graduate of Edinburgh, whose dissertation in 1816 established the principle that donor and recipient must be of the same species.

Blundell accepted this principle and reported his results of injecting human blood using a syringe. He later devised an apparatus, known as Blundell's Impellor, which consisted of a funnel and pump for the collection of donor blood for indirect transfusion into the veins of a patient. The invention of the hypodermic syringe by Alexander Wood in 1853 provided an important aid to transfusionists and led to the development of new devices to carry out transfusions.

In 1864 Dr Roussel in France and Dr James Aveling in London both used India rubber tubes to carry out direct human-to-human transfusions. James Aveling's apparatus consisted of two silver tubes that were used to enter the donor and recipient blood vessels, connected to a length of India rubber tubing, with a stopcock at both ends and a bulb in the middle. When squeezed, the bulb acted as a pump to expedite the flow of blood.

The main problem that stood in the way of the development of blood transfusion was the tendency for the blood to clot and to block the tubes or apparatus connected to the recipient. In 1873, Sir Thomas Smith of St Bartholomew's Hospital, London, is reported to have successfully transfused blood from which the clot had been removed (ie defibrinated blood). Attempts by Dr James Braxton-Hicks at Guy’s Hospital in 1883–84 to overcome this problem using sodium phosphate mixed with the blood as an anticoagulant resulted in the deaths of the patients.

In the last decade of the 19th century there was considerable debate about the benefit of using blood rather than saline. George Washington Crile carried out studies in 1898 to compare the efficacy of blood versus saline in maintaining blood pressure in shock. His conclusions kept alive the quest to find better and safer ways of transfusing blood, which did not became apparent until well into the second decade of the new century.


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