The Pampered Louse

From: acws.co.uk

No one should attempt a collection of Confederate humour without including an account of the old-time "grayback" louse, or Pediculus Vestimenti. These tiny unforgiving creatures were so well known by all Civil War Soldiers, as to have become "legends in their own time." One infantry man summed up their ever-presence by declaring simply, that each louse should have had stamped on his or her back; "IFW", "In for the war."

There are hundreds of excellent primary sources that make mention of these devilish insects. One favourite which chronicles the "comings and goings" of this "depraved little pest," was recorded by Captain William ‘Buck’ Walton, Company B, 21st Texas cavalry. Here is his excerpted version:

Head Louse
I found that many of the men had been familiar with these varmints a long time - and become accustomed to their presence. So much so, that it was part of their amusement to catch big ones and bet on their fighting qualities. It is true that the grown bug, when taken from the bodies of different men - and placed together, will rush at one another like bulldogs, and fight to the death - or until one, being whipped and wounded, will scramble out of reach if his adversary. This I saw tested one day when a number of my men were gathered together, watching very intently such a fight. They had two "big fellows" on the top of a hat, smoothed out. There was considerable excitement, and the men had their Confederate money - and were flourishing it, as I have seen men do at a horserace. I walk up to see what was the matter and saw the whole fight. The bugs were just coming together - and they certainly were mad. The gladiators unarmed save with their natural weapons were joined in conflict. It was a battle royal. They stood up on their hind feet. They closed in grapple and would roll over and over. They seemed never to weary. The battle lasted five or six minutes. The blood was very perceptible on each one. Their legs were broken and there were wounds on their bodies - to such an extent that they were maimed - and neither could run from each other. The two warriors could do nothing, but lay on the field of battle and lingering die.

Actually some of the men would not molest a very fine specimen - but let him grow and fatten on his own blood until the thought he had the most robust "gladiator" in camp and then would draw him forth privately and try his powers on a smaller specimen, that he would borrow or steal from another man. When he had tested him and made him bold by whipping smaller fellows--his owner would challenge the field - having the champion--& offer to bet on him, like he owned a press that threw off Confederate money as wanted. Sometimes they made a run with their pampered louse, and became very flush. And then some man would find a still more pampered one and win all his money. Many are the ways that idle soldiers find to amuse themselves - but I really think this was one of the most unique ways that I saw in the army. I called on two boys for two of their champion "gladiators" - for a special purpose. They cheerfully gave them, and I took them & in a letter to my Captain’s wife Mrs. Wm. Rust at Burnet, Texas, enclosed them to her - to see what we could do in the army. They were received - and proved of the right gender - & before she was aware of it, she was in possession of a flourishing colony, which caused much washing and disinfecting before she could get rid of them.

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Ambulance Trains

From: replications.com

Immediately prior to the break out of hostilities between the National Government and the Confederate States, the U.S. Army had developed and built a quantity of ambulances.  Up to that time, there was no purpose built ambulance in government service.  In previous wars, various wagons were pressed into service for the transporting the sick and wounded.  Most were found unsuitable.

The commission that developed the specifications for the first U.S. Army ambulances examined European designs and those submitted by American sources.  It was decided that a light, single horse, two-wheeled cart and a heavier, two (sometimes four) horse, four-wheeled wagon be built.   A Battalion of Infantry was to receive an allotment of one two-wheeled cart per company plus one more two-wheeled cart and a four-wheeled wagon per battalion.  Later, men were drafted from regiments to form an Ambulance Corps.  An innovation of Jonathan Letterman, the Ambulance Corps first officially appears in the Army of the Potomac (1862).  Congress would later make the institution a mandated part of the establishment (1864).

The two photographs on this page illustrate the usage of the three most common ambulances used during the war.  The first photograph shows the 2 wheeled ("Coolidge") and 4 wheeled ("Tripler") approved for use in  1859.  The second photograph shows the lighter 4 wheel pattern ("Roscrans/Wheeling") that begins to appear in numbers about the time of Fredericksburg and will generally replace the earlier models by the end of 1863.

Medical Inspector Frank Hamilton noted that the two wheeled variety continued in use through the end of the war where the roads were smooth.

Near the end of the war, an improved 4 wheeled ambulance ("Rucker") was adopted and was the standard Army pattern ambulance for the post war Indian campaigns.

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Dr. Jacob Da Silva Solis-Cohen, Laryngologist

From: nature.com

Dr. Jacob Da Silva Solis-Cohen, (1838-1927), the founder of laryngology in the United States, was born in New York City on February 28, 1838, of distinguished Spanish and Portuguese ancestry. He received his medical education at Jefferson Medical College and the University of Pennsylvania where he qualified in 1860.

After serving for a short time in the United States Army and Navy during the Civil War, he devoted himself to the study of laryngology. His first work on the subject, entitled “Inhalation in the Treatment of Disease”, was published in 1867, and was followed in 1872 by his great work “Diseases of the Throat and Nasal Passages”, which at once became a standard text-book and ranked with those of Morell Mackenzie (1860) and Francke F. Bosworth (1881) among the classics of laryngology.

In 1874, appeared Solis-Cohen’s monograph on “Croup in its Relations to Tracheotomy”, based on the study of 5,000 recorded cases ; in 1875 he published a book on “The Throat and Voice”. In 1866, he was the first in the United States to institute regular lectures on laryngology at the Philadelphia School of Anatomy.

In 1870 he was appointed lecturer on laryngoscopy and diseases of the throat and chest in the Jefferson Medical College and two years later professor of laryngology. He was one of the founders of the Archives of Laryngology and for many years edited the laryngological department of the American Journal of the Medical Sciences. He also helped to found the American Laryngological Association, of which he was the second president in 1880–82. As the result of his experience in the Civil War he excelled in the surgery of the upper air passages.

In 1892 he was the first in America to perform a successful complete laryngectomy.

His death occurred on December 22, 1927.

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Ironclad Fever: A Naval Surgeon's Civil War (Abstract)

By Sandra W. Moss

1866, young Dr. Edgar Holden of Newark (1838-1909), a recently demobilized medical officer
in the Union navy, published "An Inquiry into the Causes of Certain Diseases on Ships of War" in the American Journal of the Medical Sciences. The Index Catalogue of the Library of the Surgeon General Office lists but a handful of articles about Civil War naval medicine; The Medical and Surgical History of the War of the Rebellion was compiled and published by the Army. Thus, Holden's article is quite valuable. In it, he described three apparently novel syndromes, including a condition which he called "ironclad fever."

The proposed paper begins with a description of Holden's experiences as a naval surgeon and the general health conditions aboard the first generation of Union ironclads. At the conclusion audience members will be invited to offer a modem perspective on Edgar Holden's series of "ironclad fever" cases.

Holden was a graduate of the College of Physicians and Surgeons in New York (1860) and had the great good fortune to have studied physiology under John Call Dalton, America's first professional physiologist. Holden was better prepared than most young medical man who attended ante-bellum American medical schools. Perhaps the habit of scientific enquiry nurtured by Dalton prompted Holden to observe closely the apparently novel illness of seamen which formed the basis of his article.

A few months after graduation, Holden signed on as an Acting Assistant Surgeon in the Union Navy. His experiences and observations as medical officer of the Minnesota at the battle between the Monitor and the Merrimack (Virginia), his harrowing brush with death aboard the ironclad Passaic in the storm which claimed the Monitor off Hatteras, and his grim sickbay duties aboard the steam gunboat Sassacus in the aftermath of the encounter with the Confederate "ram" Albermarle have not been previously researched.

The paper further explores the unhealthy conditions observed by Holden and others on the early ironclads. Faulty ventilation, noxious gases, unbearable heat, constant dampness, and oppressive gloom plagued the partly submerged and densely crowded vessels. Following the failed naval bombardment of Charleston harbor in 1863, Holden, surgeon on the ironclad Passaic, observed that conditions aboard the vessel "could not fail to enervate and sicken the healthiest crew."
Holden's 1866 article in the American Journal of the Medical Sciences described three previously unrecognized disorders. A fever attributed to fetid gas from a neglected bilge was thought by Holden to be due to mold. An outbreak of glossitis was traced by Holden to the presence of heavy metals in the ship's tobacco. Both these condition occurred on conventional vessels. The third syndrome, dubbed "ironclad fever," was apparently observed on several early ironclads by a number of naval surgeons. Of some 40 cases, Holden observed 10. The mortality rate was over 80%.

A retired internist, Sandra W. Moss has since last year's annual meeting of the American Osler Society now received her masters degree in the history of medicine from Rutgers University. Her research interests center on nineteenth-century American medicine and on the medical history of New Jersey. She is a past president and longtime program chair of the New Jersey Medical History Society.

Image: U.S.S. St. Louis, First Eads Ironclad Gunboat, Renamed the Baron de Kalb in October 1862

From:  websitesasksam.com

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Dr. Jacob Solis-Cohen and Tracheotomy in the Civil War

Excerpted from: Jill's Soapbox/History of Trachs

In 1860, Abraham Lincoln was elected President of the United States on an anti-slavery platform. Within three months seven Southern states, led by South Carolina, seceded from the Union. These states formed the Confederate States of America, plunging the country into the Civil War. Virginia's loyalties were with the South, but in May 1861 Alexandria was invaded by federal troops and was occupied for the duration of the war. The city became the base for the invasion of Union troops into Richmond, Virginia, the Confederate capital.

The Civil War claimed the lives of six hundred thousand Americans, both white and black. The suffering of the wounded was eased by ether anesthesia, discovered in 1842 by Dr. Crawford Long. Amputation was the most common surgical procedure of the war and was considered the best way to save the lives of soldiers with bullet wounds in an extremity. Other common medical procedures included bullet extraction, ligation (sewing of an artery to stop bleeding), trephine (drilling a hole in the skull to relieve the pressure of a hemorrhage), and the administration of opium or morphine to kill pain. It was at this time that Dr. Jacob Solis-Cohen (1838-1927) championed laryngology in America.

Dr. Solis-Cohen, considered a founding father of the specialty, completed his medical education at the University of Pennsylvania in 1860. He served in the Civil War as a surgeon from 1861 to 1864. Throughout his career, Dr. Solis-Cohen developed lifesaving surgical techniques for the management of illness and disease associated with the air and food passages. One such technique he developed was the complete removal of the larynx (voice box), called a total laryngectomy. This procedure is most often performed to treat a well-established cancer of the vocal cords and associated organs.

Without a larynx, breathing through the mouth and nose or speaking normally is impossible. Dr. Solis-Cohen's technique for total laryngectomy allowed patients to develop speech utilizing the esophagus. His procedure also permitted the patient to breathe through a tracheotomy that did not require a tube. Tracheotomy is a surgical practice calling for cutting into the front of the neck, making an opening in the trachea (windpipe) and usually inserting a silver tube to act as the new airway.

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Two Cases of Civil War Blood Transfusion: Treatment of Haemorrhage

From: Medical/Surgical History--Part III, Volume II; Chapter XII.--Wounds And Complications.

Two cases of transfusion of blood are found on the records; one, a successful operation, was performed by Surgeon E. Bentley, U. S. V.; the other, a fatal case, by Assistant Surgeon B. E. Fryer, U.S.A. Both are here detailed:

CASE 1186.--Private G. P. Cross, Co. F, 1st Massachusetts Heavy Artillery, aged 19 years, was wounded in the right leg, before Petersburg, June 16, 1864, and entered the Grosvenor Branch Hospital, Alexandria, two weeks afterwards. Surgeon E. Bentley, U. S. V., who operated in the case, made the following report:' "The injury consisted of a flesh wound on the posterior aspect of the leg. At the date of the patient's admission he was exsanguineous from previous loss of blood. Owing to his condition no operative measures were adopted, but his languishing vital powers were sustained by stimulating treatment combined with highly nutritious diet. Under this method he slightly improved in strength, but the circulating fluid was so impoverished in quality and reduced in quantity that the face of the wound looked pale and bad, and ultimately, on August 12th, it assumed a gangrenous aspect. Local applications, such as creasote, charcoal poultices, nitric acid, etc., were applied to combat this condition. These means failed to arrest its onward progress, the leg presenting in a short space of time a mass of gangrenous sloughs, horribly fetid. Haemorrhage from the posterior tibial artery again commenced on the afternoon of August 15th, when it was deemed advisable to amputate to prevent further loss of blood. The operation was accordingly performed just at the tubercle of the tibia, the condition of the parts not allowing a flap to be made below that point. Not more than two tablespoonsful of blood was lost; but the patient not seeming to rally, it was determined to test the method of transfusion of blood as recommended by Brown-Séquard. Blood having been obtained from the temporal artery of a strong healthy German, an attempt was made to penetrate the internal saphenous vein, but was unsuccessful on account of its small size; after which an <ms_p3v2_812>opening was made into the median basilic, and about two ounces were transfused by means of a Tiemann's syringe. Immediately after the injection a marked difference was noticed in the patient's pulse, which became stronger and firmer. He was then removed to his bed and generous diet was administered, together with stimulants and tonics, under which treatment he gradually improved, his appetite became better, his strength increased, and the stump assumed a healthy aspect. On October 20th the stump had healed and the patient had so far improved as to be able to be furloughed. At its expiration he returned, and, finally, he was transferred to Webster Hospital, Manchester, January 13, 1865, cured." The patient was ultimately discharged from Central Park Hospital at New York City, June 9, 1865, and pensioned, and afterwards he was supplied with a "Hudson" artificial limb. This pensioner died August 24, 1867.


CASE 1187.--Private J. Mort, Co. E, 105th Illinois, aged 37 years, received a flesh wound in the upper third of the left leg, at Keneeaw Mountain, June 26, 1864, by a musket ball, which lodged between the tibia and fibula. He entered Brown Hospital, at Louisville, nine days after receiving the injury, the missile having been extracted and the wound looking unhealthy and sloughing. During.the night of July 24th the patient had a copious haemorrhage from what was supposed to be the anterior tibial artery, which was arrested. On July 26th bleeding again commenced, the blood welling up from between the bones and from the tissues posterior to them. It was then deemed necessary, in order to save life, to amputate, which was done through the upper third of the leg by the circular method, by Assistant Surgeon B. E. Fryer, U.S.A. Ether was used as an anaesthetic, and three ligatures were applied, the patient reacting very slowly. On the following day it was determined to transfuse some blood into the patient, for which purpose, in the absence of any other suitable apparatus, an ordinary gutta-percha syringe was used, the nozzle of which was filed to fit a small tube having a stop-cock through its centre. The right cephalic vein having been selected, an opening was made carefully into it, and the syringe having been warmed and filled with blood from a healthy man, a little of which was allowed to flow from the syringe before forcing its nozzle tightly into the tube in order that any air might be driven out, the tube was introduced and the stream of blood was slowly and carefully forced in. About sixteen ounces were thus transfused. The first effect upon the patient was to increase respiration from about fifteen to twenty-eight per minute, though it soon returned to its normal number of about sixteen. The pulse ran up from one hundred to one hundred and thirty, which, however, also soon returned to what it had been. The man's general condition was greatly improved. His pulse became fuller and slower; he slept well; his stomach retained food, and altogether the prognosis became more favorable. On August 4th haemorrhage commenced from the face of the stump, the whole surface of which appeared to be involved. From the effects of this, and from chronic dysentery, the patient died on the following day, August 5, 1864; although his condition, from the effects of chronic dysentery and of the haemorrhage at the time of the transfusion, was such as hardly to expect his recovery, the improvement was such as to show that the operation was not only justifiable, but that it was to all intents a success. The history of the case was reported by the operator.

From: medicalantiques.com

Image: An Antique 19th Century Blood Transfusion Pump

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Transfusions During the Civil War

Prior to the use of cross-typing of blood groups to determine A, AB, O compatibility
(Extracted from the Medical & Surgical Record, April 15, 1874.)

A few remarks on the Transfusion of Blood, with a modification of the Apparatus of Aveling. By B. E. Fryer, M. D., Surgeon U. S. Army. post-Civil War

To show that the subject of transfusion is one which a large portion of the profession has not yet fully weighed the importance of nor realized the fact that this measure can frequently be made applicable in cases which are now quietly otherwise yielded to death, we have only to call attention to the rarity of reported instances (see below examples) in which the operation has been taken advantage of, and refer to the many obvious ones in which it should be made available. Even in threatening dissolution from the direct loss of blood,—such as from wounds of large vessels, from prolonged epitasis, or, in probably one of the most frequent opportunities met with, from hemorrhage, post-partum, where the restoration of blood by transfusion has been, so to say, legitimatized—but few of us are prepared for the emergency, or if prepared, do promptly act and give the then affected only chance of life.

We will briefly state the kind of cases in which it has occurred to us that transfusion should "be had recourse to without hesitation, and they may be conveniently note under two headings.

We would include in the first class those cases in which a copious blood-loss has occurred and immediate death is threatened. As is well known, it is in these mainly that the measure lias been applied. It might well be tried in coses of injury accompanied by a more moderate hemorrhage, and where it is necessary to do an important surgical operation, and this operation is delayed (often disastrously) for a reaction by ordinary means. Moreover, it should be done before or aftor necessary surgical measures in the astheuic patients, fu order to avoid pytrmia and its allied evils, especially in operations where the peritoneum is involved. After labor, too, where hemorrhage may have been great, but not enough to threaten immediate death, it should be done to avoid septicemia difficulties. For that depression from the loss of blood is a most direct cause of pyemia and its pathological associates, those of us who have had to treat large numbers or gunshot and other injuries, and to operate In these cases, where hemorrhage and other depressing causes had done sad havoc, well know.

But we have in the second class a larger number of cases—diseases both acute and chronic—and bore we more commonly meet with opportunities. In such, transfusion has scarcely been thought of; but it is in these, too, it ought in be, and will Ims, we think, taken advantage of. Of the acute cases we refer to, those in which natural nutrition is for the time suspended, either from a direct lesion of the blood-making system in one or more of its divisions, or is indirectly affected in consequence of some profound systemic impression, where if we can but bridge over a short period by keeping life's machinery going. we may ultimately bring about a restoration of the healthy nutrition process, and thus save life. To particularize : acute gastric troubles, giving excessive and continuous vomiting; acute diarrheas and dysenteries; in peritoneal intluiinuatUms, in some of the low forms of fevers where waste is excessive mid the* absorption of nourishment nti. In cholera it should be done more generally than it has been. It might In tried, t"<> in sonic of the acute diseases of young children, particularly ill those' which give convulsive movements and convulsious proper, and which often indicate to us diminished blood-supply to the brain, and tell us that death can again put the nerve-centers quietly at work.

In chronic eases where the blood-making is reduced or nearly destroyed, we might often prolong life by transfusion. Such cases are not frequent, though we need not enumerate them. We might well apply the measure even in some cases of phthisis pulmoimlis.

In regard to the fluid to be transfused. As is well known, human blood is that to be, most desired, after the blood of some of the lower animals may be selected. Hutlder, of Canada, threw into the veins of some of his cholera patients fresh milk, and with excellent results. The writer has experimented with milk injections in the veins of (logs, and though the experiments have not been completed as to a test of the nourishing effects of the milk so given, no bad symptoms have become apparent. If it can be satisfactorily proved, that milk may be safely and generally used in transfusion, and with the desired result, a great advance will Iks mode in the matter, it being nearly always obtainable, while many of the difficulties and inconveniences in the use of blood will be avoided. A saline solution (such as that of Mr. Little*) should be tried to save life, if nothing else is at hand.

The instruments for transfusion are to us is well known, quite numerous, and while many of them are very good, we believe that of Aveling, for immediate transfusion, to be probably the simplest, safest, and most easy of application. We have lately modified it by adding another bulb to the tube, and by having both tube and bulbs cost of the rubber into one piece. By the additional bulb we can save time in doing the operation, and can keep the blood moving along the tube almost continuously. In having the ruin- and bulbs in one, we do away with the metal portions which couples them in Aveling's apparatus, and we thereby diminish the risk of blood lodging and coagulating; while we if necessary, compress the whole apparatus more completely. As in Dr. Aveling's instrument, there are no valves.

The instrument of Aveling is intended for immediate transfusion. We have added a glass vessel which can be fitted to the tube, and the whole then used as a mediate transfuser if desired. The accompanyiug cut gives a good representation of the apparatus.

The manner of using the instrument Is very similar to Aveling's. The canula marked S is placed in the giver's vein, that marked in the vein of the receiver. The tube and bulbs having been filled with warm water. or better, with Mr. Little's saline solution (also warm), are now adjusted to the canulas and the blood allowed to flow into the apparatus. The canula being steadied by an assistant, the tube is to be nipped tightly between the fingers, close to the giver's or efferent end, and then the bulb marked 1 is to Ite compressed, and the lilood of course forced on towards the receiver. While this bulb is still held compressed, the tulie at the giver's side is to bo relaxed, and that portion of it between the bulbs is to be nipped; bulb 1 is relaxed. a.nd No. 2 compressed and held then the tube at the receiver's side is to he seized and held to prevent regurgitation, and the whole apparatus allowed to refill. The same operation to be repeated till sufficient blood is transfused. As suggested bv Dr. Aveling, a few drops of ammonia solution may be injected into the bulbs now and then, by a fine-pointed hypodermic syringe, in order to more effectually prevent coagulation. It will be found that considerable force is necessary in sending blood or other fluids into the veins. This we discovered while doing transfusion twice in a case after hemorrage from gunshot injury, and we have also found it in our experiments on the lower animals. It is a fact that we nave not seen noted in connection with transfusion, and one well worth remembering.

In order to age the apparatus as a mediate transfuser, the vessel marked A in the cut receives the blood, the tube is to be applied, and the instrument used as before directed. If the blood is not deflibrinated and strained, three or four drops of ammonia solution are added, in order to avoid coagulation.

The instrument is made bv Messrs. George Tiemann &, Co., 67 Chatham Street, New York.

We would suggest to those who may become interested in transfusion, that though the operation is a simple one. it requires care, and it should first 'be practiced once or twice on the lower animala no difficulty will then be had in doing It on man when occasion requires.

Draw eight or ten ounces of blood from a healthy person into a clean vessel, whilst it is accumulating whip it with a silver fork, a stick of wood or a bunch of straw, then strain it through a piece of cleanly washed linen into a vessel placed within another containing warm water (about 105 C.) Warm the syringe, put the suction end A into the blood, compress the bulb, and when it flows through the canula, turn the stopcock C.

Having bared the patient's arm, raise a fold of skin over a vein at the bend of the elbow, divide it and pass a probe or thread under the vein thus brought into view. This is now held with a pair of forceps or tenaculum and an incision made with a lancet or pair of fine pointed scissors, carefully avoiding to wound its posterior wall. Now introduce the canula D, open the stopcock and inject slowly.

The bulb contains about three fluid drachms, but by moderate compression about two only are expelled. In most cases it suffices to inject from four to six ounces. If resistance, not due to external pressure be felt, or dyspnoea, or any other untoward symptom appear, the operation has to be interrupted or ended. Dress the wound as after phlebotomy.
After use, the instrument must be thoroughly cleansed, which is best done by separating all the parts and washing them in warm water.

From the Medical and Surgical History and the Geo. Tiemann Catalogue 1870's

Image: Garrigue's Transfusion Apparatus.

From: medicalantiques.com

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A Brief History of Blood Transfusion in the 19th Century

From: ibms.org

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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