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History of blood transfusions and soldiers at war

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In 1628, Dr William Harvey was an English physician who published a book in which he described the circulation of blood in humans. Researchers commenced experim­ents involving the intraven­ous injection of various substances into an­imals, which progressed into blood transfusions between animals. Richard Lower, a member of the Oxford Experiment­al Group, showed that transfusion could be used in cases of severe blood loss by exsanguinating a dog and transfusing it with blood from another.

Dr Jean-Baptiste Denys (1643–1704) was personal physician to King Louis XIV and was noted for having performed the first fully docum­ented human blood transfus­ion. In 1667 he administered tran­sfus­ions of calf's blood to a man who died during the trans­f­usion. Denys was charged with murder and although he was acquitted, the practice of blood transfusion was deemed a crim­in­al act by the French parl­iament in 1670. The Royal Society soon began to dist­ance itself from blood transfusion and the next year Pope Innocent XI banned it. Experimentation was certainly slowed down.

Dr James Blundell (1790-1878) was an English obstetrician who perf­orm­ed the first successful transfusion of human-to-human blood, to treat a haemorrhage in 1829. Shortly after Blundell int­roduced two instruments for the purpose of transfusion: the impel­l­or and the gravitator. These apparatuses appeared in The Lancet of 1829.

Blood transfusion nurses, end of WW1 
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Postpartum haem­orrhage, extreme malnutrition, puerperal fever, ruptured uterus and hydrophobia were all indications for trans­fusion then. A careful search of the literature revealed ten recorded transfusions performed by Dr Blundell but of these, only five were described as successful.

When the Franco-Prussian War (1870–71) was raging in Eur­ope, the possibility of using blood transfusions on the battle­field arose. Dr J Roussel of Geneva had first used his method of direct arm to arm transf­us­ion with success in 1865 for a patient with puerperal haemorrhage. The app­aratus he used was described in the Gazette des Hospitaux in 1867, though Roussel complained in 1876 that the app­aratus was not used as it might have been in the Franco-Prussian war. 

To overcome the hazard of coagulation and to prevent exposure of the donor's blood to air, obstetrician & gynaecologist Dr James Aveling made a sim­ple apparatus for direct transfusion from donor to recipient's vein in 1865. In 1872 a patient had suffered a severe postpartum haemorrhage; an immediate transfusion was made and the patient made a good recovery. And when no other therapies seemed to work with severe anaemia, trans­fusions were an established practice from the late 1870s up to WWI.

Not only did doctors not know how to stop blood clotting in the late C19th, but when they did manage transfusion, the patient often inexplicably died. It wasn’t until the C20th that different blood groups were discovered! Identification of three major blood groups was described by Nobel Prize winner Karl Land­st­einer in 1901. 6 years later, Czech neurologist Dr Jan Jansky accurately described four major blood groups (A, B, O and AB).

Yet despite new knowledge of blood groups and prev­ention of blood clotting, blood transfusion was not widely adopted during WW1. Note that in 1915, Capt OH Rob­ertson of Harvard Medical School dem­onstrated that blood could be safely trans­fused to wound­ed sold­iers. He developed the trans­f­usion bottle and pioneered un­iv­ersal donor blood, but the medical profession remained very sceptical. 
 
Dr Blundell's blood transfusion
The Lancet 1829

Having been impressed by a voluntary blood transfusion carried out in London’s King’s College Hospital, Percy Lane Oliver set up a vol­unteer panel of blood donors in 1921. This event­ual­ly led to the creation of the British Red Cross Blood Transfusion Service.

It was not until the Spanish Civil War that large-scale blood tran­s­­fus­ion became possible. This was among the first conflicts to re­sult in widespread targ­eting of civilians; Dr Frederic Durán-Jordà est­ab­lish­ed a blood transfusion service in Barcelona in 1936, for transfusing both soldiers and civilians. He was exiled to the UK after the Civil War and worked at the Hammersmith Hospital.

Dr Norman Bethune was a surgeon who was invited by the Committee to Aid Spanish Democracy to bring a surgical team to Madrid in 1936. Recognising the importance of bringing blood to wounded sol­d­iers and civilians rather than transporting patients to hospital for transfusion, Beth­une introduced the mobile blood bank to the men.

To help the war effort, the Plasma for Britain Campaign was created in the US. It was directed by Dr Charles Drew, who researched in the field of blood transfusions. He developed improved techniques for storage, and applied his expertise to developing large-scale blood banks early in WW2.

The main stimulus to develop blood and blood component therapy in the US was the Japanese attack on Pearl Harbour. Dr Edwin J Cohn of Harvard University developed a method of manufact­ur­ing albumin, a soluble protein found in blood plasma, for trans­f­usion. Initially made as a powder and later as a liquid, it used in the treatment of shock. It was to prove particularly important in the Pacific war and saved hundreds of thousands of lives on the battlefield.

The Korean War (1950–53) saw the in­vention of a simple plastic bag and led to a major devel­opment in blood transfusion. The bag had many advantages over the glass bottles, in terms of weight, storage and trans­p­ort. The first polyethylene blood collection bag had two tubes, one for blood collection and one to deliver blood to the recipient. War was always the major force in the organisation of blood supplies and stimulated the development of new medical technol­og­ies!

Thank you to Shaun McCann, George McLoughlin and Phil Learoyd.






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