Blood Transfusion

CHAPTER I. Historical Sketch

HISTORICAL SKETCH

From the earliest times the vital importance of blood to the human system has been fully appreciated. It has been supposed to carry in it some of the virtues, such as the youth and health, of its possessor, and it has therefore been commonly regarded as a sacrifice acceptable to the gods. References to blood in the Old Testament, in classical authors, and, it is stated, in the writings of the ancient Egyptians, refer rather to these mystical attributes than to any definite transference of it from the veins of one animal to those of another. One of the earliest references to actual transfusion of blood that has been noticed is to be found in a work by Libavius of Halle, published in 1615. The passage has been translated as follows:

“Let there be present a robust healthy youth full of lively blood. Let there come one exhausted in strength, weak, enervated, scarcely breathing. Let the master of the art have little tubes that can be adapted one to the other; then let him open an artery of the healthy one, insert the tube and secure it. Next let him incise the artery of the patient and put into it the feminine tube. Now let him adapt the two tubes to each other and the arterial blood of the healthy one, warm and full of spirit, will leap into the sick one, and immediately will bring him to the fountain of life, and will drive away all languor.”

It may be assumed, however, that this was only an idea, and had not yet been carried into practice. It was, indeed, unlikely that any attempt to perform blood transfusion would be made until the conception of the circulation of the blood had been promulgated, and this in 1615 had not yet taken place.

William Harvey had been appointed physician to St. Bartholomew’s Hospital in 1609, and already in 1616 as Lumleian lecturer had stated his theory of the circulation, but not until its publication twelve years later could it be generally known. His treatise entitled Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus, which appeared in 1628, may therefore be regarded as the point from which blood transfusion first arose. It has often been stated in the literature of the subject that the first transfusion was performed in 1492, when the blood of three boys is supposed to have been transfused into the veins of the aged Pope Innocent VIII. This, however, seems to have been a mis-statement of the facts. Actually a Jewish physician prepared a draught for the Pope from the blood of three boys, who were bled to death for the purpose. The drinking of blood was not a new idea; this particular incident is of no special interest, and may now be allowed to sink into oblivion.

It is not until after the middle of the seventeenth century that authentic references to blood transfusion are to be found. The first is in the writings of Francesco Folli, a Florentine physician, who claims to have demonstrated the operation of transfusion of blood on August 13, 1654, to the Grand Duke Frederick II. There does not seem to be any confirmation of this in the writings of others. A few years later experimental work tending in the same direction was being done in England, and the inception of this was due to the ingenious Sir Christopher Wren, who in this connexion has not hitherto received the recognition that is his due. Dr. Wren, as he was designated at the time, was one of the most active members of the recently formed Royal Society, and was responsible for many new experiments in several sciences. It is clear from references in the Philosophical Transactions that his first experiments were done in 1659, and the following statement is made by Dr. Thomas Sprat in his History of the Royal Society, published in 1667:

“He was the first author of the Noble Anatomical Experiment of Injecting Liquors into the Veins of Animals. An Experiment now vulgarly known; but long since exhibited to the Meetings at Oxford, and thence carried by some Germans, and published abroad. By this Operation divers Creatures were immediately purg’d, vomited, intoxicated, kill’d, or reviv’d according to the quality of the Liquor injected: Hence arose many new Experiments, and chiefly that of Transfusing Blood, which the Society has prosecuted in sundry Instances, that will probably end in extraordinary Success” (p. 317).

Sir Christopher Wren did not actually carry out any transfusion experiments on his own account. This was done by his friend, Richard Lower, well known for his work on the anatomy of the heart, who worked in the laboratory of Thomas Willis at Oxford. In these experiments, some account of which was published in 1666, he used a silver cannula for obtaining continuity between the artery of one animal and the vein of another. Lower must therefore receive the credit for having done the first transfusion actually performed in England. In the following year other experiments were done by Dr. Edmund King and Thomas Cox, both of whom recorded their experiences in the Philosophical Transactions.

Meanwhile Wren’s work had become known in other countries, and it is said that transfusion was performed in 1664 by Daniel of Leipsic, who thus anticipated the work of Lower. However this may be, the first transfusion done upon a human being was certainly carried out in France by Jean Denys of Montpellier, physician to Louis XIV. This is admitted in the Philosophical Transactions, but the following statement in extenuation of English hesitancy is made:

“We readily grant, They were the first, we know off, that actually thus improved the Experiment; but then they must give us leave to inform them of this Truth, that the Philosophers in England had practised it long agoe upon Man, if they had not been so tender in hazarding the Life of Man (which they take so much pains for to preserve and relieve), nor so scrupulous to incurre the Penalties of the Law, which in England, is more strict and nice in case of this concernment, than those of many other Nations are.”

Dr. Edmund King further asserts that “We have been ready for this Experiment these six Months,” that is to say, since March, 1667. Moral precedence must, however, give way to the actual, and it is clear that Denys had snatched the laurels. A translation of a full and interesting account of his earlier experiment upon animals and his first two transfusions done upon men was published in the Philosophical Transactions for July 22, 1667. Of the first of these he wrote as follows:

“On the 15 of this Moneth, we hapned upon a Youth aged between 15 and 16 years, who had for above two moneths bin tormented with a contumacious and violent fever, which obliged his Physitians to bleed him 20 times, in order to asswage the excessive heat.

“Before this disease, he was not observed to be of a lumpish dull spirit, his memory was happy enough, and he seem’d chearful and nimble enough in body; but since the violence of his fever, his writ seem’d wholly sunk, his memory perfectly lost, and his body so heavy and drowsie that he was not fit for any thing. I beheld him fall asleep as he sate at dinner, as he was eating his Breakfast, and in all occurrences where men seem most unlikely to sleep. If he went to bed at nine of the clock in the Evening, he needed to be wakened several times before he could be got to rise by nine the next morning, and pass’d the rest of the day in an incredible stupidity.

“I attributed all these changes to the great evacuations of blood, the Physitians had been oblig’d to make for saving his life, and I perswaded myself that the little they had left him was extreamly incrustated [? incrassated] by the ardour of the fever.... Accordingly my conjecture was confirmed by our opening one of his Veins, for we beheld a blood so black and thick issue forth, that it could hardly form itself into a thread to fall into the porringer. We took about three ounces at five of the Clock in the morning, and at the same time we brought a Lamb, whose Carotis Artery we had prepar’d, out of which we immitted into the young man’s Vein, about three times as much of its Arterial blood as he had emitted into the Dish, and then having stopt the orifice of the Vein with a little bolster, as is usual in other phlebotomies, we caus’d him to lie down on his Bed, expecting the event; and as I askt him now and then how he found himself, he told me that during the operation he had felt a very great heat along his Arm, and since perceiv’d himself much eased of a pain in his side, which he had gotten the evening before by falling down a pair of staires of ten steps; about ten of the clock he was minded to rise, and being I observed him cheerful enough, I did not oppose it; and for the rest of the day, he spent it with much more liveliness than ordinary; eat his Meals very well, and shewed a clear and smiling countenance.... He grows fat visibly, and in brief, is a subject of amazement to all those that know him, and dwell with him.”

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