Blood Transfusion History: Infusing Life
In 1818, British obstetrician James Blundell performed the first human-to-human blood transfusion. Although the patient died, Blundell’s transfusion experiments, and his certainty that human patients required human blood, led to advances in transfusion medicine that continue into the present. Here’s a bit of blood transfusion history. There’s even a Bonaparte connection.
Precursors to blood transfusion
Medea…took her unsheathed knife and cut the old man’s throat. Then, letting all his old blood out of him, she filled his ancient veins with rich elixir. As he received it through his lips or wound, his beard and hair no longer white with age, turned quickly to their natural vigor, dark and lustrous; and his wasted form renewed, appeared in all the vigor of bright youth, no longer lean and sallow, for new blood coursed in his well-filled veins. – Ovid (1)
Although the idea of reviving someone by injecting blood into their veins goes back to the ancients, the first successful blood transfusion was not performed until the 17th century. The story that Pope Innocent VIII was transfused on his deathbed in 1492 with the blood of three young boys is a myth. (2) It required English physician William Harvey’s discovery of how blood circulates continuously throughout the body – announced in 1616 and published in 1628 – to make blood transfusion a serious prospect. Prior to Harvey’s discovery, physicians generally believed that the veins were separate from the arteries, and that venous blood originated in the liver, while arterial blood flowed from the heart.
First successful blood transfusion
The first fully documented successful blood transfusion was performed by English physician Richard Lower in February 1665, between two dogs. Lower noted:
The most probable use of this experiment may be conjectured to be that one animal may live with the blood of another; and consequently, that those animals, that want blood, or have corrupt blood, may be supplied from others with a sufficient quantity, and of such as is good, provided the transfusion be often repeated, by reason of the quick expense that is made of the blood. (3)
This led to another successful dog-to-dog transfusion in 1666 at the Royal Society in London. On November 14, diarist Samuel Pepys wrote:
Dr. Croone told me that, at the meeting at Gresham College tonight…there was a pretty experiment, of the blood of one dog let out (till he died) into the body of another on one side, while all his own run out on the other side. The first died upon the place, and the other very well and likely to do well. This did give occasion to many pretty wishes, as of the blood of a Quaker to be let into an Archbishop, and such like. But, as Dr. Croone says, may if it takes be of mighty use to man’s health, for the amending of bad blood by borrowing from a better body. (4)
When reports of the English experiments reached Paris, French scientists began their own transfusion trials. The first successful human blood transfusion was performed in France on June 15, 1667. Jean-Baptiste Denis, a physician to King Louis XIV, transfused blood from the carotid artery of a lamb into the vein of a 15 or 16-year-old boy, who had suffered for a fever for many months and had been bled by his physicians 20 times, thus falling into “great debility and drowsiness.” (5) The boy survived the transfusion, thanks probably to the small amount of blood that he was actually given. A few days later Denis transfused sheep’s blood into a 45-year-old labourer, who also survived.
Learning of Denis’ success, Lower decided to try his luck on a human. He hired Arthur Coga, an educated man whose brain was “a little too warm,” to be the recipient of some lamb’s blood. Pepys noted in his diary:
[T]hey discourse of a man that is a little frantic (that hath been a kind of minister, Dr. Wilkins saying that he hath read for him in his church) that is a poor and debauched man, that the College have hired for 20 [shillings] to have some of the blood of sheep let into his body…. They propose to let in about twelve ounces, which they compute which is what will be let in in a minute’s time by a watch. They differ in the opinion they have of the effects of it; some think it may have a good effect on him as a frantic man by cooling his blood; others that it will not have any effect at all. (6)
The transfusion took place on November 23, 1667, “in the presence of many considerable and intelligent persons.” One week later, Pepys reported:
I was pleased to see the person who had his blood taken out. He speaks well, and this day gave the Society a relation thereof in Latin, saying that he finds himself much better since, and as a new man. But he is cracked a little in the head, though he speaks very reasonably and very well. He…is to have the same again tried upon him – the first sound man that ever had it tried upon him in England…. (7)
Coga, who reportedly spent his 20 shillings on alcohol, demanded the same amount for his second transfusion. This took place successfully on December 12, 1667, before a large crowd. Coga declined a third transfusion.
In France, Denis continued his experiments less successfully. Swedish nobleman Gustaf Bonde died after a second transfusion of calf’s blood. A 34-year-old house servant named Antoine Mauroy survived a first transfusion of calf’s blood, but developed a hemolytic reaction after a second transfusion. He died during a third transfusion on December 19, 1667. Mauroy’s wife accused Denis of killing her husband. When Denis brought the case to court in self-defence, he was cleared of wrongdoing. However, the case resulted in blood transfusion being prohibited by law in France in 1678. The Royal Society in London also abolished the practice and the Pope banned it. As a result, there was little further experimentation with transfusion until the early 19th century.
First human-to-human transfusion
In the early 1800s, British obstetrician James Blundell thought that transfusion would be of practical use in cases of hemorrhage after childbirth and other situations involving considerable blood loss. He began experimenting with transfusion on dogs, hoping to find “that the blood of animals may be safely thrown into the human vessels, in small quantities daily, for the purposes of nourishment, instead of the human blood, which it must be more difficult to procure.” However, he found that “if an animal be drained of the blood in its larger vessels and replenished with large quantities of blood derived indifferently from another genus, great danger, and in general death itself will ensue.” (8)
Blundell concluded that human blood was required for human transfusion. “[Blood] if taken indifferently from animals, and injected in large quantities, is fatal.” In addition, it was impractical to count on the availability of animal blood in an emergency.
A dog, it is true, might have come when you whistled, but the animal is small; a calf, or sheep, might, to some, have appeared fitter for the purpose; but, then, it had not been taught to walk properly up the stairs. (9)
Blundell acknowledged that there would be “considerable difficulty in obtaining arterial blood from the human body for the purposes of transfusion; but persons may be induced occasionally, sometimes from motives of affection, and sometimes for hire, to submit to the opening of an artery.” (10)
On September 26, 1818, at Guy’s Hospital in London, Blundell attempted the first documented human-to-human blood transfusion. The recipient was a man named Brazier, between 30 and 40 years old, who was suffering from a tumor in his stomach and had lost a considerable amount of blood. The donors were drawn from among the three physicians, five surgeons and other gentlemen in attendance. An ounce and a half of blood was taken by syringe and immediately injected into Brazier’s vein. The procedure was repeated 10 times during the course of 30-40 minutes. At the first the patient showed signs of improvement, but then he declined. Brazier died on the third day after his transfusion.
Blundell subsequently transfused five other patients, all of whom died. The indications for transfusion included postpartum hemorrhage, extreme malnutrition, puerperal fever, a ruptured uterus, and hydrophobia. Since each patient was critically ill, it is impossible to know whether the transfusion contributed to their death.
Finally, on December 7, 1828, Blundell completed his first unquestionably successful blood transfusion at Walworth, south of London. The patient, “a delicate woman,” age 25 and the mother of two children, was suffering from postpartum hemorrhage after delivering her third child. One of the physicians present, a Mr. Davies, was the donor. About eight ounces of blood was injected over a three-hour period. Afterwards, the woman said she felt as if “life was being infused into her whole body.” (11)
A risky procedure
Blundell continued to perform transfusions, acknowledging the risks. In 1829 he wrote:
States of the body really requiring the infusion of blood into the veins are probably rare; yet we sometimes meet with cases in which the patient must die unless such operation can be performed; and still more frequently with cases which seem to require a supply of blood, in order to prevent the ill health which usually arises from large losses of the vital fluid, even when they do not prove fatal.
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…it 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. (12)
Other practitioners also performed transfusions. The typical indication was pre- or post-partum hemorrhage, with a male donor, often the patient’s husband or other family member, providing blood. Blundell preferred men to women as donors, “as they bleed more freely and are less liable to faint.” (13)
There was so much news about transfusion that in April 1831, Napoleon’s brother Joseph Bonaparte, who was living in New Jersey, wrote to the editor of Le Courrier des États-Unis:
I have just returned from Philadelphia where I saw many of your subscribers. In general they think you have too many articles about science and even literature at a time when they are avid for political news…. [The dispatches of your Parisian correspondent] excite more interest than your articles on Blood Transfusion, which scare your readers. I am not speaking for myself, because I am interested in those articles. (14)
Sadly, Joseph’s daughter Charlotte died of hemorrhage after childbirth in 1839. She did not receive a transfusion.
The search for blood substitutes
The complications of transfusion and difficulties in obtaining blood led to a search for safer and more readily available substitutes.
During a cholera epidemic in Toronto in 1854, Drs. Edwin Hodder and James Bovell tried transfusing cow’s milk. According to Hodder:
I began to reflect, and to ask myself, What is the nearest analogue of the blood? and milk came to my mind… I found that Donné had inject it into the veins of dogs, rabbits, and bird, that it did not kill them, but, on the contrary, he, with Wagner, Gulliver, and others, were of opinion that the white corpuscles of the milk were capable of being transformed into red blood-corpuscles.” When he tried it on a man suffering from cholera, “The effect was magical…the vomiting and purging ceased, the pulse returned at the wrist…the man rallied, and speedily recovered without a bad symptom. (15)
Saline – first infused intravenously by Dr. Thomas Latta for the treatment of cholera in 1832 – became another popular blood substitute in the latter part of the 19th century. Its infusion was observed to be safer than, and frequently as effective as, blood transfusion.
One 19th-century analysis found that in 243 cases in which transfusion was performed for acute or chronic anemia prior to 1873, 143 (46.9%) resulted in complete recovery; 34 (14%) resulted in temporary benefit, but failed to save life; and 95 (39.1%) had no beneficial result. The operation was “almost invariably…resorted to in desperate cases.” In the vast majority of failures, death could not be ascribed directly or indirectly to the operation, but was due to other causes. In 113 of the cases, the operation was performed on account of hemorrhage during or immediately after childbirth. Of these, 67 cases ended in complete recovery, 7 showed only a temporary improvement, while 39 terminated in death, without any sign of previous improvement. (16)
After 1875, transfusion became used for a wider range of indications, and the number of severe adverse reactions and fatalities increased. Also, although it was evident that transfusions within the same species were more effective than transfusions between different species, animal-to-human transfusions continued to be performed until at least 1890.
Transfusion advances in the 20th century
In 1900, Austrian immunologist Karl Landsteiner discovered the ABO blood groups. He also found that transfusion between persons with different blood groups resulted in the destruction of red blood cells in the recipient. Based on Landsteiner’s findings, American hematologist Reuben Ottenberg performed the first successful ABO-matched human-to-human transfusion at Mount Sinai Hospital in New York.
In 1913, Richard Lewisohn, a German-American surgeon at Mount Sinai Hospital, used sodium citrate to prevent donated blood from clotting. This, combined with refrigeration, enabled blood to be collected and stored, rather than having to be donated at the time of the transfusion.
In 1937, Landsteiner and Alexander Wiener discovered the Rhesus (Rh) factor, another blood group system, which further increased the ability to match compatible donors with recipients and thus reduce adverse reactions.
Further advances, including the identification of more blood group systems, improvements in blood storage, the separation of plasma into therapeutic components, infectious disease testing, and improved screening of blood donors, continued throughout the 20th century and into the 21st, making transfusion therapy safe, effective and widely available.
You might also enjoy:
- Brookes More, Ovid’s Metamorphoses, Vol. I (Francestown, NH, 1978), p. 249.
- A. Lindeboom, “The Story of a Blood Transfusion to a Pope,” Journal of the History of Medicine and Allied Sciences, Vol. IX, No. 4 (October 1954), pp. 455-459; A. Matthew Gottlieb, “History of the First Blood Transfusion but a Fable Agreed Upon: The Transfusion of Blood to a Pope,” Transfusion Medicine Reviews, Vol. V, No. 3 (July 1991), pp. 228-235.
- Charles Hutton, George Shaw, Richard Pearson, The Philosophical Transactions of the Royal Society of London, From Their Commencement, in 1665, to the Year 1800, Vol. I (London, 1809), p. 131.
- Robert Latham, ed., The Shorter Pepys (London, 1985), p. 692.
- “Lettre écrite à Monsieur l’Abbé Bourdelot…Par Gaspard de Gurye Ecuier Sieur de Montpolly…Sur la Transfusion du Sang, Contenant des Raisons & des Experiences pour & contre,” September 16, 1667, p. 8
- Latham, The Shorter Pepys, pp. 849-850.
- Ibid., pp. 851-852.
- James Blundell, Researches Physiological and Pathological; Instituted Principally With a View to the Improvement of Medical and Surgical Practice (London, 1824), pp. 81-82.
- James Blundell, “Lectures on the Theory and Practice of Midwifery,” The Lancet, 1827-28, Vol. I (London, 1828), p. 677.
- Blundell, Researches Physiological and Pathological, p. 116.
- The London Medical and Surgical Journal, Vol. I (London, 1828), p. 173.
- James Blundell, “Observations on the Transfusion of Blood,” The Lancet, 1828-29, Vol. II (London, 1829), p. 321.
- Blundell, Researches Physiological and Pathological, p. 123.
- Georges Bertin, Joseph Bonaparte en Amérique: 1815-1832 (Paris, 1893), p. 356.
- Edward M. Hodder, “Transfusion of Milk in Cholera,” The Retrospect of Medicine: Being a Half-Yearly Journal, Vol. 67 (London, 1873), pp. 15-16.
- Charles Egerton Jennings, Transfusion: Its History, Indications, and Modes of Application (London, 1883), pp. 19-20.
Persons may be induced occasionally, sometimes from motives of affection, and sometimes for hire, to submit to the opening of an artery.