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«THE HISTORY OF BLOOD TRANSFUSION* *By DR. CYRUS C. STURGIS IT MAY SOUND rather naive to say this, but this is the first opportunity I ever had to ...»

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Later he went to Paris, and when he came back his hospital appointments had been taken away. But the last word was his. He declared that some day the world would realize that blood transfusions are useful. He had a considerable amount of money, so he retired in a home near London, where he had a huge library. He became a recluse and nothing more was heard of him in the field of research.

Where did Blundell get the idea for transfusions? He said he got it from seeing the poor woman dying of hemorrhage. But it seems probable that he got his idea from John Henry Leacock, for in his writings there is a brief reference to Leacock, who graduated three years ahead of Blundell at Edinburgh. Dr. Crosby, of the University of Michigan, went to Aberdeen last year as visiting professor, and I asked her if she would try to find John Henry Leacock's inaugural dissertation for me while she was over there. She located it through the librarian at Edinburgh, and got a photostatic copy, which she sent to me. It is on hemorrhage, and it is very likely that this gave James Blundell his idea. Leacock evidently got the idea of transfusions from a Dr. Jones from the Barbadoes, who had performed all his experiments on dogs. And where did he get his idea? That is as far as I got. I know that Dr. Jones was supposed to have written a book on hemorrhage, so let me know if you ever find such a book by Dr. Jones.

The two major problems in blood transfusion are how to prevent clotting, and how to know if one blood is compatible with another. Great difficulties were often encountered because blood used for transfusion was not compatible with that of the patient.

Here is the apparatus which Blundell used for transfusions, which is very formidable looking, but is fairly simple and worked fairly well.

The apparatus was attached to the back of the chair, and the blood passed through a tube into the recipient's arm.

This is the dissertation of John Henry Leacock-a very famous piece of work, but no one paid any attention to it at the time, although Blundell says he does owe his inspiration to this particular man.

This is another type of blood transfusion apparatus called the "impeller," introduced by an American named Aveling. In this process, blood was pumped by a valve through the tube.

illl

THE HISTORY OF BLOOD TRANSFUSION

The point in which I am interested is when was the first blood transfusion in the United States. I am not sure. In the Philadelphia Journal of Medicine and Physical Sciences published in 1825, there is an

Abstract

of Blundell's work which was published in 1818, and at the bottom of this abstract is a note by the editors stating that this same procedure had been carried out thirty years earlier by Philip Syng Physick, a Philadelphia surgeon. Tk at would make the date of the first American blood transfusion 1795. However, there is no evidence that he ever did such a transfusion. He had been called the father of American surgery, but although he did a lot of talking he did practically no writing.

Three years later in 1828 the American Journal of Medical Science published a statement referring to this and saying that if Philip Syng Physick ever transfused anyone, no record was made of it, and as far as the editor knew, no transfusion had been performed in America prior to 1828 and he knew of none at that time. However, a little later several people in the United States were interested in this problem. At a meeting of the New York Academy of Medicine which occurred in 1874, Austin Flint presided, and Benjamin Fordyce Barker presented six cases of blood transfusions.

There were three main difficulties encountered in giving transfusions: first, they didn't know how to prevent clotting; second, they did not know how to select proper donors; and third, they didn't know the proper indications for. blood transfusions.

What about knowledge of anti-coagulants? The first persons who ever tried any experiments along this line were Prevost and Dumas, who used caustic soda. This wasn't particularly successful, but it was a step in the right direction.

That brings us to the introduction of defibrated blood. Dr. J. B.

Hicks, an English physician and obstetrician, made the best attempts in this direction and found that sodium phosphates had been used in 1839.

He did not follow this up, however; I don't know why.

No headway was made in finding effective anti-coagulants until suddenly in 1915 several persons discovered the effect of sodium citrate at the same time. Everyone was claiming the credit, and it was the worst mess imaginable.

In 1914 sodium citrate was used to prevent clotting. Louis Agote reported a transfusion on November 14, 1914, in which sodium citrate was used. This was published in January, 1915. Richard Lewisohn of New York reported his discovery in a paper which appeared in the Medical Record on January 23, 1915. Richard Weil of New York gave a report on his findings before the New York Academy of Medicine on December 17, 1914, which was later published in the Journal of the American Medical Association in January, 1915. But none of these men should have the credit. It was a man by the name of Albert Hustin who was reDR. CYRUS C. STURGIS ally the first to use sodium citrate so that clotting was prevented. He told of this in a paper presented before the Royal Society of Medicine and Natural Science of Brussels on April 6, 1914, which was published in May, 1914.

There is one other thing to be settled. From the very beginning, it was noticed that even human blood sometimes gave the recipient a reaction, with chills, fever, and dark-colored urine. Some thought this was due to air bubbles which were permitted to enter the veins during transfusion, but this theory has been disproven. A lot of air in the veins is not to be recommended, but it doesn't do much harm.

In 1900 an article by Carl Landsteiner contained a footnote indicating that individuals could be divided into three types as far as blood is concerned, and he named the first three types. He said that donors must be selected according to the type of blood. The fourth group was discovered by two students, De Castello and Sturli, in 1902.

So today blood transfusion is reduced to a very safe procedure. We have an average of 2,300 transfusions a year at University Hospital, and only three or four per cent reactions, which may be caused by various circumstances. These successful transfusions were in a large measure made possible by the discovery of Carl Landsteiner, who was a member of the staff of the Rockefeller Institute. I saw him last year, and though he is quite old, he is hale and hearty, and his eyes are as bright as ever. He is now retired.

It is a strange thing that after waiting two and a half centuries to learn how to make blood transfusion safe, men in clinical medicine paid no attention to Landsteiner when he told of his discovery in 1900.

It was not until thirty years later that he was awarded the Nobel prize.

It is a regrettable fact that we frequently pay no attention to valuable information. Ludwig Haktoen emphasized the idea later on, in 1907, but not until 1908 was any use made of this knowledge.

That problem was then solved. Recent developments I can pass over.

You have all heard of the development of blood banks. It is possible to keep blood stored for thirty days. This is used entirely in University Hospital at the present time. Oswald H. Robinson of the University of Chicago was the first to use stored blood in 1918. The first blood bank was established at Chicago in 1934, at the Cook County Hospital. There are many of those in this country now.

Wangensteen of Minnesota tried using beef plasma for human injection in treatment of shock. This brought about very severe reactions, but it had promise. Edwin Cohn of Harvard divided beef plasma, removing the globulin and using the albumen to give intravenous injections as treatment in case of shock. During the war, wounds may be

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