Matthew Rowlinson, “On the First Medical Blood Transfusion Between Human Subjects, 1818”

Blood transfusion as a medical practice dates to the seventeenth century;[1]> the first experiments were performed a few decades after William Harvey published his demonstration that blood circulates in the body in De Motu Cordis (1628).  Harvey’s discovery showed that blood circulated indefinitely, rather than being either consumed within the body or expelled from it. To cure pathologies of the blood was thus no longer exclusively a matter of stimulating or preventing its evacuation; now the goal was to affect blood’s circulation within the body and its interaction with other organs. The earliest blood transfusions involving human subjects were carried out almost simultaneously in France and England in 1667. Unlike modern transfusion, these first experiments did not treat subjects who had suffered losses of blood. Rather than deficiency in the quantity of the circulation, they hoped to cure defects in its quality, as expressed by the temperament of the subject.  They were thus in every case transfusions between species and in no case aimed to treat hemorrhage or any other type of blood loss.  In England on 23 November, a 22-year-old Bachelor of Arts was transfused with the blood of a sheep, in order to moderate what was considered the excessive heat of his brain.  The recipient survived the operation, and Pepys records in his diary that after six days he gave a report to the Royal Society, speaking in Latin, in which he pronounced himself better.  In the same year in France a series of similar experiments were made by Jean-Baptiste Denis, who was physician to Louis XIV.  In the fourth and most celebrated of his cases, he on two occasions transfused calf’s blood into the veins of a certain Antoine Mauroy, in order to endow him with docility.  Denis claimed temporary successes—Mauroy seems to have gone into shock—but was unable to continue the treatment with a third transfusion owing to the patient’s refusal.  When Mauroy shortly after died, Denis was tried for manslaughter; though he was acquitted, transfusion was made illegal in France and abandoned throughout Europe for over a century (Maluf 64-67).

When transfusion experiments resumed in the nineteenth century it was on different principles.  James Blundell’s original article on the subject appeared in 1818, shortly before his first attempt on a human subject. In it, he describes the death of a female patient from uterine hemorrhage, and reflects that she “might very probably have been saved by transfusion . . . by means of the syringe” (Blundell “Experiments” 56-57). Following upon these reflections, Blundell undertook a series of experiments with dogs, draining them of blood until the point of what he terms “apparent death” (Blundell “Experiments” 63, 64, 74), and then reviving them by transfusion. In these experiments, Blundell established that arterial and venous blood were equally effective in restoring life; that small quantities of air could be introduced into the circulation without risk; and that blood would not be rendered unfit by its passage through the syringe. He also came to the conclusion that the prevailing view regarding the interchangeability of blood between different animals was mistaken; experiments in which dogs were transfused with human blood and sheep’s blood, though they could produce an immediate improvement, usually led to death within a few days. As a result, Blundell throughout his work in transfusion advocated that “in . . . transfusion on the human body, the human blood alone should be employed” (Blundell Researches 92).

Blundell’s experiments with dogs built on the work of John Henry Leacock, who had been his pupil at the University of Edinburgh before returning to practice in his native Barbados (Schmidt “Forgotten Transfusion History”). Leacock, though, never transfused a human subject; it was Blundell who aimed to put the techniques they had developed to therapeutic purpose when in the fall of 1818 he was called to the bedside of a patient suffering from a tumor in the stomach. He had been unable to keep food down for three months, and appears to have been starving. Blundell states that he had gradually bled during the course of his illness, estimating that by the time of the operation the loss amounted to a gallon and a half. The patient, whose name was Brazier, was transfused on September 26; the donors were drawn from the gentlemen in attendance.[2] Blundell avers that on the day following the operation Brazier felt less faint and was able to eat and drink.  Over the course of the following thirty-six hours, though, he declined and eventually died on the third day following his transfusion (Blundell “Account”).

This first transfusion was one of a relatively small number Blundell would perform; in his major work on the subject, published in 1825, he gives six case histories, including that of Brazier (Blundell Researches).[3] In none of these cases did the transfusion save the patient, though in 1828 Blundell was able to report two cases of post-partum hemorrhage as having been successfully treated by his technique (Young 163).

During the period of his transfusion experiments, Blundell was rising to a position of eminence in the field of obstetrics; he lectured on midwifery at Guy’s hospital from 1817 to 1834, after which he continued a large private practice until about 1847 (Young 159-60). The association between transfusion and obstetrics was to remain strong until the 1870’s, with later work in the field being done by major figures in obstetric practice such as John Braxton-Hicks and Samuel Aveling (Pelis “Blood Clots”). As we have seen, Blundell’s original researches were prompted by the idea of developing a treatment for uterine hemorrhage. In the typical nineteenth century scene of transfusion a male donor, often the patient’s husband, provides blood to replace that lost by a woman in childbirth, as in Blundell’s illustration of an instrument he developed to perform the operation. (See Fig. 1.)

Figure 1: James Blundell’s Gravitator, from “Observations on the Transfusion of Blood”

Anne Marie Moulin writes that in nineteenth-century transfusion, women were rarely donors, as their blood was held to be less plentiful and vital (Moulin 154). Blundell advised in 1825 that men should be used as donors, as he had found that their blood flowed more freely than women’s and that they were less liable to faint (Moulin 123). Human transfusion was thus from the beginning a medical technique that embodied gender hierarchy, not only because of the relations of donors and recipients of transfused blood, but also because the emergence of transfusion as a part of obstetrical practice corresponded historically with the rise of obstetrics itself as a medical specialization and the displacement of the midwife by the male professional as the normal attendant on childbirth in the middle and upper classes. The gendered character of the scene of transfusion is faithfully reproduced by literary representations in George Eliot’s “The Lifted Veil” (1859) and Bram Stoker’s Dracula (1897).

Not only the result of a new pathologizing of the bleeding female body, transfusion in the early nineteenth century also expresses a vitalist understanding of blood itself. Blundell’s transfusions in every case treated patients who had apparently suffered actual blood loss; other practitioners used the therapy to treat different ailments including cholera and hydrophobia (rabies). Blundell’s own accounts of his experiments make it clear that he did not view transfusion simply as the replacement of a certain quantity of lost blood with an equivalent amount of donor blood. The first of his human patients was suffering principally from wasting caused by a stomach tumor; in his case history, and still more in his writing on experiments with dogs, Blundell suggests that he understands blood as a form of nourishment, and transfusion as a treatment that can alleviate starvation or the inability to take food. Kim Pelis observes that Blundell’s experiments were nearly contemporaneous with literary texts like Mary Shelley’s Frankenstein and John Polidori’s The Vampyre in which the protagonists obtain power to put off death or to bring dead matter to life (Pelis “Moving Blood” 205), and, as we’ve seen, Blundell’s case histories focus on the moment when his subjects are restored to life from “apparent death.”  In an 1828 account of his early work with dogs, he describes how an “animal drained of blood” after being transfused “has soon afterwards arisen from the table, as if it had experienced a resurrection from the dead” (Blundell “Observations” 676). In an 1834 description of transfusing a woman patient, Blundell wrote that “life seemed to be immediately reanimated as by an electric spark” after “two ounces and a half of blood from the arm of the woman’s husband [was] thrown in” (Pelis “Blood Clots” 339). In an even more literary spirit, Blundell’s lecture on transfusion in his physiology course described it as endowing doctors with powers that realized “the tales of romance” and led medical men “like Vathek, into the intimate recesses of nature, and put into our hands the talismans by which her operations are controlled” (Pelis “Moving Blood” 205).

By the middle of the nineteenth century, however, the identification of blood with food or with some even more fundamental principle of life disappears from the literature. In The Physiology of Common Life (1859), George Henry Lewes describes transfusion’s lifesaving power, but insists that the operation can benefit only patients who have suffered a dangerous loss of blood:

In all cases of disease it is useless, or worse. The ancients, indeed, thought that by infusing new blood into an old and failing organism, new life would be infused; and wild dreams of a sort of temporal immortality were entertained. Completely as these notions are banished, the initial error of supposing that . . . if blood be purified the organs will be restored to health and vigour—this error is still general, even among men of science. It rests on a misconception of the laws of Nutrition. Because the organs are nourished by materials drawn from the blood . . . it has been supposed that the point of departure of Nutrition was in the blood itself, and that the blood formed the organs. It is not so. (1. 277)

Lewes understands blood only as a means of conveyance by which nutriment is brought to the different parts of the body and waste is carried away from them; he compares it to a river carrying traffic into and out of a city, and contrasts this mechanical view of the circulation not only to views held in Classical times but also to the vitalist ideas that prevailed earlier in the century.

As a mechanistic view of the circulation came to prevail, British medical practice became more open than it had been earlier in the century to the idea of substituting other substances for human blood in the operation of transfusion. Lewes himself writes of Charles-Edouard Brown-Séquard’s experiments in transfusion between different species (1.276). In the 1870s, German practitioners frequently transfused lamb’s blood into human recipients, while experiments were also made in Britain and in the United States with transfusions of cow’s milk (Pelis “Transfusion Solutions” 187). As a result of this breakdown of consensus on the appropriate fluid for transfusion, the Obstetrical Society of London commissioned a report on the question; it appeared in the Society’s Transactions in 1879. The report was unequivocal in recommending that the fluid used in transfusion should be blood, and that it not be drawn from animals of other species. Nonetheless, during the 1880s practice in Britain moved away from the use of blood in transfusion; in the treatment of hemorrhage and elsewhere it was increasingly supplanted by the infusion of saline solution. By 1900, Kim Pelis writes, “transfusion could be dismissed as a dangerous procedure conducted in medicine’s dark and dubious past” (“Blood Clots” 357). As she notes, the portrayal of transfusion in Stoker’s Dracula, though it dates from the end of the century, describes medical practice in the time of James Blundell seventy years earlier.

When the history of blood transfusion resumed, it was on the battlefields of World War I; its reacceptance was the result of the gradual dissemination of Karl Landsteiner’s discovery of human blood types in 1900, for which he received the 1930 Nobel prize. In light of this discovery, it would be easy to view nineteenth-century blood transfusion as a mere historical dead end, no less lethal an error than the experiments in cross-species transfusion of the seventeenth century. Even with the benefit of hindsight, though, the case is, in fact, not clear. Using the distribution of blood types in the white population of the United States as a base, T.J. Greenwalt has calculated that in transfusions where the blood type of neither donor nor recipient is known, one could expect that they would prove compatible in 64.4% of cases (555). Even allowing for differences in the populations and for the fact that in some cases, such as Blundell’s, nineteenth-century doctors used more than one donor in a single transfusion, there is still reason to think that transfusion between humans in the period might often have had therapeutic value.  Its abandonment, just as much as its adoption, should appear to us as an historical problem rather than as part of a narrative of scientific advance and self-correction.