Medical Contributions of The Great War: Blood Transfusion

This Remembrance Day we commemorate not only the sacrifices of those who serve their country in times of war, but also the innovations pioneered by men and women in uniform.

By Rebecca Jemmett, Curatorial Volunteer, with Pamela Peacock, Curator.

Prior to the World War One, blood transfusion was a rarely performed and risky procedure. On the eve of the war, scientific development in relation to transfusion technology progressed making it a more viable procedure. Survival rates on the front lines increased as new transfusion techniques were mastered. The benefits of the medical developments that occurred during the war should not only be remembered on Remembrance Day, as blood transfusions continue to save hundreds of lives each day.

Blood transfusion is a medical process that involves introducing healthy blood into a patient’s vein. Transfusions are performed in instances of excessive blood loss or when a patient is incapable of making their own blood properly. The process can take anywhere from one to
four hours and involves connecting an IV with healthy blood to a patient’s blood vessel. Today, blood for transfusions is acquired through blood banks, generously stocked by blood donors.

The first known blood transfusion took place shortly after British physician William Harvey discovered the circulation of blood in 1628. From that time until World War One, blood transfusions were practiced on humans, dogs and other animals. In 1665, Richard Lower performed a successful dog-to-dog blood transfusion. Dr. Jean-Baptiste Denys, a physician for King Louis XIV of France, performed multiple animal-to-human transfusions in the seventeenth century. In 1665 he transfused sheep’s blood into a 15 year old boy’s body and frequently he transfused calf blood into the body of Antoine Mauroy. Early procedures such as these were often successful since small quantities of blood were transfused, but it was later found that mixing species could cause an allergic reaction and have negative results.

An early blood transfusion from lamb to man (1705). L0000096, Wellcome Library,

In the early years of the twentieth century, researchers made significant discoveries about the properties of blood. In 1900 Karl Landsteiner identified the different blood groups and in 1907 Ludvig Hektoen noted the benefit of matching blood groups for compatibility in transfusions, while in 1912 Roger Lee demonstrated that type O was a universal donor and AB was a universal recipient. Despite this increase in knowledge, most surgeons still did not perform blood transfusions because of the high risk involved.

Blood transfusions became more common as a result of the horrors of the First World War. New discoveries and heightened demand for the practice propelled the procedure forward.

The discovery of anticoagulants improved the ability to store blood. In 1914 sodium citrate was shown to be an effective anticoagulant, and Jay McLean discovered heparin – still one of the most commonly used anticoagulants – in 1916. The ability to store blood for longer periods of time without it clotting meant that blood could be stored in depots for easy access and person-to-person transfusions could decrease. This was a particularly useful advance in wartime, where person-to-person transfusions were impractical. Despite these discoveries, many believed that transfusion was too difficult until the actions of two army officers, both named Robertson, showed them otherwise.

Canadian and American surgeons pioneered blood transfusion techniques during the War. Maj. L.B. Robertson of the Canadian Army Medical Corps performed a number of transfusions, without cross-matching, in 1916 and 1917 and wrote articles discussing his successes. He initiated new techniques, such as the syringe-cannula technique, that simplified transfusion procedures.

Maj. L.B. Robertson of the Canadian Army Medical Corps

Capt. Oswald H. Robertson of the US Army Medical Officer Reserve Corps proved that transfusions were safe. Robertson demonstrated the effectiveness of using typed, stored blood for transfusions in 1917 and was an instrumental force behind popularizing this procedure during
the War. Instead of collecting blood as the need arose, Capt. Robertson advocated for storing it in advance. He is credited by some for establishing the very first ‘blood bank.’ Because of blood’s greater accessibility thanks to anticoagulants and storage depots, more patients in need of transfusions were able to be treated and to survive.

Capt. Oswald H. Robertson of the US Army Medical Officer Reserve Corps

For some time after the war, the practice of transfusion using preserved blood did not catch on in civilian life. Unless necessary, surgeons preferred to use fresh blood in person-to-person transfusions. It wasn’t until the 1930’s that storage facilities known as Blood Banks began to appear in the United States and Europe. In Canada, blood was not banked until World War Two.

Blood transfusions were popularized thanks to advances pioneered in military hospitals
during the First World War. These advances have benefited soldiers, and civilians, ever
since. L0024143, Wellcome Library, London.

Over time, knowledge and the skills to transfuse blood have grown. Developments have been widespread and range from relatively simple advances, such as switching from a metal vacuum container to plastic bags to store blood, to more complex processes, such as cold ethanol fractionation (the process of separating blood plasma into components and products). Since World War One, medicine has come to master the art of blood transfusion. The result of such growth is positive, as thousands of patients across Canada are successfully given blood via
transfusion everyday with little to no complication.

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