CODEX Entry 4102: Early medical understanding of blood
“Medea took her unsheathed knife and cut the old man’s throat letting all of his blood out of him. She filled his ancient veins with a rich elixir. Received through his lips and wound, his beard and hair no longer white with age, turned quickly to their natural vigour, dark and lustrous; his wasted form renewed, appeared in all the vigour of bright youth”.
Metamorphoses, by Ovid, 43BC.
During the reign of Ptolemy in Alexandria (325–246 BC), Herophilus was the first record we have, of a physician authorized to dissect the human body in public, for the study of disease. Herophilus meticulously described the main arteries of the human cadaver, carefully distinguishing arteries from veins.
There are several noted citations in the Old Testament indirectly bearing on blood transfusion, which has led some orthodox groups to reject transfusions on religious grounds. Another Hebrew manuscript refers to a transfusion:
“Naam, leader of the armies of Bed-Adad, King of Syria, afflicted by leprosy, consulted physicians, who in order to cure him drew out the blood from his veins and put in that of another.”
The ancient kings of Egypt, and wealthy Romans and Greeks bathed in blood believing it “… resuscitate the sick and rejuvenate the old”. Pliny the Elder wrote in the 1st Century AD, of how spectators rushed into the arena to drink the blood of dying gladiators until, in AD193, a decree prohibited this practice.
Pope Innocent VIII, Giovanni Cibo, supposedly had a transfusion around 1490. The Pope had repeatedly slipped into a semi-comatose state. Three 10-year-old shepherd boys were selected as ‘donors’ for one ducat apiece. All three boys apparently died shortly after, and the Pope’s condition did not improve.
Dr Richard Lower began experimenting with the administration of medications into the veins of dogs. Sir Christopher Wren, who was to achieve far greater fame in mathematical calculus, astronomy, and as Britain’s leading architect, was impressed by Lower’s work, and arranged demonstrations in front of colleagues at the Royal Society. As his associate Robert Boyle, of Boyle’s Law fame, proclaimed, “By this operation, Creatures were immediately purged, vomited, intoxicated, killed or revived, 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 many instances, that will probably end in extraordinary success.”
Soon inmates of a London prison were being used as ‘human volunteers’. Dr. Lower recommended transfusions to replace blood in the case of severe haemorrhage, having successfully restored to health a dog drained of blood. The diary of Samuel Pepys describes “the amending of bad blood by borrowing from a better body.” In November 1667, Lower transfused a man named Arthur Coga with 12 oz of sheep’s blood, and two years later, performed the first successful direct transfusion from one man’s artery to another’s vein.
At the same time, in France, Dr Jean Denys, a young physician to King Louis XIV, also performed numerous dog-to-dog transfusions. But in 1667, Denys was asked to treat a 15-year-old boy, whom he bled then gave nine ounces of blood from a lamb. The boy became alert for the first time, though he experienced some symptoms of blood incompatibility. Denys continued to favour the use of animal blood for his transfusion experiments because he believed it less likely “… to be rendered impure by passion or vice”. He felt, like many physicians, that blood carried a person or animal’s temperament, beliefs, and strength.
In 1669, Antoine Mauroy, suffering from a derangement brought on by an unfortunate love affair eight years earlier, was brought to Denys. The man had recently walked the streets of Paris stark naked, and his wife, at the end of her tether, agreed to a transfusion. Ten ounces of blood was replaced with six ounces of blood from a calf, with no obvious effects. So, two days later, the man was transfused a second time but experienced a severe haemolytic reaction. Animal blood contains proteins incompatible with those of human blood. The transfused animal red cells are rapidly destroyed, haemoglobin appears in the urine, which it blackens. The symptoms of anaphylaxis follow and if a transfusion is repeated, it can be fatal. Several months later, Antoine Mauroy again became violent, and his wife persuaded Denys to repeat the transfusion. A transfusion was attempted, but since the flow of blood was poor, it was abandoned. Mauroy died the following evening. Through their transfusion experiments, Denys had acquired many enemies among the physicians of Paris, who persuaded Mauroy’s widow to accuse Denys of contributing to the death of her husband. The Faculty of Medicine of Paris published pamphlets condemning the practice. Following a prolonged legal battle, Denys was exonerated, and it was discovered that the widow had been poisoning her husband with arsenic. However the Faculty of Medicine of Paris issued a decree stating that the procedure of transfusion was not to be performed without its permission. This permission was not given for one hundred and fifty years. An edict from the French parliament also ruled transfusion to be a criminal act if performed in France. This had repercussions in London where the Royal Society rapidly washed its hands of transfusion as well. Finally, in 1679 the Pope announced a ban on the procedure on religious grounds.
It was James Blundell who reactivated its study. He had seen his tutor use an ox ureter as the ‘tube’ with crow quills as the ‘needles’ attached to both ends to resuscitate exsanguinated animals by transfusion. Blundell now introduced the use of the syringe to facilitate vein-to-vein transfusions. In 1818 his first successful transfusion was of a woman who recovered from severe post-partum haemorrhage after receiving eight ounces of blood in three hours. This case was published in ‘The Lancet’ in 1829. One of the most active ‘transfusionists’ of the time was Dr Doubleday who transfused a woman with her husband’s blood. He noted that after six ounces had been given the woman, previously semi-comatose, suddenly exclaimed, “By Jasus, I feel strong as a bull!”. Blundell, like all innovators, remained a controversial figure, frequently at odds with the Medical Society of London.