Blood transfusion

The invention: A technique that greatly enhanced surgery patients’
chances of survival by replenishing the blood they lose in
surgery with a fresh supply.
The people behind the invention:
Charles Drew (1904-1950), American pioneer in blood
transfusion techniques
George Washington Crile (1864-1943), an American surgeon,
author, and brigadier general in the U.S. Army Medical
Officers’ Reserve Corps
Alexis Carrel (1873-1944), a French surgeon
Samuel Jason Mixter (1855-1923), an American surgeon
Nourishing Blood Transfusions
It is impossible to say when and where the idea of blood transfusion
first originated, although descriptions of this procedure are
found in ancient Egyptian and Greek writings. The earliest documented
case of a blood transfusion is that of Pope Innocent VII. In
April, 1492, the pope, who was gravely ill, was transfused with the
blood of three young boys. As a result, all three boys died without
bringing any relief to the pope.
In the centuries that followed, there were occasional descriptions
of blood transfusions, but it was not until the middle of the seventeenth
century that the technique gained popularity following the
English physician and anatomistWilliam Harvey’s discovery of the
circulation of the blood in 1628. In the medical thought of those
times, blood transfusion was considered to have a nourishing effect
on the recipient. In many of those experiments, the human recipient
received animal blood, usually from a lamb or a calf. Blood transfusion
was tried as a cure for many different diseases, mainly those
that caused hemorrhages, as well as for other medical problems and
even for marital problems.
Blood transfusions were a dangerous procedure, causing many
deaths of both donor and recipient as a result of excessive blood loss, infection, passage of blood clots into the circulatory systems of
the recipients, passage of air into the blood vessels (air embolism),
and transfusion reaction as a result of incompatible blood types. In
the mid-nineteenth century, blood transfusions from animals to humans
stopped after it was discovered that the serum of one species
agglutinates and dissolves the blood cells of other species. A sharp
drop in the use of blood transfusion came with the introduction of
physiologic salt solution in 1875. Infusion of salt solution was simple
and was safer than blood transfusion.Direct-Connection Blood Transfusions
In 1898, when GeorgeWashington Crile began his work on blood
transfusions, the major obstacle he faced was solving the problem of
blood clotting during transfusions. He realized that salt solutions
were not helpful in severe cases of blood loss, when there is a need to
restore the patient to consciousness, steady the heart action, and raise
the blood pressure. At that time, he was experimenting with indirect
blood transfusions by drawing the blood of the donor into a vessel,
then transferring it into the recipient’s vein by tube, funnel, and cannula,
the same technique used in the infusion of saline solution.
The solution to the problem of blood clotting came in 1902 when
Alexis Carrel developed the technique of surgically joining blood
vessels without exposing the blood to air or germs, either of which
can lead to clotting. Crile learned this technique from Carrel and
used it to join the peripheral artery in the donor to a peripheral vein
of the recipient. Since the transfused blood remained sealed in the
inner lining of the vessels, blood clotting did not occur.
The first human blood transfusion of this type was performed by
Crile in December, 1905. The patient, a thirty-five-year-old woman,
was transfused by her husband but died a few hours after the procedure.
The second, but first successful, transfusion was performed on
August 8, 1906. The patient, a twenty-three-year-old male, suffered
from severe hemorrhaging following surgery to remove kidney
stones. After all attempts to stop the bleeding were exhausted with
no results, and the patient was dangerously weak, transfusion was
considered as a last resort. One of the patient’s brothers was the dofew days later, another transfusion was done. This time, too, he
showed remarkable improvement, which continued until his complete
recovery.
For his first transfusions, Crile used the Carrel suture method,
which required using very fine needles and thread. It was a very
delicate and time-consuming procedure. At the suggestion of Samuel
Jason Mixter, Crile developed a new method using a short tubal
device with an attached handle to connect the blood vessels. By this
method, 3 or 4 centimeters of the vessels to be connected were surgically
exposed, clamped, and cut, just as under the previous method.
Yet, instead of suturing of the blood vessels, the recipient’s vein was
passed through the tube and then cuffed back over the tube and tied
to it. Then the donor’s artery was slipped over the cuff. The clamps
were opened, and blood was allowed to flow from the donor to the
recipient. In order to accommodate different-sized blood vessels,
tubes of four different sizes were made, ranging in diameter from
1.5 to 3 millimeters.Impact,
Crile’s method was the preferred method of blood transfusion
for a number of years. Following the publication of his book on
transfusion, a number of modifications to the original method were
published in medical journals. In 1913, Edward Lindeman developed
a method of transfusing blood simply by inserting a needle
through the patient’s skin and into a surface vein, making it for the
first time a nonsurgical method. This method allowed one to measure
the exact quantity of blood transfused. It also allowed the donor
to serve in multiple transfusions. This development opened the
field of transfusions to all physicians. Lindeman’s needle and syringe
method also eliminated another major drawback of direct
blood transfusion: the need to have both donor and recipient right
next to each other.