Blood Transfusion in History

Dr. Abdul Nasser Kaadan, MD, PhD*

Dr. Mahmud Angrini, MD*
1430
2009

Chairman, History of Medicine Department, Aleppo University, Syria.

The President of ISHIM (www.ishim.net).
P.O. Box: 7581, Aleppo, Syria.
E-mail: a.kaadan@scs-net.org
Phone 963 944 300030, Fax 963 21 2236526
*
Master Degree Student, History of Medicine Department, Aleppo University, Syria.
Master Degree in Laboratory Medicine.
E-Mail: dr-ma@aloola.sy
Phone 963 932 406664

Contents
Page
Introduction

Chapter One: Blood in History

Chapter Two: A History of the Discovery of the Circulatory system

Chapter Three: Blood Transfusion from A to Z

11

I- Blood Transfusion in The Ancient and Medieval Eras

11

II- Blood Transfusion in The Modern Era

13

1- First Thoughts of Blood Transfusion

13

2- Blood Transfusion from an Animal to an Animal

15

3- Blood Transfusion from an Animal to a Man

19

4- Blood Transfusion from a Man to a Man

23

5- Establishing Transfusion Procedures

28

6- The Impact of War

33

7- Blood Transfusion in The Last Sixty Years

37

Abstract

41

Notes and Comments

42

References

43

Introduction
For thousands of years, the human body was a mystery to the world
of science. Indeed, cultures across the globe employed various forms of
observation, experience, ritual, intuition, and other methods to combat
illness; such efforts met with varying degrees of success. Yet, profound
exploration of human physiology remained elusive. Nowhere was this
more apparent than in the understanding of blood ... what it is; what it
does; where it flows; how it is created; and many other questions went
unanswered. For many, one issue was clear: blood transfusion was a
sound medical procedure.
The practice of blood transfusion, that is the transference of blood
from the circulation of one individual to that of another for practical
therapeutic purposes, is of relatively recent origin. Although it only
became a practical possibility during and shortly after the Second World
War, the concept of transfusion has a longer history.
The transfusion time line highlights many of the discoveries,
inventions, observations, and practices, which, since ancient times, have
led to remarkable progress and resulted in the effective treatments that are
now taken for granted. The 20th Century has witnessed the most progress
in the enumerable transfusion practices, activities and safety.
The practicality of transfusion has, to some degree, paralleled and in
some instances been the consequence of, developments in other sciences.
The idea though of the theoretical beneficial effects of blood transfusion
has been recognized for over three centuries. This older history is based
on the traditional idea of blood as being the living-force of the body.
Man must have recognized that loss of blood was frequently
associated with weakness and death. This was manifested by Greeks and
Romans committing suicide by opening a vein (involving cutting their
wrists). Blood was recognized as having numerous mysterious properties,
including initially that of carrying both the mental and physical characters
of its owner. Early attempts at replacing lost blood involved the drinking
of blood by the patient. By choice, this was from a young, healthy, fit
person or animal. The legend of the vampire originates from this concept.
This somewhat mystical fascination with the properties of blood is to
some degree still with us today1.

In my study Ill follow the next arrangement:

WS: Means Web Site. For Example, WS3: Web Site Number 3
Without WS, the number refers to Comments and Notes.

Chapter One

Blood in History
I- Blood in Myths, Beliefs and Religions:
Due to its importance to life, blood is associated with a large number
of beliefs. One of the most basic is the use of blood as a symbol for
family relationships; to be "related by blood" is to be related by ancestry
or descendance, rather than marriage. This bears closely to bloodlines,
and sayings such as "blood is thicker than water" and "bad blood", as well
as "Blood brother". Blood is given particular emphasis in the Jewish and
Christian religions because LeviticusWS11 17:11 says "the life of a creature
is in the blood". This phrase is part of the Levitical law forbidding the
drinking of blood, due to its practice in idol worship by surrounding
societies. Mythic references to blood can sometimes be connected to the
living-giving nature of blood, seen in such events as childbirth, as
contrasted with the blood of injury or death.
1- Indigenous Australians:
In many indigenous Australian Aboriginal peoples' traditions, ochre
(particularly red) and blood, both high in iron content were applied to the
bodies of dancers for ritual. As the Robert Lawlor (1939-Now) statesWS11:
In many Aboriginal rituals and ceremonies, red ochre is rubbed all
over the naked bodies of the dancers. In secret, sacred male
ceremonies, blood extracted from the veins of the participant's arms is
exchanged and rubbed on their bodies. Red ochre is used in similar
ways in less secret ceremonies. Blood is also used to fasten the
feathers of birds onto people's bodies. Bird feathers contain a protein
that is highly magnetically sensitive.
The anthropologist and historian Robert Lawlor comments that
blood employed in this fashion is held by these peoples to attune the
dancers to the invisible energetic realm of the Dreamtime.
2- Indo-European Paganism:
Among the Germanic tribes (such as the Anglo-Saxons and the
Norsemen), blood was used during their sacrifices; the BlotsWS11. The
blood was considered to have the power of its originator and after the
butchering, the blood was sprinkled on the walls, on the statues of the
gods and on the participants themselves. This act of sprinkling blood was
called bleodsian in Old English and the terminology was borrowed by the
2

Roman Catholic Church becoming to bless and blessing. The Hittite word
for blood, ishar was a cognate to words for "oath" and "bond". The
Ancient Greeks believed that the blood of the Gods, ichor, was a mineral
that was poisonous to mortals.
3- Judaism:
In Judaism, blood cannot be consumed even in the smallest quantity
(Leviticus 3:17 and elsewhere); this is reflected in Jewish dietary laws
(Kashrus). Blood is purged from meat by salting and soaking in water.
Other rituals involving blood are the covering of the blood of fowl
and game after slaughtering (Leviticus 17:13); the reason given by the
Torah is: "Because the life of every animal is in his blood" (ibid 17:14).
4- Christianity:
Christians believed that life of living being is located in his blood.
"the life of the flesh is in the blood" (Leviticus 17:11)1.
Some Christian churches, including Roman Catholicism, Eastern
Orthodoxy, and Anglicanism teach that, when consecrated, the
EucharisticWS17
wine
actually becomes the blood
of Jesus (symbolism). Thus
in the consecrated wine,
Jesus becomes spiritually
and physically present. This
teaching is rooted in the
Last Supper as written in
the four gospels of the The Last Supper by Leonardo da Vinci Painted in MilanWS5
(1498)
Bible, in which Jesus stated to his disciples that the
bread which they ate
was his body, and the wine was his blood. "This cup is the new testament
in my blood, which is shed for you." (Luke 22:20)WS11.
Various forms of Protestantism, especially those of a Wesleyan or
Presbyterian lineage, teach that the wine is no more than a symbol of the
blood of Christ, who is spiritually but not physically present. Lutheran
theology teaches that the body and blood is present together "in, with, and
under" the bread and wine of the Eucharistic feast.
Christ's blood is also seen as the means for atonement for sins for
Christians. "take drinkthis is my blood, which is shed for you, for the
remission of sins" (Matthew 26)2.
At the Council of Jerusalem, the apostles prohibited Christians from
consuming blood, probably because this was a command given to Noah
"Only flesh with the life thereof, which is the blood thereof, shall ye not
3

eat." (Genesis 9:4). This command continued to be observed by the

Eastern Orthodox.
5- Islam:
Consumption of food containing blood is forbidden by Islamic
dietary laws. This is derived from the statement in the Qur'an, sura AlMaida (5:3)WS11: "Forbidden to you (for food) are: dead meat, blood, the
flesh of swine, and that on which hath been invoked the name of other
than Allah."
6- Jehovah's Witnesses:
Due to Bible-based beliefs, Jehovah's WitnessesWS24 do not eat blood
or accept transfusions of whole blood or its four major components
namely, red blood cells, white blood cells, platelets, and whole plasma.
Members are instructed to personally decide whether or not to accept
fractions, and medical procedures that involve their own blood.
7- Chinese and Japanese Culture:
In Chinese cultureWS11, it is often said that if a man's nose produces a
small flow of blood, this signifies that he is experiencing sexual desire.
This often appears in Chinese-language and Hong Kong films as well as
in Japanese culture parodied in anime. Characters, mostly males, will
often be shown with a nosebleed if they have just seen someone nude or
in little clothing, or if they have had an erotic thought or fantasy.
8- Blood Libel:
Various religious and other groups have been falsely accused of
using human blood in rituals; such accusations are known as blood
libelWS12. The most common form of this is blood libel against Jews.
Although there is no ritual involving human blood in Jewish law or
custom, fabrications of this nature (often involving the murder of
children) were widely used during the Middle Ages to justify AntiSemitic persecution and some have persisted into the 21st century.
9- Vampire Legends:
VampiresWS45 are mythological beings which live forever by
drinking the blood of the living. Stories of creatures of this kind are
known all over the world. Most of these myths in Western culture
originate from Eastern European and Balkan folklore.
10- Blood in Art:
Blood is one of the body fluids that has been used in art. In
particular, the performances of Viennese Actionist Hermann NitschWS11,
Franko B, Lennie Lee, Ron Athey, Yang Zhichao and Kira O' Reilly
4

along with the photography of Andres Serrano have incorporated blood as

a prominent visual element. Marc Quinn has made sculptures using
frozen blood, including a cast of his own head made using his own blood.
11- Blood in Films:
Blood is commonly associated with gore in motion pictures. Films
with bloody scenes tend to receive a high rating by film licensing bodies,
ranging from PG-13 to NC-17WS61, depending on its depiction and its
prominence29. Blood in video games has led to video game censorship.

II- Blood in Medicine:

1- Egypt:
Egyptians3 bathed in blood for their health. It is believed that the
ancient kings of Egypt apparently bathed in blood, believing such baths
to " resuscitate the sick and rejuvenate the old and incapacitated" 4, as
well as, believing it to be a cure for elephantiasis! The Egyptians also
used bleeding to treat patients. A tomb illustration in Memphis-Egypt,
belongs to 2500 BC depicts a patient being bled from the foot and neck.

2- China:
In 1000 BC5 the Chinese believed that the soul was contained in the
blood.

3- Classical Greek medicine:

In classical Greek medicine, blood was associated with air,
springtime, and with a merry and gluttonous (sanguine) personality. It
was also believed to be produced exclusively by the liver. In Hippocratic
medicine, blood was considered to be one of the four humors, together
with phlegm, yellow bile and black bile, and their imbalance causes
disease.

4- Roman Empire:
In classical times the Romans and Greeks, as well as bathing in
blood, have reportedly drank it. Taurobolium6 mentioned the practice of
bathing in blood as it cascaded from a sacrificial bull, was practiced by
the Romans. Pliny the Elder7, wrote in the 1st Century AD, describing
how spectators rushed into the arena to drink the blood of dying
gladiators. These people did this because they felt that such blood was
especially beneficial since the athletes were strong and brave, qualities
that they believed were present within, and therefore transmissible by, the
blood of the person concerned. The situation apparently became so bad
that by AD193, a decree was issued by Septimus Severus prohibiting
5

this practice. Pliny the Elder also wrote: ". a man's blood rubbed upon
himself will relieve him of pain" and that the drinking of blood ". as if
out of a loving cup" was a cure for epilepsy. About the same time, the
writer Galen advised that the drinking of the blood of a weasel, or of a
dog, was a cure for rabies.

5- Viking Tribes:
Ancient Norwegians reportedly drank the blood of seals and whales
as a remedy for epilepsy and scurvyWS11.

6- Modern Era:
The first person to describe red blood cells was probably the young
Dutch biologist Jan Swammerdam (16371680)8, who had used an early
microscope in 1658 to study the blood of a frog. Unaware of this work, a
Dutch doctor Anton van Leeuwenhoek (1632-1723)WS8 provided
another microscopic description in 1674.
It was the German anatomist Max Schultze (1825-1874)9 who first
offered a description of the platelet in his newly-founded journal Archiv
fr mikroscopische Anatomie. He describes "spherules" much smaller
than red blood cells that are occasionally clumped and may participate in
collections of fibrous material.
Giulio Bizzozero (1846-1901), building on Schultze's findings, used
"living circulation" to study blood cells of amphibians microscopically in
vivo. One of his findings was the fact that platelets clump at the site of
blood vessel injury, which precedes the formation of a blood clot. This
observation confirmed the role of platelets in coagulation.
In 1878, the German-born physician Paul
Ehrlich (1854-1915) formulated dyes for staining
cells and transformed the field of hematology. He
invented a simple technique for preparing blood
films using one of his stains. One of Ehrlichs more
significant achievements in regard to blood staining
was the ability to clearly view white blood cells.
Although white blood cells had been discovered
about a century before Ehrlich made his discovery,
WS34

scientists had little information about the cells. Paul Ehrlich (1854-1915)
Using his unique staining techniques, Ehrlich was able to identify the two
main types of white blood cells, lymphocytes and granulocytes. He was
awarded Nobel Prize for his work with blood staining.
In 1959, English doctor Max Perutz discovered the structure of
HemoglobinWS50.
6

Chapter Two

A History of the Discovery of the

Circulatory system
The discovery of the circulation of the blood didn't belong to a single
man, or indeed to a single era. There were three principal errors which
masked the great fact of the circulation. The first was, the arteries
contained only air not blood; the second was, the septum between
ventricles of the heart was perforated; and the third was, the veins carried
the blood to the extremities instead of bringing it from them. Let's see
with whom these errors originated and who destroyed them.
The earliest known writings on the
circulatory system are found in the Ebers
Papyrus (16th century BC)WS16, an
ancient Egyptian medical papyrus
containing over 700 prescriptions and
remedies, both physical and spiritual. In
the papyrus, it acknowledges the
connection of the heart to the arteries. The
Egyptians thought air came in through the
mouth and into the lungs and heart. From
the heart, the air traveled to every member
through the arteries. Although this concept
of the circulatory system is greatly flawed,
it represents one of the earliest accounts of
scientific thought.

Ebers Papyrus (1552 BC)WS66

The knowledge of circulation of vital fluids through the body was

known to Sushruta (6th century BCE)WS42. He also seems to have
possessed knowledge of the arteries, described as 'channels' in his
medical treatise Sushruta Samhita. The valves of the heart were
discovered by a physician of the Hippocratic School around the 4th
century BC. However their function was not properly understood then.
Because blood pools in the veins after death, arteries look empty. 350
BC, Greek philosopher Aristotle believes that the heart is the central
organ of the body and therefore the seat of the soul. He conducts
dissections of many different animals and describes their anatomical

structures. Based on his observations, Aristotle presumes the heart is a

three-chambered organ, even in humans.
Ancient anatomists included Herophilos (335-280 BC)WS20 and
Erasistratus (304-250 BC)WS17 assumed they were filled with air not
blood and that they were for transport of air.
Greek physician Herophilos distinguished veins from arteries but
thought that the pulse was a property of arteries themselves. Greek
anatomist Erasistratus observed that arteries that were cut during life
bleed. He ascribed the fact to the phenomenon that air escaping from an
artery is replaced with blood that entered by very small vessels between
veins and arteries. Thus, he apparently postulated capillaries but with
reversed flow of blood.
The 2nd century AD, Greek
physician, Galen (129-217 AD)WS63,
knew that blood vessels carried blood not
air; thus, he solved the first error. He
identified venous (dark red) and arterial
(brighter and thinner) blood, each with
distinct and separate functions. Growth
and energy were derived from venous
blood created in the liver from chyle,
while arterial blood gave vitality by
containing air and originated in the heart.
Galen (129-217)
He mistakenly assumed that air caused
pulse. Blood flowed from both creating organs to all parts of the body
where it was consumed and there was no return of blood to the heart or
liver. The heart did not pump blood around, the heart's motion sucked
blood in during diastole. He still believed that the septum between
ventricles of the heart was perforated and the veins carried the blood to
the extremities instead of bringing it from them. These two errors were
destined to pass from him to the moderns.
GalenWS16 believed that the arterial blood was created by venous
blood passing from the left ventricle to the right by passing through
'pores' in the interventricular septum, air passed from the lungs via the
pulmonary artery to the left side of the heart. As the arterial blood was
created 'sooty' vapors were created and passed to the lungs also via the
pulmonary artery to be exhaled.

In 1242, the Arabian physician, Ibn alNafis (1210-1288)WS64, became the first
person to accurately describe the process of
blood circulation in the human body,
particularly pulmonary circulation, for which
he is considered the father of circulatory
physiology. In 1924 an Egyptian physician
Dr. Muhyi al-Din Altawi, discovered a script
No. 62243, titled Commentary on Anatomy
in Avicenna's Canon in the Prussian State
Library in Berlin, in which Ibn al-Nafis
Stated10:
"...the blood from the right chamber of the
heart must arrive at the left chamber but
there is no direct pathway between them.
The thick septum of the heart is not
perforated and does not have visible pores
as some people thought or invisible pores
as Galen thought. The blood from the right
chamber must flow through the vena
arteriosa (pulmonary artery) to the lungs,
spread through its substances, be mingled
there with air, pass through the arteria
venosa (pulmonary vein) to reach the left
chamber of the heart and there form the
vital spirit..."
Ibn al-Nafis solved the second mistake;
he found the real way which blood uses to
pass from the right side to the left side of
the circulation. It was through lungs, not
through the assumed perforation of the
heart.

Ibn al-Nafis (1210-1288)WS64

Illustration of the
Minor Circulation of the Blood
According to Ibn al-Nafis11

Contemporary drawings of this

process have survived. In 1552, Spanish
physician Michael Servetus (15111553)WS32 described the same, and the
Italian physician Realdo Colombo (15161559)WS37 after six years proved the
concept, but it remained largely unknown
in Europe.
William Harvey (1578-1657)WS65
9

Andrea Cesalpino (1519-1603)12 used the term circulation and

believed that the veins and arteries were connected by a fine vascular
network.
Finally, the English physician William Harvey (1578-1657)WS65, a
pupil of Hieronymous Fabricius ab Acquapendente (1533-1619),
who13 had earlier described the valves of the veins without recognizing
their function, performed a sequence of experiments and announced in
1628 the discovery of the human circulatory system as his own and
published an influential book "Exercitatio Anatomica de Motu Cordis et
Sanguinis in Animalibus" about it. This book of one hundred pages is
considered by many as a master piece and its exposition slowly
convinced the medical world. He discovered the real function of cardiac
and venous valves. Besides, He concluded that arterial pulsation is only
due to blood. Nevertheless, he never discovered the capillary system. He
also contributed to the discovery of the circulation in fetus.
The Italian physician Marcello Malpighi (1628-1694)WS30
completed Harveys work and discovered the capillary system connecting
arteries and veins.
Gaspare Aselli, or Asellio (1581-1626)14 an Italian physician, was
noted for the discovery of the lacteal vessels of the lymphatic system in
1622. The Ancients knew nothing of the lymphatic vessels.

10

Chapter Three

Blood Transfusion from A to Z

I- Blood Transfusion in The Ancient and Medieval Eras:
There are many early documented references to the use of blood, for
what can be at best described as medicinal purposes.
One of the first of these
relating to a transfusion is
contained in the seventh book of
the epic poem Metamorphoses,
which was written by the Roman
poet Ovid (Ovidius)WS31, the
narrative poem, composed in
fifteen books that describes the
creation and history of the world.
Ovidius wrote in 43BC in the
seventh book named Medea,
Cephalus and Procris, describing
how (the witch) Medea rejuvenated
Jason's aged father Aeson as
follows15:
"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
Cover of the English edition of
no longer white with age, turned
Ovid's MetamorphosisWS31
quickly to their natural vigor, dark
and lustrous; his wasted form renewed, appeared in all the vigor of
bright youth".
Medea's remarkable success was achieved with an elixir brewed in a
bronze cauldron containing the following ingredients16:
". root-herbs, seeds and flowers, strong juices and pebbles from the
farthest shores of oceans east and west; hoar-frost taken at the full of
the moon, a hoot owl's wings and flesh, a werewolf's entrails, a fillet
of a snake, the liver of a stag and the eggs and head of a crow which
had been alive for nine centuries."
11

Medea's practice as a transfusionist was not confined to this single

event, since she is later reported to have killed Pelias, by pretending to
perform a similar miracle on him, having first gained his confidence by
apparently changing an aged sheep into a lamb!
In addition to these early mythical writing, there are several noted
citations in the Old Testament indirectly bearing on (blood) transfusion.
These have a social impact to the present day, relating to the denial of a
blood transfusion by certain persons, on religious grounds.
Although these references refer to the drinking of blood or the
application of blood to the skin, an ancient Hebrew manuscript refers to
an actual possible transfusion as follows17:
"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."
An early recognition of the dangers of the custom of ingestion of
blood, as well as probably the first rather fanciful description of what
could be described as the management of an adverse reaction, is
contained in the works of the 13th Century Italian writer Pietro d'Abano
(1250-1316)WS35, who wrote18:
who drinks of menstrual blood or that of a leper will be seen to be
distracted and lunatic, evil minded and forgetful, and his cure is to
drink of daisies powdered and mixed with water of honey, and to bath
in tepid water and to copulate with girls according to the law natural
The Arabic physicians practiced venesection, cupping and blood
leech in order to treat diseases. The venesected veins differed according
to the complaint of patient. The famous physician Abu
al-Qasim Al-Zahrawi
(Albucasis) (936WS67
1013)
, in the thirty Essay of his best work
Kitab al-Tasrif19, described the method and
indications of venesection and drew pictures of
the Scalpels that he designed and used in
venesection. He also mentioned the benefits and
procedure of Cupping, describing the Cupping
vessels he used. He limited the use of blood leech
in lips, gums, nose and finger where physician
couldnt use cupping. He also mentioned the
method of positioning leech.
Albucasis (936-1013)WS67

12

II- Blood Transfusion in The Modern Era:

It is likely that all references to the transfusion of blood before
1628, the date of Harveys Discovery of systemic circulation, must be
considered at best, questionable. Since most of the ancient and medieval
references probably refer to the ingestion of blood, rather than to its
infusion, it is in fact difficult to determine when the first authentic
attempt at transfusion was actually performed.

1- First Thoughts of Blood Transfusion:

One of the most frequently quoted candidates for
this noteworthy honor is Pope Innocent VIII
(1432-1492)WS36, Giovanni Cibo, who was
reputedly transfused sometime between 1490
and 1492. Pasquale Villari (1827-1917)WS33, the
Italian historian, some considerable time later
recounted the incident, claiming that the Pope
had some sort of illness (in the light of present
knowledge, this was probably chronic renal
Pope Innocent VIII (1432-1492)WS36
disease), that rendered him semi-comatose.
This was described as being so profound at times that the Pope was
mistakenly thought to be dead20. On one occasion, after all means to
revive the Pope had failed, it is reported that a physician (or mystic) of
dubious reputation, named Abraham Meyre, appeared in the court and
promised to save the Popes life by transfusing him with the blood of
young donors. Apparently, three young 10-year-old shepherd boys were
selected as donors and Villari states that the blood of the dying Pope was
passed into the veins of one of the boys, " who gave him his own in
exchange". The process was apparently repeated with the other two boys.
All three boys apparently died shortly after the procedure, possibly as a
result of air embolism, but there was no change to the Pope's condition.
This story is however controversial and is open to interpretation, being
based on translations from the original script. It is possible that this
presumed
transfusion stems from an incorrect translation by Villari of an earlier
account of the Pope's illness. If this is the case, what is likely to have
happened is that the Pope was asked to drink the blood. In any event, all
authors seem to agree that the three boys, " costing one ducat a
piece"21, died shortly after the procedure, as apparently did the Pope
(presumably from his renal condition. The physician who instigated the
treatment was apparently punished and subsequently disappeared
(probably very quickly!).
13

The second incident of interest in this

first period is the statement made in 1615 by
the chemist, Andreas Libavius (15551616)WS7. He imagined how blood was taken
from the artery of one young man and infused
into the artery of another old man. He
described blood transfusion accurately and
vividly enough, but he never transfused
anyone. He wrote the following comments
while defending his chemical theories against
critics22:

Andreas Libavius (1555-1616)

"Let there be a young man, robust, full of spirituous blood, and also
an old man, thin, emaciated, his strength exhausted, hardly able to
retain his own soul. Let the performer of the operation have two silver
tubes fitting into each other. Let him open the artery of the young man,
and put it into one of the tubes, fastening it in. Let him immediately
after open the artery of the old man and put the other tube into it, and
then the two tubes being joined together, the hot and spirituous blood
of the young man will pour into the old one as if it were from a
fountain of life, and all of his weaknesses will be dispelled. Now, in
order that the young man may not suffer from weakness, to him are to
be given good care and food, but to the doctor, hellebore."
In 1628, Harvey's discoveries initiated considerable speculation
regarding not only the possibility of the transfusion of blood, but also the
infusion of other medications or potions. Harvey himself is in fact
thought unlikely to have used blood transfusion in relation to his medical
practice, though there is evidence that, in order to test his theories, he
pumped water through the circulation of a dead man.
During the 25 years or so following the publication by Harvey of the
description of the circulation of the blood and the role of the heart, it is
only to be expected that several people in different European countries
should be thinking along similar lines. This gave rise to conflicting
priority claims as to the first person to actually transfuse blood.
In 1628, Giovanni Colle da Belluno (1558-1630)WS2, a professor
at the University of Padua (who may well have had knowledge of
Harvey's work), whilst writing on the methods of prolonging life,
mentioned blood transfusion as a possible means of achieving this goal.
There is however no evidence that he ever attempted to carry out a
transfusion in practice.
14

2- Blood Transfusion from an Animal to an Animal:

Based upon his readings of Ovid's story of Medea, Francis Potter
(1594-1678)23 is thought by some to possibly be the first person to
conceive of transfusion on a practical basis. Potter was the vicar of
Kilmarton in England and apparently something of an eccentric and
recluse, whose efforts were documented in the writings of his
contemporary friend John Aubery (1626-1697)WS25, an English antiquary
and writer. According to these writings, Potter originated the idea of
transfusion as early as 1639, and devised quills (as needles) and tubes
for the purpose. In 1649 he wrote to John Aubery reporting that he had
attempted the procedure of transfusion between two chickens, though it is
likely that because of the size of such birds, it probably proved
unsuccessful24:
"I am as yet frustrated in ipso limine, but it is my own inexpertness,
who never attempted any such thing on a creature before; for I
cannot, although I have tried divers times strike the veins so as to
make him bleed in any considerable quantity. I have prepared a little
clear transparent vessel (like unto a bladder) made of the craw of a
pullet; and I have fastened an ivory pipe to one of the necks of it, and I
have put it into a veins which is most conspicuous about the lower
joint of the hinder legs; and yet I cannot produce above 2 or 3 drops
of blood to come into the pipe or bladder."
The above account didnt refer that the Reverend Francis Potter
greatly advanced the science of blood transfusion to any great degree. No
record remains of the fate of the chickens!
One certainly false claim of priority in blood
transfusion is made by Florentine physician,
Francesco Folli (1624-1685)WS4, who published a
book in 1680 setting out his claim to be the originator
of blood transfusion. He stated that he read of
Harvey's work in 1652 and thereupon formed the idea
that the transfusion of blood should be possible to
cure diseases and to rejuvenate the aged. In 1654
Folli wrote25:

Francesco Folli (1624-1685)

"This I pointed out in my pamphlet on life culture which was published

for no other reason than to make known to all that blood transfusion
had been invented by me at the end of 1654 and demonstrated to his
Serene Highness Ferdinand II, Grande Duke of Tuscany, of undying
memory. The novelty of it had pleased him, or the fascinating
ingenuity or the considerable experimental elaboration. To no one
15

else did I impart my idea, believing that if such an invention were

successful, Monarchs alone were worthy of it."
Later Folli described in some detail the apparatus required and the
method of using it. He even postulates the presence of twenty young men
as blood donors, so that the patient may receive blood of a fresh donor
every day over a considerable period. The apparatus apparently used,
consisted of a funnel, connected by a tube formed from a goat's artery,
with a gold or silver cannula to be inserted into the patient's vein. Though
Folli describes the theory of transfusion, near the end of the book comes
the confession, which spoils it all from a practical viewpoint, where he
identifies that he did not actually carry out the process!26:
"Finally I know that I have said too much concerning the manner of
carrying out the operation, not having made the experiment...but I
have done it solely so that everyone, however simple or ignorant,
could understand, be inspired, and even make the experiment with the
least possible expense, and to this end only I have written in the
vulgar tongue."
The French may also lay some claim to being the first to perform a
transfusion. At a meeting of a learned society, held in Paris in July 1658,
Robert des Gabets (1610-1678)27, a French Benedictine monk, discussed
the discovery of the circulation of the blood by Harvey, and claimed that
he was convinced that he could establish another type of movement of the
blood. He termed this "communication", by which he meant " the
effective passage of blood of a healthy man or other animal to the veins of
an individual weak or diseased". He also claimed that seven years earlier,
a friar called Pichot, had prepared an instrument consisting of two small
silver tubes, connected by a leather purse about the size of a walnut,
which could be used for this purpose.
The established priority claim
however for proposing and demonstrating
the
intravenous
administration
of
medications (into the veins of dogs) is made
by Dr (later to become Sir) Christopher
Wren (1632-1723)WS15, who was to achieve
far greater fame as an English astronomer
and architect. He developed in 1656 an
animal bladder attached to two
quills for this purpose. Dr
Thomas Sprat (1635-1713)WS43, in
his history of the Royal Society in 1657,
records the following 28:
16

Christopher Wren (1632-1723)

". Wren was the first author of the Noble Anatomical Experiment of
Injecting Liquors into the Veins of Animals: an experiment now
vulgarly known, but long since exhibited to the Meetings at Oxford,
and thence carried by some Germans, and published abroad. 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."
Wren's experiments were later to be
described in some detail by his associate
Robert Boyle (1627-1691)WS39, in his book,
Usefulness of Experimental Philosophy,
published in 1663.
The Royal Society was founded in
London during 1661 and received its Royal
Charter in 166229. It was founded by Thomas
Willis, Christopher Wren, Richard Lower,
Robert Hooke, Robert Boyle, Sir
William Petty, Thomas Sydenham, and
Samuel Pepys. It was this philosophic
assembly of distinguished scientists
that witnessed the beginnings of
experiments of blood transfusion in
animals. It was the practice of the time,
that experiments should first be

Robert Boyle (1627-1691)WS39

The Royal Society

demonstrated in front of
colleagues and peers, and
then written down and
published (usually by the
Royal Society itself).
Among several persons
involved
in
these
experiments
was
the
Cornish Physician Richard
The Royal Society (Physicians Practicing And Discussing)

Lower, a doctor practicing in Oxford, who claims priority for the first
17

practical transfusion. Richard Lower (16311691)30 was the first person to give a blood
transfusion to animals successfully. He did this,
early in February of 1665, when he bled one dog
almost to the point of death. Then he tied the
artery, and transfused this dying dog from a larger
dog-a mastiff-and revived the bled dog. He did
this three times, exhausting the donor each time,
but he had very clearly saved the animal from
dying by the performance of blood transfusion.
WS38
Many of the early experiments were performed Richard Lower (1631-1691)
on dogs using "liquors", which included such substances as ale, wine and
opium. Although the practice at the time, the animals used in these
experiments were obviously treated unacceptably by present day
standards, since they were reported to have undergone "suffering
vomiting, intoxication and I fear death". These and many other various
entries in the Journal Book of the Royal Society, record the earliest
suggestions and attempts to carry out blood transfusions in animals or
birds. In a report dated 31st May 1665, there appeared the first mention of
a direct artery-to-vein transfusion from an animal to a human. The major
part of future work was done by Dr Richard Lower, whose first statement,
written in a letter to famous chemist Robert Boyle, was read to the Royal
Society on the 26th September 1666. Lower's book on the heart Tractatus
de Corde, published in 1669, proves him to have been one of the great
pioneers in anatomy and physiology. In it he makes the following
statement about blood transfusion31:
".. to reveal the conduct of the whole affair and at the same time
show by what train of thought reasoned it out and undertook it, and
finally, by what means and aids it was carried into effect."
He then proceeds at great length to give an account of the first
(published) description of a successful direct transfusion from artery to
vein (having first attempted vein to vein direct transfusion and failed due
to the blood clotting in the silver tubing used for the purpose). It seems
clear that Lower was the first to define the appropriateness of the
transfusion replacement of blood in severe hemorrhage, since he was able
to demonstrate that a dog could be exsanguinated to the point of death
and then be completely restored by transfusion.
Lower's efforts were the stimulus for a series of experiments on
animals, by various people throughout Europe, and eventually led to the
transfusion of blood from an animal to a man. The priority of this
procedure occasioned a somewhat heated debate between Lower and a
man he described as "a certain Denis", who was actually a Frenchman
called Dr Jean Denys.
18

3- Blood Transfusion from an Animal to a Man:

On the 22nd of November 1666, Richard Lower, assisted by Dr
Edmund King, transfused a 32 old man named Arthur Coga32. The event
took place in England and was later detailed in the Transactions of the
Royal Society. The initial part of the account describes the quills and
silver pipes used to carry the blood between the carotid artery of the
donor sheep and a vein of the recipients arm. The account however
concludes33:
"The blood did run all the
time of those two minutes
and we concluded.... upon
the man's saying he thought
he had enough. The man
after this operation, as well
as in it, found himself very
well, and hath given in his
own narrative under his own
hand, enlarging more upon
the benefit he thinks he hath
received than we think fir
Richard Lower And Edmund King
to own as yet. He urged us
Transfused Arthur Coga in 166634
to have the experiment
repeated upon him within three or four days after this, but it was
thought advisable to put it off somewhat longer."
This second experiment did in fact occur (the following month) and
apparently proceeded without mishap. Afterwards, the subject Arthur
Coga said he felt better, although Pepys wrote in his diary " he is
cracked a little in the head The excuse for performing a transfusion
was that it was believed that it might improve his
mind. Arthur Coga was a little cracked in the head,
and the idea was that a transfusion might cure him.
Lamb's blood was used for the transfusion too. It
should be remembered that these early medical
transfusion experiments were carried out at a time
when the popular medical treatment used by
doctors to treat many illnesses was blood-letting,
i.e. bleeding the patient, rather than transfusion
them.!
Jean-Baptiste Denys
Dr Jean-Baptiste Denys (1640-1704)WS23, a
young French physician on the large staff attached to King Louis XIV,
read of Lower's experiments in the Journal des Savants, of 31st January
(1640-1704)WS23

19

1667. In association with a surgeon, Paul Emmerez (1690)35, Denys

initiated his own trials approximately a month later, performing numerous
dog-to-dog transfusions. On the 15th June 1667, Denys was asked to treat
a 15-year-old boy, who had suffered from a fever for many months, for
which he had been bled by his physicians twenty times, ". to assuage
the excessive heat. Denys wrote36:
"Before this disease, he had not observed to be of a dull spirit, his
memory was happy enough, and he seemed cheerful and nimble in
body; but since the violence of his fever, his wit seemed wholly sunk,
his memory perfectly lost, and his body so heavy and drowsy that he
was not fit for anything."
Accordingly he was bled to the extent of about three ounces and
received in exchange nine ounces of blood from the carotid artery of a
lamb. The change that ensued in the patient was described as startling
and presently the boy was showing " a clear a smiling countenance"
where previously he had apparently passed the time " in an incredible
stupidity". The boy had also felt " a very great heat along his arm (a
present-day indication of an incompatible transfusion reaction!), but there
were apparently no further ill effects.
Denys second transfusion was performed on a 45-year-old man
using a reported 20 ounces of lambs' blood and described the man as
feeling stronger than before the transfusion. Further transfusions were
performed; one of which involved the description of a variety of reactions
in the patient that would be indicative nowadays of a severe hemolytic
transfusion reaction. Denys submitted a report of his transfusion of the
teenage boy to the Royal Society in July 1667, which due to the editor of
the Journal being in the Tower of London at the time, was not published
until the 23rd September 1667. Therefore, although Lower performed the
first animal-to animal transfusions, there now seems little question that
Denys performed the first animal to man transfusion .
Denys favored the use of animal blood for his transfusion
experiments because he believed it less likely37 " to be rendered impure
by passion or vice". This way of thinking about blood, as carrying a
persons (or in this case animals) temperament, beliefs, strength or
courage, was typical of the time. Following the transfusion of at least four
individuals, Denys and his associate performed a further transfusion in
1668. This transfusion was to have far-reaching and significant
repercussions, and in fact determined that the practice of transfusion was
to lay dormant for nearly one hundred and fifty years. A 34-year-old man,
Antoine Mauroy, was described by Denys as suffering a severe
phrensy, which apparently had lasted seven or eight years, and had
20

reportedly been due to an unfortunate love affair. Apparently one day the
man escaped from his wife's control and paraded through the streets of
Paris clothed " only
in
nature's
garb,
followed
by
an
admiring throng". Such
an opportunity was
apparently not to be
lost by the enthusiastic
researcher such as
Denys, who pounced
on this luckless fellow,
proposing a transfusion
to allay the " heat in
his blood ..". Shortly
after, ten ounces of
blood were removed
from the vein of his
Dr Jean-Baptiste Denys Transfused Antoine Mauroy
right
arm,
being
5 or 6 ounces of calfs bloodWS4
replaced with five or six
ounces of blood from a calf, with no obvious untoward (or obviously
beneficial) effects. Two days later, the man was transfused a second time.
This resulted in what is now recognized as a hemolytic transfusion
response. Denys' description of this second transfusion could in fact be
considered to be a classic medical description of this phenomenon38:
"As soon as the blood entered his veins, he felt the heat along his arm
and under his armpits. His pulse rose and soon after we observed a
plentiful sweat over all his face. His pulse varied extremely at this
instant and he complained of great pains in his kidneys, and that he
was not well in his stomach, and that he was ready to choke unless
given his liberty. He was made to lie down and fell asleep, and slept
all night without awakening until morning. When he awakened he
made a great glass full of urine, of a colour as black as if it had been
mixed with the soot of chimneys."
Denys also recounts that the following morning (the second day),
Mauroy had further hemoglobinuria and epistaxis. However, by the third
day, his urine had cleared and, his mental state having apparently
improved, the man returned to his wife. Denys attributed the colour of the
urine to a "black choler" which had been retained in the body and had
sent vapors to the brain, causing the patient's mental disturbance.

21

Several months later, Antoine Mauroy again became violent and

irrational and his wife persuaded Denys and his associate Emmerez to
repeat the transfusion. A transfusion was attempted, but since the flow of
blood was poor, it was apparently abandoned. Mauroy died the following
evening. Through their transfusion experiments, Denys and Emmerez had
acquired many enemies among the physicians of Paris, since the medical
practice of the day involved bleeding the patient, principally by the use of
leaches. Three of these physicians persuaded Mauroy's widow to accuse
Denys and Emmerez of contributing to the death of her husband by the
transfusion. Other physicians in the Faculty of Medicine of Paris, an
apparently extremely conservative body who refused even to recognize
Harvey's theory of circulation, were opposed to transfusion and published
pamphlets condemning the practice. At one point the widow offered to
withdraw the lawsuit provided she would receive payment from Denys,
however he replied "That those physicians, and herself, stood more in
need of the transfusion than even her husband had done". Denys lodged a
counter-complaint against the widow, so that when the trail came to
court, he appeared as the plaintiff, not the defendant. Following a
prolonged legal battle, the outcome was that Denys was exonerated. The
widow was in fact subsequently shown to have poisoned her husband
with arsenic! More importantly however, due to the enemies that Denys
had made, the Faculty of Medicine of Paris issued a decree based on the
results of the trail, stating that the procedure of transfusion was not to be
performed without the permission of a member of the Faculty of
medicine. Since the Faculty was bitterly opposed to the whole idea, this
permission was never given and the practice of transfusion rapidly fell
into disuse. Eventually, in 1678, an edict from the French parliament
ruled transfusion to be 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 joined the general
outcry and also announced a ban on the procedure. As a result, quite
understandably, interest in transfusion rapidly waned. Although the
practice of transfusion had essentially ceased, some text books published
in the 17th and 18th centuries still included classical accounts of how the
procedure could be accomplished.
Apart from Lower's comments associated with his initial dog
experiments, during this period, little consideration was given to the use
of transfusion for the replacement of blood loss. The most popular use for
transfusion was the possibility of it being able to alter the mental state of
the patient and the possibility of restoring youth to the aged.

22

4- Blood Transfusion from a Man to a Man:

Following the decrees of the mid-17th century forbidding blood
transfusion throughout most of Europe, the practice fell into general
disrepute for more than a century and a half. The credit for placing
transfusion on a scientific basis and re-awakening interest in its use must
be given to James Blundell (17901877)WS22. James Blundell was a noted
physician, physiologist and one of the
outstanding obstetricians of his day. He
is credited not only with rekindling
interests in blood transfusion in the
second decade of the 19th century and
providing it with a semblance of a
national approach, but he was also the
first to transfuse human blood. Many
people in fact regard Blundell as the the
father of modern blood transfusion.
WS22
Even though he was one of the pioneers of James Blundell (1790-1877)
blood transfusion, the Dictionary of National Biography makes no
reference at all to his work on transfusion, but does note that he left a
fortune of 350,000 at his death in 1877!
Blundell39 initially became interested in transfusion as a method of
treating postpartum hemorrhage. He wrote: "appalled at my own
helplessness at combating fatal hemorrhage during delivery". His
experiments began by exsanguinating dogs and then reviving them by the
transfusion of arterial blood from other dogs. From his experiments, he
concluded that the blood from one animal could not be substituted for that
of another with impunity, and he therefore turned to the use of human
blood for human transfusion. Besides, there is impracticability in using
animal blood due to the difficulty of finding an appropriate animal in an
emergency.
It must however be noted, that Blundell received his medical degree
from the University of Edinburgh and was undoubtedly influenced in his
early experiments by the work of American physician John Henry
Leacock (1729-1802)WS3. Although Leacock's manuscript on the subject
of transfusion was written whilst he was in Barbados, his experiments
were performed during his tenure in Edinburgh, where one of his
contemporaries was Blundell.
Utilizing40 a six-inch length of ox ureter (as the tube) with crow
quills (as the needles) attached to both ends, Leacock operated on dogs,
resuscitating exsanguinated animals by transfusion. Although Leacock
23

did not perform a human transfusion, he argued against the mixing of

blood from different species and his experiments quite clearly pointed to
the advantages of such treatment. In 1817, Leacock eloquently concluded
his dissertation on transfusion as follows41:
"The consequences of hemorrhages where the functions are not
dangerously affected, do not of course, require transfusion, since
other remedies will suffice. But when the danger is imminent, and the
common means are ineffectual, as when a parturient women trembles
on the brink of the grave from uterine hemorrhage, or when a soldier
is at the point of death from loss of blood, what reason can be alleged
for not having recourse to this last hope, and for not attempting the
recruit the exhausted frame and turn the ebbing tide of life."
Blundell initially advocated direct transfusion; however, shortly after
he introduced the use of the syringe to facilitate vein-to-vein transfusions.
He described transfusion by syringe in several papers, noting the
necessity of removing air from the instrument before transfusion, as well
as experiencing the problems of blood clotting, "....the blood is
satisfactory only if it is allowed to remain in the container for but a few
seconds."
The historic date assigned to the first documented transfusion of
human blood is the 22nd December 1818. The procedure was published
in 1819, under the title Some account of a case of obstinate vomiting in
which an attempt was made to prolong life by the injection of blood into
the veins. This case study describes how Blundell, with the help of the
surgeon Henry Crine Noyes42, his nieces husband, transfused a 35-yearold man with what would now be called gastric carcinoma, but was then
described as "scirrhosity of the phylorus". When first seen by Blundell,
the patient was near to death. Approximately 14 ounces of blood were
administered by syringe in small amounts, from several donors, at
intervals of 5-6 minutes. Despite temporary improvement in his
condition, the patient died 56 hours later. His disease was incurable and
nothing could really have been expected from the transfusion.

24

Blundell then invented a rather strange instrument called an impellor,

Diagram of The Impellor of Blundell which appeared in his book, published in 1824WS4

which was essentially a funnel and pump combined; a diagram of which

appeared in his book, published in 1824. The
outer compartment of the funnel was first
filled with warm water (to help keep the
blood fluid) and the donor's blood was made
to flow into the funnel. The action of the
pump (within the water filled jacket of the
funnel) forced the blood along a tube to a
cannula inserted in the patient's vein, by
means of two oppositely acting spring valves
below the funnel. According to the
illustration, the impellor was designed to be
fixed to the back of a chair to give the The Impellor of Blundell
Fixed to a ChairWS22
equipment stability (as well as possibly being
for the benefit of the blood donor!).
Later Blundell43 invented another instrument, the Gravitator, in
which, as the name implies, gravity provided the motive force for pushing
the blood into the patient's vein. The equipment consisted of a funnel at
the end of a long flexible bracket, which was again attached to a chair or
similar object for stability. The funnel is connected to a tube with a
cannula, which was buckled to the patient's arm. Illustrations published in
1829 show the blood donor standing by the equipment while he watched
his blood gushing into the funnel!
Blundell was at great pains, like a number of his contemporaries, to
show (by extensive experiments) that the blood was not injured by its
passage through an instrument and that the introduction of "a few air
25

bubbles" into the circulation was, contrary to the belief of earlier

observers "quite harmless"!.
Between 1818 and 1829, Blundell and his colleagues performed a
total of ten transfusions using human blood, of which no more than four
can have been successful as two patients were in fact noted to already
be dead when transfusion was commenced! The first successful
transfusion was of a woman who recovered from severe post-partum
hemorrhage after receiving eight ounces of blood from Blundell's
assistant during the course of three hours.
This case was published in journal The Lancet in 1829. Blundell
still reported patients who "... suffered fever, backache, and headache and
passed dark urine" (presumably due to ABO incompatibility).

Blundell Performed The First Human to Human Successful Transfusion in

1828 using his Gravitator44

Blundell also actively encouraged his contemporaries to practice

transfusion. For the most part, these were obstetricians who used the
procedure in cases of postpartum haemorrhage. One of the most active
transfusionists of the time was the English physician Henry Doubleday
(18101902)WS19 who described in great detail the transfusion of a
woman (suffering postpartum haemorrhage) with her husband's blood. He
noted that after six ounces had been given the woman, previously semicomatose, suddenly exclaimed, "By Jesus, I feel strong as a bull".
Similarly, in 1829 Blundell, describing a transfusion of postpartum
hemorrhage, claimed that45:
26

".... the patient expresses herself very strongly on the benefits resulting
from the injection of the blood; her observations are equivalent to this
- which she felt as if life were infused into her body".
James Blundell established, during his interest in transfusion, so
many fundamental points that it is difficult to exaggerate the importance
of his work in the history of transfusion medicine. However, after 1830,
James Blundell's interest in blood transfusion waned. He retired from
medical practice in 1847, at the age of 57, undoubtedly well facilitated by
a fortune of approximately 500,000, which is recorded to have been
accumulated from his medical practice and bequests. During this period,
considerable debate continued regarding the use of transfusion and
various views being recorded in the minutes of the Medical Society of
London. Many people felt that the procedure was dangerous and that it
may have hastened the death of some of the patients in whom it was used.
Furthermore, it was claimed that most of the patients who benefited from
the procedure would have recovered anyway without the use of a
transfusion. Dr Blundell argued strenuously however on behalf of the use
of transfusions, noting repeatedly that the dangers of haemorrhage, in
these patients, far outweighed the possible danger from transfusion.

27

5- Establishing Transfusion Procedures:

It is obvious that one of the first problems that had to be solved
before blood transfusion could be placed on a practical footing was the
prevention of coagulation or blood clotting. During the 19th century,
attempts to overcome this problem took several forms. James Blundell
noted that vein-to-vein direct transfusions were impractical due to blood
clotting, yet attaching the artery of the donor to the vein of the recipient
rendered the procedure feasible (if not presumably rather messy!).
Considerable use was also being made around this time of
defibrillated blood, that is to say, blood from which the (platelet) clot has
been removed. A variety of techniques were described
to achieve this goal. One of the first people to use
an anticoagulant additive was J. Neudorfer, who
in 1860 recommended the addition of sodium
bicarbonate as an anticoagulant. Two other
physicians who actively sought an answer to the
problem of coagulation were the English doctor
John Braxton Hicks (1823-1897)WS26, who
used a solution of sodium phosphate (in six
notably unsuccessful transfusions), and the
Mauritian physician Charles-douard BrownSquard (1817-1894)WS14, who used defibrillated
blood for his experiments performed in the John Braxton Hicks (1823-1897)
early 1850's. Defibrillation of blood was generally accomplished by
whipping or twirling the blood, then removing the clot and transfusing the
remaining fluid. However, half a century was to elapse before a practical
means of anticoagulation was devised. Efforts during the remainder of the
19th century were directed towards the development of (usually)
unproved devices for direct transfusion or the refinement of surgical
procedures to facilitate direct transfusion. Many of the devices for direct
transfusion were quite ingenious, attempting to incorporate the features of
rapid administration, measuring the amount injected and, in some
instances, warming the blood. Although anticoagulation of blood was
becoming more popular during the mid-19th century, one of the chief
exponents of a more direct or immediate manner of
transferring blood was another obstetrician in
America, Dr James Hobson Aveling (18281892)WS3.
His apparatus was described and illustrated in an
article published in 1873. It consisted of a simple tube
with a central rubber bulb, which provided a pumping
Transfusion Apparatus
of AvelingWS4

action produced by squeezing the bulb together with

28

WS26

the tube at alternative sides of the bulb. Aveling described the apparatus
as being extremely convenient, so much so that he wrote, "I carried the
apparatus around in my pocket to every confinement I attended for eight
years until at length the opportunity for using it arrived". From this
statement it may be correctly inferred that the concept of sterility was
unknown at this time! Dr Aveling finally used his direct transfusion
apparatus in 1872, when he attended a lady, aged 21 years, "in extremis"
from post-partum haemorrhage. She received 60 drachms of blood from
her coachman and apparently soon recovered, certainly enough to
reportedly be able to remark that she was dying! Dr Aveling added in his
report that46:
" the mental improvement of the patient was not as marked and
rapid as I anticipated, but this was perhaps due to the quantity of
brandy she had taken."
The coachman, he was pleased to record, was not only "collected
and cheerful", but able to make several useful suggestions during the
transfusion process, though unfortunately Dr Aveling does not record
what these suggestions actually were! No reason was given as to why this
man was chosen as a donor, other than presumably because he was a
servant, or even if he was a willing donor!
Defibrillated blood was used by Sir Thomas Smith (1809-1881)WS59
who, in 1873, used the procedure in St Bartholomews Hospital for in the
first reported case of a transfusion to an infant (who was suffering from
Hemolytic Disease of the Newborn). His defibrillating apparatus, on this
occasion, included a wire eggbeater and a hair sieve, with which to
remove the clot. Defibrillated blood has been used until relatively recent
times by various operators, but the process results in the removal of a
large part of the protein content of the blood, as well as some of the cells,
and is also time consuming and difficult to perform correctly. A
somewhat important instrument modification was introduced in 1857 by
M.B Higginson47, who applied the principle of a rubber sealed syringe
with ball valves for transferring the blood from the receptacle into which
it was drawn to the vein of the patient. Higginson's syringe was later
used for a different purpose (in the treatment of syphilis in men), but it
was successfully applied by its inventor in a series of seven transfusions.
One of these transfusions is recorded to have been given to a woman,
who, having been transfused with about 12 ounces of blood from a
healthy servant, fell into " a state of quietude following her previous
restlessness". A few minutes later the patient was seized with a rather
severe rigor. It did not last long, but led to a state of reaction and
excitement during which she "sang a hymn in a loud voice". Although
this is a somewhat unique description of a patient experiencing a
29

transfusion reaction, the final outcome was apparently satisfactory and

Higginson reported that some benefit was obtained from five of the seven
transfusions he performed.
Although so much of the early work on blood transfusion had been
performed in England, and its revival during the 19th century was started
in the United Kingdom, most of the references to transfusion up to 1874
are to be found in continental publications.
During the final quarter of the 19th Century, frustration and
discouragement with blood as a transfusion product resulted in a brief
period of enthusiasm for the transfusion of milk, which was thought of as
a blood substitute. This form of treatment achieved its greatest
popularity in the United States between 1873 and 1880, with the milk of
cows, goats and humans being used. The most outspoken advocate of
milk transfusions was T.G. Thomas, who was discouraged by the use of
blood because of its "tendency to coagulation". However, by 1880
increasing numbers of adverse reactions associated with the
administration of milk led to its general abandonment. A major
contributing factor in the final decline of the use of animal blood and
milk for transfusion must however have been the introduction, between
1875-1880, of physiological saline solution for infusion use, with its
associated convenience and lack of danger to the recipient.
During the latter part of the 19th Century, the Franco-Prussian war
was raging in Europe
and the possibility of
using
blood
transfusions on the
battlefield naturally
came to the fore. The
chief authority at the
time
was
Dr
J.Roussel. He had
first used his method
of direct arm to arm
transfusion
with
success in 1865 for a
patient
with
48
puerperal haemorrhage. Dr J.Roussel used his apparatus in direct arm to arm transfusion
The apparatus he used was described in the Gazette des Hospitaux in
1867 and later in various other publications. The basis of the transfusion
technique was to place a glass vessel over the donor's arm, the apparatus
was filled with water and a lancet operated through the top of the vessel
then punctured the donors vein. The operator, by means of a two-way
30

tap, then rejected the water through one cannula and injected the blood
into the recipient through a second cannula inserted in a vein.
In 1882, in Paris, he reported on a total of sixty transfusions
performed since 1865 in Switzerland, Austria, Russia, Belgium, England
and France. Roussel's transfuseur apparatus was subsequently officially
adopted for use by the French Army and apparently used in time of war.
The dangers of infection (both local and systemic) relating to safe
transfusion methods started to be resolved when in 1865 Louis Pasteur
(1822-1895)WS68 recognized that bacterial / fungal contamination causes
putrefaction and the work of Joseph Lister who in 1867 discovered
antiseptics. As a result, the sterilization of instruments and antiseptic
methods began to be introduced.
Throughout the 19th century, the main use of transfusion was
however in the treatment of obstetric cases. Beyond this fact, a number of
major practical problems
remained to be solved.
One of these was
the number of severe
transfusion
reactions
which were, for a long
time, attributed only to
the introduction of air
bubbles
into
the
recipient's circulation.
The discovery (in 1900)
of the human ABO
blood groups by Dr
Karl
Landsteiner
(1868-1943)WS69
in
Vienna was the major
step in understanding
that these reactions were
Karl Landsteiner (1868-1943)49
in fact due to what is now
known to be blood group
incompatibility (probably associated with intravascular haemolysis).
Landsteiner discovered the ABO blood group system by mixing the red
cells and serum of each of his staff. He demonstrated that the serum of
some people agglutinated the red cells of other. From these early
experiments he identified three groups, called A, B and C (C was later to
be re-named O). The forth much rarer blood group AB, was discovered a
year later. He was awarded Nobel Prize in Physiology or Medicine in
31

1930. Landsteiner identified that most people had naturally occurring

antibodies in their serum that reacted with the antigens present on the red
cells of a person of a different blood group. The presence of these
antibodies, together with the variable frequencies of the different blood
groups in European populations, identified why blood transfusion from
one person to another had been so unpredictable, as receiving the wrong
ABO group blood can be fatal. For example, if a group O person
receives red cells from a group A person, the antibodies present in their
plasma will react with and destroy the donor red cells, releasing the
hemoglobin out of the red cell into the persons circulation. If present in
large amounts, the free hemoglobin is poisonous, possibly resulting in
renal failure and death. However, it wasnt until 1907 that American
surgeons Reuben Ottenberg and Schultz suggested that it might be a
good idea if both donor and recipient were ABO grouped before
transfusion and their blood mixed in the laboratory (cross matched) to
ensure compatibility.
At Mount Sinai Hospital in New York, American Doctor Reuben
Ottenberg (1882-1959)WS56 performs the first transfusion using cross
matching, and over the next several years successfully uses the procedure
in 128 cases, virtually eliminating transfusion reactions. He was also the
first to suggest that human blood groups are inherited according to
Mendel's law.
In 1911, Dr. Ludvig Hektoen of Chicago recommends checking the
blood of donors and recipients for signs of incompatibility (or cross
matching) prior to transfusion.
In 1913, The Kimpton-Brown
transfusion apparatus50, developed by dr.
Kimpton and dr. Brown, was commonly
used before using citrate. It consisted of a
paraffin-coated gradient glass cylinder with
a horizontal side tube for suction. It was in
use until approximately 1918.
In a series of reports between 1916 and
1918, Bruce Robertson of the Canadian
Army, explained the advantages of the
syringe-cannula technique, which he had
introduced into the British Second Army
area. The method was far simpler than the
Kimpton-Brown technique, but at that it
was not simple, and it required a team of
three persons to carry it out.
32

The Kimpton-Brown transfusion

apparatus used (1913-1918)

6- The Impact of War:

From the First to the Second World War, scientists and physicians
inspired rapid progress in the large-scale storage and use of blood. War
was not an incidental factor to these developments, as it created
unprecedented demand for the life-saving fluid. Much as the Spanish
Civil War was a prelude to World War II, so was blood first transported
to the front lines of battle in Spain. By the time war had spread through
Europe, the Allied forces were aided by a well-organized blood supply.
Science and technological developments became more and more involved
in the development of transfusion during the 20th Century. One of the
other previously identified practical problems associated with blood
transfusion was that of blood clotting (coagulation), which effectively
meant that blood was transfused by direct techniques and could not be
stored for even short periods.
In 1914, almost simultaneously, researchers Albert Hustin of
Brussels and Luis Agote of Buenos Aires discover that adding sodium
citrate to blood will prevent it from clotting.
In 1915, the American physician Richard Lewisohn (1875- 1961)WS55, at
New York's Mount Sinai Hospital, formulates the optimum concentration
of sodium citrate that can be mixed with donor blood to prevent
coagulation, but pose no danger to the recipient. He carried out blood
transfusion using the method described in the illustration. Blood is

Richard Lewisohns Method in performing blood TransfusionWS51

33

collected in a citrated flask, and immediately transfused. At the beginning

of World War II, it had become the exclusive method of blood
transfusion used in surgery and medicine.
Dr. Richard Weil determines that citrated blood can be refrigerated
and stored for a few days and then successfully transfused.
In 1916, At the Rockefeller Institute in New York, Francis Peyton
Rous and J.R. Turner used a glucose additive as a red cell energy
supplement to improve red cell preservation. Thus, they develop a citrateglucose solution that allows blood to be stored for a few weeks after
collection and still remain viable for transfusion. This mixture made the
blood extremely dilute (1:1 solution: blood ratio), so it had to be removed
prior to transfusion.
In 1917, While serving in the U.S. Army, the British physician
Oswald Robertson (1886-1966)WS58, familiar with the work of dr.
Peyton Rous and dr. Turner, collected and stored type O blood, with
citrate-glucose solution, during the Battle of Cambrai in World War I.
Thereby, he establishes the first blood depot.
The voluntary blood donor scheme was pioneered in London in 1921
by the British librarian Percy Lane Oliver (18781944)WS57 following a request of the Red Cross
service to provide two blood donors at short notice.
Oliver's work attracted attention worldwide and
many countries sent representatives who sought
and acted upon his advice on setting up similar
organizations. The development of electrical
refrigeration resulted shortly after in the first
blood bank being set up in Barcelona in 1936.
Percy Lane Oliver
In 1937, an exhibition at a meeting of the
WS57
Voluntary Blood Donors Association featured the idea (1878-1944)
of stored blood which, although originally used by Canadian doctor
Henry Norman Bethune (1890-1939)WS51 in the First World War, set up
a mobile blood-transfusion service to rush bottled blood in refrigerated
trucks to the wounded at the front in the Spanish Civil War. During the
Spanish Civil War, the Republican Army banked 9000 liters of blood
later administered at casualty stations and base hospitals. This was to
become the basis of the war-time blood bank which Oliver helped to
create at Luton in 1939. Small-scale refrigerated storage of whole blood
had been used first in World War I, and this had been developed in
Russia into a larger-scale system of blood depots.

34

Charles Drew (1904-1950)WS53 was asked to be the medical

supervisor on the "Blood for Britain" campaign,
launched by the Blood Transfusion Betterment
Association in 1939. At the height of World War
II, Nazi warplanes were bombing British cities
regularly and there was a desperate shortage of
blood to treat the wounded. In order to meet the
huge demand for plasma, Drew initiated the use
of "bloodmobiles" trucks equipped with
refrigerators. In 1941 after the success of "Blood
Charles Drew

for Britain," Drew became director of the American

(1904-1950)WS53
Red Cross Blood Bank in New York. He was asked to
organize a massive blood drive for the U.S. Army and Navy, consisting
of 100,000 donors.
Bernard Fantus (1874-1940)WS10, at Chicagos Cook County
Hospital, established the first blood bank in the United Stated in 1937. He
conducted further experiments in blood storage, culminating in the
preservation of blood for up to ten days. He established a Blood
Preservation Laboratory at the hospital. However, he changed its name
before launch to Cook County Hospital Blood Bank. Thus, he invented
the name blood bank.
Dr Philip Levine (1900-1987)51 co-discoverer with Karl Landsteiner
and Alexander Wiener (1907-1976)52 the Rhesus (now termed Rh)
blood group system factors, associated with the potentially fatal condition
of Hemolytic Disease of the Newborn, described a severe reaction in a
Type O woman given a transfusion of her husbands Type O blood
following a stillbirth. Her serum agglutinated 80% of Type O blood.
Landsteiner and Wiener, later in 1940, described the method of Rh
typing. This leads to dramatic decrease in the incidence of hemolytic
disease of the newborn.
During the world war II, a
development in the instrument used in
blood transfusion occurred.
Effective
preservation
and
refrigeration lead to the ability to blood
bank. It began in 1940 when Freeze dried
plasma was developed.
In 1943, acid-citrate-dextrose (ACD)
anticoagulant preservative solution, was
developed for the storage of blood by
35

World War II syringe for direct inter

human blood transfusion

Australian doctor John Loutit and British Professor Patrick Mollison

(1914-2003)53, which extended the vitality of blood units to 21 days.
Plasma fractionation
was developed by Edwin
Cohn (1892-1953)WS52 in
1944. The basis of the
chemical procedure used
was
the
differential
precipitation of the plasma
proteins with ethyl alcohol
at low temperature, with
careful control of salt
concentration, temperature,
and acidity or alkalinity of
54

Edwin Cohn developed Plasma fractionation in 1944

the medium. The most
urgently needed plasma protein was serum albumin, for transfusion in
treatment of shock; useful albumin preparations were obtained by 1942.
Therefore, every unit of blood could treat more people. Nowadays, At
least 17 different components are available through a blood bank.

Later, there was a development of a method of freezing blood.

In 1945, the British Professor Robin Coombs (1921-2006)WS41
described anti-globulin testing, which is nowadays referred to as
Coombs Test. This test has formed the base of a large number of
laboratory investigations in the fields of hematology and immunology.

36

7- Blood Transfusion in The Last Sixty Years:

Most of the important developments in transfusion medicine have
only been achieved in last sixty years.
Blood was collected into
reusable glass bottles in the
first half of the twentieth
century. Whole blood was
transfused.
Pyrogenic
reactions from contamination
due to incomplete cleaning
were frequent. Air embolism
was
also
a
common
complication due to the
vacuum systems used on
glass bottles.

Reusable Glass Bottles used in the first half of 20th

century for blood collectionWS4

In 1949, trials of plastic bags were conducted by

the American Red Cross. Plastic bags were disposable
and, because of their flexibility, facilitated the
separation of blood components and the advent
ACD preservative solution was supplanted in 1957
by citrate phosphate dextrose (CPD), which extended
Current Plastic Bags
the vitality of blood units to 28 days. CPDA-1 was
developed in 1979 and extended the shelf time of blood units to 35 days,
CPDA-2 (Citrate Phosphate Dextrose Adenine) was developed in the
1980s. It extended the shelf time of blood units to 42 days.
Cryoprotective agents, such as glycerol, gain use in the 1960s,
enabling freezing of blood for long-term storage.
Dr. Judith Graham Pool (1919-1975)WS27 was an American
physiologist at Stanford University. She is best known for the discovery
of cryoprecipitation in 1965, a process for creating concentrated blood
clotting factors (especially Factor VIII). The cryoprecipitates (or cryo) are
found to have much greater clotting power than plasma and given to
hemophiliacs to stop bleeding episodes. It prevents the need for
hemophiliacs to travel to the hospital to be treated, since cryo can be kept
frozen at home and infused, after being thawed, by a physician.
Dr. Kenneth Merle Brinkhous (19082000)WS28, a professor at the
University of North Carolina at Chapel Hill, discovered Factor VIII and
showed that it was lacking in hemophiliac patients in 1939. He also
investigated other clotting disorders, including Von-Willebrand disease.
37

Besides, he discovered PTT test. In the Late 1960s he produced a highly

concentrated form of Factor VIII by pooling large quantities of plasma
that generate vast amounts of cryo, which are then re-dissolved, treated,
filtered, and centrifuged. The resulting powder's clotting power is 100
times stronger than raw plasma, easily stored in a portable vial, and can
be injected with a syringe by the hemophilia patient.
In 1967WS50, Rh immune globulin is commercially introduced to
prevent Rh disease in the newborns of Rh-negative women.
In 1969, S. Murphy and F. Gardner demonstrate the feasibility of
storing Platelets at room temperature, revolutionizing platelet transfusion
therapy.
In 1970, Blood banks move toward an all-volunteer blood donor
system.
In 1971, Hepatitis B surface antigen (HbsAg) testing of donated
blood begins.
In 1981, The first cases of a syndrome initially called GRID (Gayrelated Immunodeficiency Disease), due to its prevalence among gay
men, are reported. It is later renamed AIDS (Acquired Immune
Deficiency Syndrome).
In 1983, the French doctor Luc
Montagnier (1932-now)WS29 at the
Pasteur Institute, in France, isolate the
virus that causes AIDS. They locate it in
the swollen lymph node in the neck of a
Parisian AIDS patient and label it LAV
(lymphadenopathy-associated virus). He
was awarded the Nobel Prize in
Physiology or Medicine in 2008.
After dozens of Americans are
infected with AIDS from blood
Luc Montagnier (1932-now)WS29
transfusions, the first blood-screening test
to detect the presence or absence of HIV antibodies -- the ELISA test -- is
licensed by the U.S. government in 1985. The test is universally adopted
by American blood banks and plasma centers.
A legal battle ensues over who deserves credit for the discovery of
the AIDS virus, which finally ends in 1987 when the U.S. and French

38

governments agree to share credit and royalties from the sales of test kits
for the virus.
In 1987WS50, Two tests for screening for indirect evidence of
hepatitis C are developed and implemented, hepatitis B core antibody
(anti-HBc) and the Alanine Aminotransferase Test (ALT).
In 1989, Human T Lymphotropic Virus I antibody (anti-HTLV-I)
testing of donated blood begins.
In 1990, Introduction of first specific test for hepatitis C, the major
cause of "non-A, non-B" hepatitis, although the hepatitis C virus (HCY)
has never been isolated.
In 1992, Testing of donor blood for HIV-I and HIV-2 antibodies
(anti-HIV-I and anti-HIV-2) is implemented.
In 1996, HIV p24 antigen testing of donated blood begins. Although
the test does not completely close the HIV window, it shortens the
window period.
From 1987 to 2008, a series of more sensitive tests are developed
and implemented to screen donated blood for infectious diseases:

Detect HBV: by using ELISA test to detect HbsAg.

Detect HCV: by detecting Anti-HCV.
Detect Syphilis: by carrying out VDRL or TPHA.
Detect AIDS: by using ELISA test to detect Anti-HIV1 or AntiHIV2 or by detecting the HIV p24 antigen test.
Detect Malaria: by carrying out Blood Film.
Detect Toxoplasmosis Gondi: by using ELISA test to detect IgM or
IgG Antibody.
Detect CMV: by detecting Anti-CMV.
Detect Human T-Lymphotropic Virus I antibody test (anti-HTLVI)
Recently, Polymerase Chain Reaction (PCR) directly detects the
genetic material of viruses like HCV and HIV.

Blood banks now standard in communities and hospitals, with

regional blood centers collecting approximately 75% of the blood supply
for the United States. 13,588,000 units collected in the US in 1992.
In the late 1990s, there was a transition in terminology from Blood
Banking to Transfusion Medicine.

39

Nowadays, Progress in the medical field has caused many to

consider bloodless medicine. Where will this lead us? Professor Luc
MontagnierWS62, discoverer of the AIDS virus, states: "The evolution of
our understanding in this field shows that blood transfusions must one
day die out." In the meantime, alternatives to blood are already saving
lives.
Current voluntary blood donation process together with the
sophisticated methods for the collection, storage, processing and testing
of blood required by the complex medical and surgical procedures of the
present day are a long way from the early beginnings of drinking the
blood of gladiators.
Finally, it is a strange thing that after waiting more than 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.

40

Abstract
The transfusion time line highlights many of the discoveries,
inventions, observations, and practices, which, since ancient times, have
led to remarkable progress and resulted in the effective treatments that are
now taken for granted.
The recent practice of transfusion isnt the result of one mans effort;
but, it is the glamorous consequence of many inventors and physicians of
deferent eras and regions.
In my treatise, I tried to shed light on the most important events in
the history of blood transfusion epic. First of All, I discussed the
development in the social and religious point of view towards blood.
Then, in chapter two, I summarized the major points in the history of
discovery of the blood circulation, which was very essential in the
understanding of the importance of blood transfusion. Finally, in the third
chapter, I tried to follow the steps in the development of blood
transfusion, from the ancient and medieval eras to the modern era. I
conventionally divided the history of transfusion in the modern era to
seven periods, according to the main concern of every period.
Although the major development of blood transfusion was in the last
sixty years, we cant ignore the contributions of the Ancient physicians
who created the dream that has recently become true.

41

Comments and Notes

1- Brailey, Transfusion Medicine. Page 2.
2- Brailey, Transfusion Medicine. Page 2.
3- Brailey, Transfusion Medicine. Page 3.
4- Learoyd, A Short History of Blood Transfusion. Page 2.
5- Brailey, Transfusion Medicine. Page 3.
6- Brailey, Transfusion Medicine. Page 3.
7- Learoyd, A Short History of Blood Transfusion. Page 7.
8- McGraw, Swammerdam, Jan (16371680). Page 13.
9- Brewer, Max Schultze (1865), G. Bizzozero (1882) and the discovery of the
platelet. Page 252.
10- Al-Ghazal S, Ibn al-Nafis and the discovery of Pulmonary Circulation. Page 4.
11- Al-Ghazal S, Ibn al-Nafis and the discovery of Pulmonary Circulation. Page 4.
12- Brailey, Transfusion Medicine. Page 8.
13- Flourens, a History of the Discovery of the Circulation of the Blood. 58-65
Pages.
14- Flourens, a History of the Discovery of the Circulation of the Blood. 77-80
Pages.
15- Learoyd, A Short History of Blood Transfusion. Page 2.
16- Learoyd, A Short History of Blood Transfusion. Page 2.
17- Learoyd, A Short History of Blood Transfusion. Page 3.
18- Learoyd, A Short History of Blood Transfusion. Page 3.
19- Kaadan, The Surgery of al-Zahrawi. Page 318-344.
20- Learoyd, A Short History of Blood Transfusion. Page 4.
21- Sturgis, The History of Blood Transfusion. Page 116.
22- Brailey, Transfusion Medicine. Page 6.
23- Bauer, From Blood Transfusion to Haemotherapy the Anniversary of the
German Society for Transfusion Medicine and Immunology (DGTI) from a
Medicinal-Historical and Bioethical Perspective. Page 3.
24- Learoyd, A Short History of Blood Transfusion. Page 5.
25- Learoyd, A Short History of Blood Transfusion. Page 5.
26- Learoyd, A Short History of Blood Transfusion. Page 5.
27- Learoyd, A Short History of Blood Transfusion. Page 6.
28- Learoyd, A Short History of Blood Transfusion. Page 6.
42

29- Sturgis, The History of Blood Transfusion. Page 107.

30- Brailey, Transfusion Medicine. Page 10.
31- Learoyd, A Short History of Blood Transfusion. Page 7.
32- Sturgis, The History of Blood Transfusion. Page 107.
33- Learoyd, A Short History of Blood Transfusion. Page 8.
34- Brailey, Transfusion Medicine. Page 12.
35- Bauer, From Blood Transfusion to Haemotherapy the Anniversary of the
German Society for Transfusion Medicine and Immunology (DGTI) from a
Medicinal-Historical and Bioethical Perspective. Page 3.
36- Learoyd, A Short History of Blood Transfusion. Page 9.
37- Sturgis, The History of Blood Transfusion. Page 108.
38- Learoyd, A Short History of Blood Transfusion. Page 10.
39- Learoyd, A Short History of Blood Transfusion. Page 12.
40- Sturgis, The History of Blood Transfusion. Page 110.
41- Learoyd, A Short History of Blood Transfusion. Page 12.
42- Keynes, Transfusion. Page 82.
43- Learoyd, A Short History of Blood Transfusion. Page 14.
44- Brailey, Transfusion Medicine. Page 17.
45- Learoyd, A Short History of Blood Transfusion. Page 13.
46- Learoyd, A Short History of Blood Transfusion. Page 15.
47- Learoyd, A Short History of Blood Transfusion. Page 15.
48- Brailey, Transfusion Medicine. Page 24.
49- Brailey, Transfusion Medicine. Page 20.
50- Brailey, Transfusion Medicine. Page 27.
51- Zallen D.T., The Rhesus Factor and Disease Prevention, Page 100
52- Zallen D.T., The Rhesus Factor and Disease Prevention, Page 105
53- Zallen D.T., The Rhesus Factor and Disease Prevention, Page 101
54- Brailey, Transfusion Medicine. Page 32.

43

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1- http://www.abcb.com/laws/index.htm
2- http://artscad.com/A.nsf/Opra/SRVV-6MDNX5
3- http://www.bmj.com/cgi/content/full/325/7378/1485
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7- http://en.wikipedia.org/wiki/Andreas_Libavius
8- http://en.wikipedia.org/wiki/Antonie_van_Leeuwenhoek
9- http://en.wikipedia.org/wiki/Blt
10- http://en.wikipedia.org/wiki/Bernard_Fantus
11- http://en.wikipedia.org/wiki/Blood
12- http://en.wikipedia.org/wiki/Blood_libel
13- http://en.wikipedia.org/wiki/Blood_transfusion
14- http://en.wikipedia.org/wiki/Charles-douard_Brown-Squard
15- http://en.wikipedia.org/wiki/Christopher_Wren
16- http://en.wikipedia.org/wiki/Circulatory_System
17- http://en.wikipedia.org/wiki/Erasistratus
18- http://en.wikipedia.org/wiki/Eucharist
19- http://en.wikipedia.org/wiki/Henry_Doubleday_(18101902)
20- http://en.wikipedia.org/wiki/Herophilos
21- http://en.wikipedia.org/wiki/Hippocrates
22- http://en.wikipedia.org/wiki/James_Blundell_(physician)
23- http://en.wikipedia.org/wiki/Jean-Baptiste_Denys
24- http://en.wikipedia.org/wiki/Jehovah's_Witnesses_and_blood
25- http://en.wikipedia.org/wiki/John_Aubrey
26- http://en.wikipedia.org/wiki/John_Braxton_Hicks
27- http://en.wikipedia.org/wiki/Judith_Graham_Pool
28- http://en.wikipedia.org/wiki/Kenneth_Brinkhous
29- http://en.wikipedia.org/wiki/Luc_Montagnier
30- http://en.wikipedia.org/wiki/Marcello_Malpighi
31- http://en.wikipedia.org/wiki/Metamorphoses
32- http://en.wikipedia.org/wiki/Michael_Servetus
33- http://en.wikipedia.org/wiki/Pasquale_Villari
34- http://en.wikipedia.org/wiki/Paul_Ehrlich
35- http://en.wikipedia.org/wiki/Pietro_d'Abano
36- http://en.wikipedia.org/wiki/Pope_Innocent_VIII
37- http://en.wikipedia.org/wiki/Realdo_Colombo
38- http://en.wikipedia.org/wiki/Richard_Lower_(physician)
39- http://en.wikipedia.org/wiki/Robert_Boyle
40- http://en.wikipedia.org/wiki/Robert_Lawlor
41- http://en.wikipedia.org/wiki/Robin_Coombs
42- http://en.wikipedia.org/wiki/Sushruta
43- http://en.wikipedia.org/wiki/Thomas_Sprat
44- http://en.wikipedia.org/wiki/Thomas_Wentworth_Higginson
45- http://en.wikipedia.org/wiki/Vampire
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47- http://www.pbs.org/wnet/redgold/history/timeline2.html
48- http://www.pbs.org/wnet/redgold/history/timeline3.html
45

49- http://www.pbs.org/wnet/redgold/history/timeline4.html
50- http://www.pbs.org/wnet/redgold/history/timeline5.html
51- http://www.pbs.org/wnet/redgold/innovators/bio_Bethune.html
52- http://www.pbs.org/wnet/redgold/innovators/bio_cohn.html
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55- http://www.pbs.org/wnet/redgold/innovators/bio_Lewisohn.html
56- http://www.pbs.org/wnet/redgold/innovators/bio_ottenberg.html
57- http://www.pbs.org/wnet/redgold/innovators/bio_Oliver.html
58- http://www.pbs.org/wnet/redgold/innovators/bio_Robertson.html
59- http://www.psri.net/bloodbank/highlights.html
60- http://www.scienceclarified.com/Al-As/Anatomy.html
61- http://uk.imdb.com/mpaa
62- http://www.watchtower.org/e/20000108/article_03.htm
63- http://en.wikipedia.org/wiki/Galen
64- http://en.wikipedia.org/wiki/Ibn_al-Nafis
65- http://en.wikipedia.org/wiki/William_Harvey
66- http://en.wikipedia.org/wiki/Ebers_Papyrus

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