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Posted on: November 9th, 2016
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Originally published in 2011 in the Surgeon’s Call, Volume 16, No. 2 LEARN ONL

The story of the history of blood transfusion and its subsidiary, parenteral infusion, must
begin with the story of the discovery of the circulation of blood.  This process was not well
understood by the ancients.  Blood was believed to be formed in the liver and travel to the
heart where it was distributed to the body.  Galen believed that it moved from the right side of
the heart to the left through invisible holes in the septum between the chambers of the heart. 
It moved to the rest of the body through the veins.  Because the arteries were empty at death,
it was felt by many that air moved through them to the parts of the body.  The role of the
lungs was not appreciated.

William Harvey is generally considered the rst to understand that pulmonary circulation was
important and that all blood passed through the lungs.  His book, du Mortu Cordis, was
published in 1628.1  He injected water into arteries and found that it passed through the
veins and then to the right side of the heart.  The blood then moved through the pulmonary
artery into the lungs and then to the left side of the heart. From there it was pumped into the
aorta and the arteries, starting its journey all over again. Harvey did not describe the capillary
connection between arteries and veins.   Harvey does, however, suggest injecting into the
circulatory system as a means of administering medications.  He does credit an Italian,
Realdo Colombo, with this discovery, but certainly Harvey popularized the concept in western
European medicine.  Harvey may have seen Colombo’s work while studying in Padua.

Realdo Colombo published his work on pulmonary circulation in 1559 from the University of
Padua in Italy.2  Colombo read the work of Andreas Vesalius stating that no holes existed in
the cardiac septum and the blood could not pass right to left in this fashion.  He dissected
many animals and humans and con rm to this.  In 1552 Michael Servetus had published his
ndings regarding the importance of pulmonary circulation although few were aware of this
publication.3  Unfortunately Servetus’ description was published in a theological work in
which he denied the existence of the Trinity.  Because of this argument, the Roman Church
declared his works heretical and ordered all copies of the book destroyed.  By chance, three
copies survived, although this was not recognized for many years.

The story becomes more convoluted when one nds that, as early as 1242, the great Arab
physician known as Ibn al-Na s4, 5 (full name Ala al-Din Abu al-Hasan AliIbn Abi al-Hazam al-
Qarshi al-Dimashqui)  published the story of circulation, including the importance of the
lungs. Western medicine was unaware of his account until 1924, when scholars discovered a
copy of his book in a museum in Germany.  In any event, William Harvey is credited with the
discovery of pulmonary circulation and it is his work that changed the concept of circulation
in western medicine.  Harvey actually proposed that injection into the circulatory system
would be a useful way to give medications.
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The relationship between blood and life was well known to the ancients.  Many believed that
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the soul resided in the blood.  The book of MUSEUM
Leviticus in theOF
Hebrew bible has a statement “The
CIVIL WAR MEDICINE
life of the body is in the blood” (Leviticus 17:11).  Many ancient and aboriginal cultures drank
blood, particularly from strong, courageous animals and men.6  It was felt that by drinking the
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blood, one could obtain the strength and courage of the individual.  In ancient Rome the
blood of the gladiators was used for this purpose.  The practice was so prevalent that the
Hebrew bible instructs believers to drain the blood from animals and eat only the meat.

Reports of the infusion of materials into the veins of animals and at least the concept of
blood transfusion appear in the 1600s.6  In 1615, Andreas Libavius of Halle, Saxony,
Germany, gave directions for the transfusion of blood between animals.  Although this was
detailed, there is no evidence that he actually did such a transfusion.  Georg von Wahrendorff
injected wine into the veins of hunting dogs as early as 1642 in Germany.  In 1664 Johann
David Major in Germany infused medicines intravenously and suggested the transfusion of
blood. (He had graduated from Padua a generation after Harvey.)

The most famous series of reports is of Christopher Wren in 1656 injecting wine into the vein
of a dog using funnels and cannulas.  Wrenn injected many substances into the veins of
dogs, including opium.  He observed that opium stupe ed the dogs but did not kill them.  His
apparatus was a quill attached to a small bladder.  Wrenn planned an injection into a man in
1657 but the man fainted and the experiment was discontinued.7 This work led to a urry of
reports in England, of which that of Richard Lower is the best known and documented.  He
published Tractatus de Corde in 1669,8 reporting the rst direct transfusion of blood between
animals.   This was from the artery of a large dog to the jugular vein of a small dog.  The
recipient was almost exsanguinated before the transfusion began and the amount of blood
actually transfused is not precisely known.  The next day the small dog moved around
normally.  Lower believed that blood could be transfused between species.  Lower would
subsequently transfuse a small amount of sheep’s blood into man.  This idea of heterologous
transfusion would, of course, be proved incorrect.  A large body of reports appeared in the
1660s and many different materials were infused into animals including alcohol, water,
opium, and tartar emetic.  It was noted that opium narcotized dogs but threw cats into
delirium.

Early transfusions were not given for blood loss as today but rather for personality problems. 
It was believed that a person’s qualities were determined by his blood.  Transfusion was
indicated for melancholy, lunacy, and arthritis.  The oxygen-carrying function of the blood had
not yet been discovered.

The rst man-to-man transfusion occurred in Paris, France, in 1667.  Jean-Baptiste Denis and
his assistant, Mr. Emmerz, transfused four patients.6, 9-11  The rst was a young man with an
obscure fever.  The second was a healthy paid volunteer.  The third was a moribund patient
whose death “may have been delayed.”  The fourth patient was a servant who was frequently
a runaway and the purpose of the transfusion was to improve his behavior.  Some of his
reported symptoms are now recognized as symptoms of transfusion reaction: pain in the
muscles of the arm of injection, a rapid and irregular pulse, sweating, pain in the back, and
black urine.12  A second transfusion resulted in death and a lawsuit entailed.  Denis was
exonerated and the wife found guilty of poisoning him.  Nevertheless, The Faculty of
Medicine declared a moratorium on this work and the action was followed by the Vatican and
by the Royal Society of London.

It would be more than a century before the transfusion of blood in humans was revisited.  In
the meantime several signi cant events had transpired.  Harvey, Lower, and Hooke had all
noted that blood in the pulmonary veins was brighter than blood in the pulmonary arteries.  It
appeared that the lung took something vital from the air.6  The dephlogisticated air of

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Priestley was discovered in 1774.13  Antoine Lavoisier called this air “oxygen” and described
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respiration as the combustion of oxygen.14  In 1773, Friend published works documenting
CIVIL WAR MEDICINE
the injection of many different materials.7  He also was the rst to demonstrate the danger of
injecting
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volumes of airEVENTS
into the&veins.
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Michele Rosa and Antonio Scarpa in Italy noted that animals in severe shock could not be
resuscitated by serum alone but needed whole blood.6  As added support, Marie-Francois-
Xavier Beichet connected the carotid artery of one dog to the distal end of the carotid artery
of another.  When the donor dog was suffocated so that its blood became dark, the recipient
dog became unconscious.6   It is perhaps unfortunate that dogs were the primary animal
used for blood transfusion research.  Dogs do not have major blood group antibodies as do
humans so transfusion reactions are not seen.

It was noted that when nitrous and other neutral salts were added to blood, the blood
became brighter.  This anti-coagulation effect was known among those who prepared food
from the blood of cattle.  This was discussed by William Hewson in London as early as
1780.6  Blood was placed into a vessel containing common salt and agitated as it fell so that
coagulation was prevented.  Blood kept uid in this way by Glauber’s salt still could be
coagulated by heat.  This anti-coagulation of blood allowed larger amounts to be transfused
before it clotted.

The nineteenth century opened with a review of human blood transfusion and the intravenous
administration of medications by Paul Scheel of Copenhagen.  James Blundell, an
obstetrician in London, noted that some post-partum women went into shock with blood loss
and died.  Because of this he revived an interest in transfusion.  In 1818 he published his rst
paper on experimental transfusion.  Blood was drawn from the femoral artery of one dog and
injected into the femoral artery of another using a brass syringe, perfectly clean with no oil. 
Blundell actually suggested transfusion only for hemorrhage endangering life.  He showed
that severely bled dogs could be resuscitated by immediate homologous transfusion.  If
blood ow and breathing had stopped, they could not be resuscitated.  He warned against
heterologous transfusion between species.15  He apparently was the rst to use human
blood for human transfusion in 1824.  He reported ve cases of whom two were dead at the
time of transfusion and three who were moribund.  In 1829 the journal Lancet published his
report of a successful transfusion.16  He subsequently transfused at least ten patients, ve
of whom lived.  Blundell drew the blood from the donor and infused it into the recipient using
an intermediate funnel and plunger mechanism.  His transfusions were vein to vein, not to
artery.

Transfusion with blood that would not clot became the rule and one third to one half of
patients survived.  It had been previously emphasized that transfusion was a treatment of
last resort for hemorrhage and this continued to be the maxim.  Blood now, when transfused,
was being given to save a life because of blood loss, not to change the recipient’s
personality.  No gures exist of the total number of patients transfused, successfully or not.
Little information exists regarding amounts of blood transfused but it was usually only a few
ounces, at times only one syringe full.  More reports did appear about transfusion reactions,
probably because more of the anti-coagulated blood could be given.  It would not be until
1901 that Karl Landsteiner would discover the ABO blood groups that were the major cause
of transfusion reactions.10, 17, 18

Jean Louis Prévost and Jean Baptiste André Dumas rea rmed that heterologous blood
transfusion resulted in death for the recipient.  They found that death was not due to
obstruction of the vessels and that uncoagulatable blood was as capable of resuscitation as
was untreated blood. They de brinated the blood by rapid agitation and removal of the
froth.17  This practice would remain in use until the beginning of the twentieth century. 
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Francois Magendie found that, in heterologous transfusion, the red blood cells of the infused
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blood rapidly vanished.  Charles-Edouard MUSEUM OF in 1850 con rmed this.  He
CIVIL WAR MEDICINE
demonstrated that 15 minutes after the infusion, the red cells were readily discernible but
one hour later none were to be found.19
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Their work was known in America and here, too, some experiments with transfusion were
performed.  Philip Syng Physic is said to have given human blood to a human as early as
1795.  This is based on second-hand information from the Philadelphia Journal of the Medical
and Physical Sciences as a side-note on the publication of Blundell’s report in 1825.  Physic
did not publish but the editor had been a student of Physic’s at the time.20  Dr. George
McClellan is reported to have transfused during the cholera epidemic  in Philadelphia,
Pennsylvania, in 1832.17, 20  Note that Dr. McClellan is the founder of Jefferson Medical
College and, parenthetically, the father of General McClellan.   William Hammond, while an
assistant surgeon with the army in Annapolis, Maryland, transfused up to 18 ounces of
bullock blood to soldiers with cholera enroute to Mexico in 1849.20  The patients died. 
Hammond would become the Union Army Surgeon General in 1862.  In 1859, Benedict from
New Orleans, Louisiana, reported transfusing two and one-half ounces of blood to a patient
with yellow fever with a successful result,17, 20 and Austin Flint, Jr. reported giving a patient
seven ounces of blood in the same city in 1860 with the patient surviving another 24 hours. 
On a different note, a Dr. D. Brainard in Chicago, Illinois, collected the blood lost during a leg
amputation and revived his patient with a two ounce autotransfusion of the patient’s own
blood in 1860.20  This was the rst of this type of transfusion recorded.

Blood loss was a major cause of death during the Civil War, and although not commonly
done, at least two transfusion attempts were made on active-duty wounded soldiers by Union
surgeons and reported in the War Department’s Medical and Surgical History of the War of the
Rebellion.20, 21  Surgeon E. Bentley reported a transfusion given to Private G. P. Cross at
Grosvenor Branch Hospital, Arlington, Virginia, on August 15, 1864.  His leg injury occurred
June 16 and he had lost so much blood that it was felt unsafe to operate.  By August 12 the
wound was gangrenous and local treatment did not produce results.  Hemorrhage from the
posterior tibial artery began on August 15, so amputation at the tubercle of the tibia was
deemed necessary.  Blood loss was minimal but the patient did not rally so it was decided to
try transfusion.  Blood was obtained from a healthy volunteer and a Tiemann’s syringe was
used to inject two ounces of blood into the median basilica vein.  It is stated that the patient’s
pulse  immediately became stronger and rmer.  He improved rapidly and by October 20 the
stump had healed.  The patient was ultimately discharge, pensioned, and a Hudson’s arti cial
limb was supplied.  He survived until August 1867.  Cause of death is not stated.  Certainly
the transfusion was a success but it is questionable whether such a small amount of blood
could have accomplished this.  Perhaps he received more blood than realized.20-22

Assistant Surgeon B. E. Fryer at Brown Hospital in Louisville, Kentucky, operated on a Private

J. Mott on July 24, 1864, about a month after his initial injury.  The ball had lodged between
the tibia and bula and had been removed, but 28 days later hemorrhage began from the site
and a mid-thigh amputation was done to preserve his life.  The patient responded very slowly
so the day after surgery it was decided to transfuse blood.  A gutta-percha syringe was tted
to a small tube with a stop-cock in its center.  The tube was placed into the cephalic vein of
the patient.  The syringe was lled from a healthy man.  About sixteen ounces were given. 
Initially respiration increased from 15 to 28 times a minute but soon returned to 16.  Pulse
increased from 100 to 130 but soon returned to the initial value.  The patient did well, slept
well, and retained food.  He appeared to be doing well for several days.  Unfortunately, nine
days later hemorrhage began from the face of the wound, which was necrotic, and could not
be stopped.  Although the patient died ten days after transfusion, the transfusion should be
considered a success because death was due to further infection and subsequent
hemorrhage not directly related to the transfusion.20-22

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There is no indication that transfusion ever became regularly practiced during the war, either
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in military or civilian practice.  MUSEUM
Only these two cases wereOFidenti ed by the writers of the
CIVIL WAR MEDICINE
Medical and Surgical History of the War of the Rebellion.  There would, however, be a gradual
increase after the war both in the United States and in Europe with a small proportion
VISIT
surviving.  OfEXPLORE
course it must EVENTS & PROGRAMS
be remembered that the procedure was still considered a last Search

resort in moribund cases only.  Local infection at the site of injection was a problem, as was
generalized blood-born infection.  Transfusion would not become generally accepted as a
worthwhile procedure until after 1901 and the discovery of the blood antibodies in
humans.18  Karl Landsteiner’s discovery of the ABO blood groups and the subsequent
clari cation of this began the more general use of blood transfusion by the medical
community.

Sources
1. Harvey W. Du Mortu Cordis. London, England; 1628.
2. Bruce D. Realdo Colombo Biography (c. 1516-1559). Faqs.Org: Faqs.Org; 2010.
3. Cattermole GN. Michael Servetus: Physician, Socinian and Victum. J. Royal Soc Med
1997;90:640-44.
4. Kaf al-Ghazal S. Ibn al-Na s and the Discovery of Pulmonary Circulation. Foundation for
Science, Technology, and Civilisation. Manchester, UK: FSCT Limited; 2007.
5. West JB. Ibn al-Na s, the Pulmonary Circulation, and the Islamic Golden Age. J. Appl
Physiol 2008;105:1877-80.
6. Maluf NSR. History of Blood Transfusion. J. Hist Med & Allied Sci 1954:59-107.
7. Fortescue-Brickdale JM. A Contribution to the History of Intravenous Injection of Drugs.
Guy’s Hospital Reports 1904;lviii:15-80.
8. Franklin KJ. Richard Lower (1631-1691), and His “De Corde,” London, 1669. Ann Med
History 1931;3:599-602.
9. Zarychanski R, Ariano RE, Paunivic B, Bell DD. Historical Perspectives in Critical Care
Medicine: Blood Transfusion, Intravenous Fluids, Inotropes/Vasopressors, and Antibiotics.
Critical Care Medicine 2009;25:201-20.
10. Hutchin P. History of Blood Transfusion: A Tercentennial Look. Surgery 1968;64(3):685-
700.
11. Hoff HE, Guillemin R. The First Experiments on Transfusion in France. J. Hist Med & Allied
Sci 1963:103-24.
12. Keynes G. Tercentennial of Blood Transfusion. Brit Med J 1967;4:410-11.
13. Preistley J. Observations on Different Kinds of Air. Phil Trans R. Soc London 1772;62.
14. Cousin MT. Oxygen in France. Its Discovery and Its Early Uses in Anaesthesia and
Asphyxia. International Conference Series 1242: Elsevier Science B. V.; 2002. p. 127-34.
15. Blundell J. Experiments on the Transfusion of Blood by the Syringe. Trans Med Chirurg Soc
London 1818:56-92.
16. Blundell J. Obsverations on Transfusion of Blood. Lancet 1829;2:321-24.
17. Hosgood G. Blood Transfusion: A Historical Review. J. A. V. M. A. 1990;197(8):998-1000.
18. Giangrande PLF. The History of Blood Transfusion. Brit J Haematol 2000;110:758-67.
19. Brown-Sequard E. Experimental Researches on the Faculty Possessed by Certain
Elements of Blood of Regenerating the Vial Principles. Med. Times Gazette London
1855;11:492.
20. Schmidt PJ. Transfusion in America in the Eighteenth and Nineteenth Centuries. N. E. J. M.
1968;279(24):1319-20.
21. Kuhns WJ. Blood Transfusion in the Civil War. Transfusion 1965;5:91-94.
22. Barnes JK, editor. The Medical and Surgical History of the War of the Rebellion (1861-1865).
12:411-412, Washington, DC: United States Printing O ce; 1883.

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