The History of Blood Transfusion

The basic techniques involved in this life-saving procedure are relatively simple and it is thus perhaps surprising that blood transfusion only became a part of routine clinical practice relatively recently. Blood-letting (venesection) was widely practised for a variety of medical conditions from the time of Hippocrates (<430 bc) through to the nineteenth century in Europe and yet transfusion only became a commonplace therapeutic intervention less than 100 years ago. This is because both an understanding of the nature of blood as well the physiology of the circulation were required as a foundation for the development of blood transfusion and these were not forthcoming until the middle of the seventeenth century. The views of the Romans and ancient Greeks exerted a profound influence on both the traditions and practise of Western medicine for nearly 2000 years. The principal beliefs of the ancient Greeks and Romans were based on the writings of Hippocrates. The central doctrine of the humoral theory is set out in the treatize entitled `On the nature of man', in which it was proposed that all living matter is composed of four basic ingredients, namely blood, phlegm, yellow bile and black bile (Lloyd, 1978). Although recognized as a vital element in the constitution of man, blood was certainly not viewed as being more or less important than the other humours. Differences in personality were viewed as reflecting different mixes of humours in people and this belief extended well into the Renaissance period (Fig 1). Indeed, words still used today such as `sanguine', `phlegmatic', `melancholic' and `choleric' can be considered to be linguistic fossils from that era. An important consequence of the acceptance of the humoral theory was that it encouraged a holistic approach to medicine, in which illness came to be regarded as being due to an imbalance of the four humours. Correction of the imbalance was thus required for restoration of health and this could be achieved by attention to diet and environment, although medical procedures such as dieting, purging and blood letting could also be used. Anatomical knowledge was also required for an understanding of the circulation of the blood, the cornerstone for the practice of transfusion. The anatomical knowledge of the Greeks was very limited and they believed that blood simply ebbed and flowed through the peripheral veins with some blood passing through the pores of the interventricular septum to mix with the `pneuma' (or vital spirit) that was inspired with the air and which fed the brain. William Harvey (1578±1657), who studied medicine in Padua after graduating from Cambridge, was the first to understand the circulation of the blood and his treatize entitled `Exercitatio anatomica de motu cordis et sanguinis in animalibus' was first published in 1628.