Before the precise knowledge known today, many beliefs and theories surrounded blood. For Galen, who was with Hippocrates one of the two great creative doctors of Greco-Roman antiquity, the blood was made in the liver from food and drink coming from the digestive tract. He thus entered the veins and was transported to all parts of the body. At the time of Galen, in the 2nd century AD, the main belief was that the blood was constantly consumed by the tissues and then reconstituted at each meal.
The theory of Humorism
For two millennia, the principles of medicine remained largely the same, and revolved around a theory: that of Humorism, which suggests that the human body is composed of four substances, called humors. These humors must maintain a perfect balance between them. When the disease is pronounced, whether physical or mental, it means that the balance is broken.
For millennia, the human body was understood as a vessel for four liquids: black bile, yellow bile, lymph and blood. Each one corresponded to one of the four classic elements – fire, earth, water and air (blood) – from which it was thought that everything in the cosmos was made.
The key to health was the ideal balance between the four humors. If the danger prevailed, it was crucial to carry out periodic micturition, the evacuation of any liquid or substance present in the body. Most of the time, the body took care of it naturally: the black bile, the yellow bile and the lymph were expelled by excrement, sweat, tears and nasal discharge. But, aside from menstruation, the body had no spontaneous means of getting rid of its blood, and that is where bloodletting comes in.
In connection with the theory of humorism, since it is considered as a means of restoring equilibrium, bloodletting is particularly advocated by Hippocrates and Galen. It is difficult or even impossible to date with certainty the beginnings of this practice. We know that it was already used in ancient Egypt, well before Hippocrates, who lived in the 5th century BC.
Much later, Leonardo Botallo, royal physician of France of the second half of the sixteenth century, who took care of Charles IX and Henry III, said that boodletting is the “only remedy for all diseases.” Nearly a hundred years later, Molière, in the Imaginary Patient (1673), makes fun of the arrogant doctors Diafoirus, father and son, who advocated for, in particular, bloodletting in a systematic way.
The place of religion
It must also be known that for centuries, doctors could be sentenced to death for bad practice. This had several effects on the profession of surgeon-doctor by the year one thousand. In the West, at that time, the medical-surgical practice was the one of religious, practicing it in convents or the first hospitals.
In 1163, at the Council of Tours, the Church decreed: “Ecclesia abhorret a sanguine,” “the Church hates blood.” With this decree, doctors, most of them members of clergy at the time, could no longer practice surgery, and it was therefore relegated to a lower rank for several centuries.
This is why a new type of profession developed itself: the barber surgeon. The surgeon barber was in fact a multi-faceted craftsman! He was a barber, hairdresser, makeup artist and therefore surgeon. They are true caregivers the population came to see regularly, for a beard trimming, a haircut, or a bloodletting. This profession, which can be considered already far from traditional medicine, could sometimes be synonymous with social climbing, as for example for Ambroise Paré. Son of barber surgeon, he would take over the business of his father before becoming the surgeon of several kings of France, namely the successors of Francis I: Francis II, Charles IX and Henry III.
Abuse in practices
But it is clear that the practice of bloodletting has been peppered with abuse. Benjamin Rush, one of the founding fathers of the United States of America, having signed the Declaration of Independence, was nicknamed “The Prince of the Bloodletting.” Convinced of his effectiveness, he was confident in the fact that removing 2.42 liters of blood from a patient was an effective treatment. George Washington, the first President of the United States, probably died because of excessive bloodletting. Suffering from an Influenza like Illness in 1799, he had four liters of blood removed in three days and died two days later.
The practice of bloodletting was therefore almost systematic. We can for instance use the example of Louis XIII’s 47 bloodlettings in one single year, and the 2 000 bloodlettings that Louis XIV experienced throughout his 76 years of existence (about 26 bloodlettings per year).
The beginnings of blood transfusion
But little by little, medicine would turn to another process: blood transfusion. William Harvey, a British scientist, was the first to describe the blood circulation. All of his work on the subject, begun in 1616, is the subject of a book in 1628: An anatomical exercise on the movement of the heart and blood in animals. In 1667 (June 15, precisely), Jean Baptiste Denis, personal physician of Louis XIV of France, was the first to inject, in a well-documented way, the blood of an animal to a man. Confident in his achievement, he then treated four other patients by transfusion in the same year 1667. While the first two survived, the last two died. The treatment of the last patient even caused great controversy. Indeed, the controversy arose from the patient’s wife, who accused Denis of being at the origin of the death of her husband. The doctor was charged with murder and acquitted at the trial. The deceased’s wife would then be sentenced for poisoning her husband with arsenic. This affair made a great noise at the time, and Denis’ practices, very new for the time, began to be a problem, and the Parliament had to forbid by decree any transfusion in 1670.
Four years later, a Dutch doctor named Van Leeuwenhoeck, discovered red blood cells, by carefully studying many animals and humans.
And it is only a century and a half later that new attempts at progress would be made.
In 1829, James Blundell, an English scientist, published an article in “The Lancet” to promote transfusion from man to man. Indeed, the use of animal blood to transfuse it to men was no longer common practice because there had been too many cases of death. However, Blundell’s article did not make an impact. Many problems still remained, such as blood clotting, which made the transfusion still complicated. This problem would remain for many decades. Methods had been tested and used to prevent it. For example, sodium citrate was first added in 1914, then dextrose (glucose syrup) two years later. But these processes were only slightly effective.
The great breakthroughs of the 20th century
The twentieth century is the century of great breakthroughs, and it began strongly since in 1900, Karl Landsteiner, an Austrian biologist, discovered several types of blood group (A B O). Thanks to this discovery, most transfusions became successful. Landsteiner would eventually receive the Nobel Prize in Medicine in 1930 for his discoveries.
During the First World War, there were improvements in transfusion procedures. The already known method of “arm-to-arm” transfusion was firstly used almost exclusively, but it was also the time of the beginnings of the so-called modern transfusion, with a separation between the collection of blood and the actual transfusion of the patient. And as people started to realize that this practice was working, the next step was to start organizing the blood collection.
In 1928, Arnault Tzanck, a French doctor, who was a military paramedic during the First World War and who had therefore grasped the importance of blood transfusion, founded the first Blood Transfusion Center at the Saint-Antoine Hospital in Paris, under the name of Work of the Blood Transfusion of Urgency. The center would perform 262 transfusions in 1929, 3,738 in 1932 and more than 35,000 in 1948. In 1949, he created the National Blood Transfusion Center, rue Cabanel in the 15th arrondissement of Paris. But at the time, blood was not given, it was sold. Arnaud Tzanck then campaigned for that gesture to become free and voluntary. He was among the inspirers of the French law of July 21, 1952 regulating the ethical principles of blood donation. One year later, the National Federation of Voluntary Blood Donors was created.
Norman Bethune, a Canadian doctor, and engaged in the Republican side in the Spanish Civil War in the late 30s, created the first blood bank in Europe on December 23, 1936. He invented the concept of mobile collection, which was set in the back of a truck.
But other breakthroughs also took place at the time. For instance, in 1951, Patrick Mollison, a British hematologist, performed the first transfusion with frozen blood, that had been thawed out. During the Second World War, Mollison had already distinguished himself with his colleague Loutit, as part of the war effort, by developing “the” preservation solution called “ACD” for citric acid, citrate, and dextrose, which keeps the blood whole for 21 days. Today, this ACD solution is still very widely used.
In 1952, Carl Walter and William Murphy described the first plastic blood bag, replacing glass vials. This discovery was made again during a war effort, namely the Korean War (1950-1953). This technology, revolutionary at the time, would take more than 20 years to take its rightful place, but today, it is impossible to imagine a transfusion without it.
The decades that followed would be the ones of biological breakthroughs and transfusion risk control.
To conclude, let us mention the creation of the French Blood Establishment (EFS) in January 2000, single operator of blood transfusion in France under the supervision of the Ministry of Health. In 2016, national self-sufficiency in blood products was secured through the mobilization of nearly 1,600,000 donors, of whom 270,000 donated for the first time. Nearly 3 million donations were made. The average donation is 1.84 donations per donor.
Finally, women account for 52% of donors, half of donors are under 40 years of age and one third of new donors are 18-19 years old.
83 years after the invention of mobile collection by Norman Bethune, nearly 80% of donations are made through this process.
History of Blood
La Revue du Praticien, vol 67, December 2017, by Prof. Pierre Brissot
Hippocrates and the theory of essential humors in humans
The New Yorker – History of Blood, by Jerome Groopman
History of the Blood Bank
The birth of scientific medicine, By Simon Singh and Edzard Ernst
History of blood transfusion
Blood donation in France