Mr Lane and the blood of a stout young woman

A Lancet Letter on post-surgical haemorrhage in a ‘bleeder’ treated by blood transfusion might not seem newsworthy until one noticed the date: 1840. The story as recounted by M r Samuel Lane [l] , Lecturer on Anatomy and Surgery in St George’s Medical School, London, was as follows: A boy aged 11 years was brought to Mr Lane for surgical correction of squint. At operation, there was thought to be more bleeding than usual, though it soon stopped and the boy walked home. Unfortunately he soon began to bleed again, and this continued intermittently for 6 days and five nights despite local pressure, applications of gum and of hairs scraped from a hat (in which a large temporary coagulatum formed). It was noted that the flowing blood ‘appeared less disposed to coagulate than usual’. The boy eventually became pulseless and virtually comatose; and as a last resort it was decided to transfuse human blood. A transfusion syringe had apparently been introduced by a Dr Blundell, who had demonstrated in animal experiments that intraspecific blood transfusions could be safely given. The equipment seems to have been available commerically, because it was obtained at short notice from messrs Philip and Wicker, ‘of St James’s-street’ (Fig. 1 in Lancet letter reproduced herewith). The syringe carried a two-way tap, operated by a lever on the barrel. The forward outlet carried a tapered tube to be inserted into the recipient’s vein, and the vertical side-port bore a funnel into which the donor’s blood could flow. Before use, the apparatus was warmed in water. The patient’s arm was prepared by effecting a cut-down even more formal than the procedures which long memories can recall from 50 years ago. A skin fold was raised across an antecubital vein, the base of the fold was pierced with a bistoury and, by cutting upwards, a skin incision an inch long was opened along the course of the vein. The exposed vein was steadied by a probe passing beneath it and then incised with a lancet. A M r Ancell now opened a vein of ‘a stout, healthy young woman’, and about two ounces of her blood was directed into the funnel. From this the syringe was changed, and then held vertically while the air was expelled from the delivery tube. However, when the tube was now inserted into the boy’s vein, the blood in the syringe had begun to clot. The tube was withdrawn and the apparatus washed through with warm water. Before trying again, the tube was filled with water and inserted into the boy’s vein before the donor was bled again; this avoided the initial delay while air was expelled. A further ounce of donor blood was received into the funnel and half was drawn into the syringe and cautiously injected. All went well; and bit by bit 5% ounces were eventually injected, although it was necessary to flush the equipment n o fewer than four times to clear out clots. The flow of the donor’s blood began to slow after she had given some 10 or 12 ounces, and the exercise was brought to an end. The pulse returned at the patient’s wrist, and over the next hour or two he recovered sufficiently to sit up and drink some warmed wine. Bleeding from the eye was permanently arrested; and there is no mention of unexpected bleeding from the cut-down wound which healed in about 10 days. The boy appears to have recovered completely in about a month, with an excellent surgical correction of the squint. I t transpired that there had previously been two incidents of prolonged bleeding after losing teeth and after a cut. On another occasion the boy had been admitted with ‘an affection of the knee-joint’ (immediate cause, if any, not stated); this was treated with leeches but the leech-bites continued to bleed until they were sutured. There is no mention of family history, but presumably the boy suffered from one of the disorders which we know generically as ‘haemophilia’. Unfortunately, M r Lane’s striking achievement seems to have passed without sequel, and many other, ineffective, treatments were applied over the following years to patients with abnormal bleeding. The titles of publications describing them listed in the Catalogues of the United States Surgeon General provide a sort of archeology of antihaemophilic treatment. The Second Series of 1901 has papers describing the use of liver, oxygen, thyroid, bone marrow, hydrogen peroxide and gelatin. In the Third Series of 1926 we find descriptions of the injection of sodium citrate, calcium lactate and peptone; of splenectomy, the ‘galvanic needle’ and the induction of anaphylaxis. Even in the Fourth Series of 1942 there is mention of a-irradiation, autohaemotherapy and the application of bird’s muscle; vitamins are much in evidence; and female hormone therapy is described, in the belief that femininity prevents the expression of the haemophilic gene. In fact, the Third Series (1926) had included 12 references to the treatment of haemophilia by blood transfusion. While still a medical student, R. G. Macfarlane reviewed some of the literature in 1931 [2] and concluded that ‘transfusion of human blood is the best, though transient, haemostatic measure’. He followed this in 1938 [3],