Читать книгу Transfusion Medicine - Jeffrey McCullough - Страница 13

Others to whom the idea for blood transfusion is attributed include Hieronymus Cardanus (1501–1576) and Magnus Pegelius. Little is known about Cardanus, but Pegelius was a professor at Rostock, Germany, who supposedly published a book describing the idea and theory of transfusion [1]. It can be substantiated that Andreas Libavius (1546–1616) proposed blood transfusion in 1615 when he wrote:

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 soul. Let the performer of the operation have two silver tubes fitting into each other. Let him enter the artery of the young man, and put into it one of the tubes, fastening it in. Let him immediately open the artery of the old man and put the female 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 it were from a fountain of life, and all of this weakness will be dispelled [1].

Despite these possibilities, it also seems unlikely that the concept of transfusing blood could have developed before William Harvey’s description of the circulation in 1616. Despite Harvey’s description of the circulatory system, there is no evidence that he considered blood transfusion. However, the concept of the “circulation” may have preceded Harvey’s publication. For instance, Andrea Cesalpino (1519–1603), an Italian, used the expression “circulation” and proposed that fine vessels (capillaries) connected the arterial and venous systems [1, 4].

A number of the major developments that led to the beginning of blood transfusion occurred during the mid‐1600s [1]. In 1656, Christopher Wren, assisted by Robert Boyle, developed techniques to isolate veins in dogs and carried out many studies of the effects of injecting substances into the dogs. It is not clear whether Wren ever carried out blood transfusion between animals. The first successful transfusion from one animal to another probably was done by Richard Lower [1, 5, 6]. Lower [6] demonstrated at Oxford the bleeding of a dog until its strength was nearly gone, but then revitalized the previously moribund dog by exchange transfusion using blood from two other dogs, resulting in the death of the donor animals.

Subsequently, a controversy developed over who had first done a transfusion. In 1669, Lower contended that he had published the results of transfusion in the Philosophical Transactions of the Royal Society in December 1666. In 1667, Jean Denis of France described his experiments in animals and applied the technique to human, which Lower had accomplished only in animals. Others mentioned as possibly having carried out animal‐to‐animal transfusions about this time are Johann‐Daniel Major of Cologne, Johann‐Sigismund Elsholtz of Berlin, don Robert de Gabets (a monk) in France, Claude Tardy of Paris, and Cassini and Griffone in Italy [1].

Denis apparently was a brilliant young professor of philosophy and mathematics at Montpellier and physician to Louis XIV. In 1667, Denis carried out what is believed to be the first transfusion of animal (lamb’s) blood to a human. A 15‐year‐old boy with a long‐standing fever who had been bled multiple times received about 9 ounces of blood from the carotid artery of a lamb connected to the boy’s arm vein. Following the transfusion, the boy changed from a stuporous condition to a clear and smiling countenance. During the next several months, Denis may have given transfusions to three other individuals [1]. The second patient, Antoine Mauroy, was an active 34‐year‐old who spent some of his time carousing in Paris. It was thought that blood from a gentle calf might dampen Mauroy’s spirits. On December 19, 1667, he received with no untoward effects 5 or 6 ounces of blood from the femoral artery of a calf. Several days later, the procedure was repeated. During the second transfusion, Mauroy experienced pain in the arm receiving the blood, vomiting, increased pulse, a nosebleed, pressure in the chest, and pain over the kidneys; the next day he passed black urine. This is probably the first reported hemolytic transfusion reaction. Mauroy died about 2 months later without further transfusions. Reportedly, members of the Faculty of Medicine who were opposed to transfusion and hated Denis bribed Mauroy’s wife to state that he had died during the transfusion [1]. Denis was tried for manslaughter but was exonerated. It was later revealed that Mauroy’s wife had been poisoning him with arsenic and that was the actual cause of his death [7]. Also in late 1667, Lower performed a human transfusion before the Royal Society in England. The man received 9–10 ounces of blood from the artery of a sheep and was said to have “found himself very well” afterward [1]. However, the death of Mauroy was used by Denis’s enemies as an excuse to issue an edict in 1668 that banned the practice of transfusion unless the approval of the Faculty of Medicine in Paris was obtained. This series of events led to the discontinuation of transfusion experiments, but more importantly to the abandonment of the study of the physiology of circulation for approximately 150 years [1].