Page 113 - JSOM Fall 2021

An Ongoing Series

Blood Transfusion as a Therapeutic Maneuver

Justin Lee Anderson ; Jay Johannigman, MD, FACS *
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ne might wish to think that the practice of medicine solution, and the work of Rous and Turner to describe the pro-
is a progressive accumulation and advancement of cess of cross-matching to test for sera incompatibility. These
Oknowledge and technology. In fact, it is often the case timely advances set the stage for innovation and exploration
that perceived advances in medicine represent the recognition of blood transfusion during World War I. At the beginning of
of previously described, and then forgotten, advances or prin- World War I, the dominant medical therapeutic strategy for
ciples of care. Perhaps one of the most dramatic examples of fluid resuscitation consisted of salt-containing crystalloid solu-
this maxim has been the recent evolution of the use of whole tions or primitive colloid solutions such as gum arabica. The
blood as a key component of resuscitation of the injured Sol- direct relationship of hemorrhagic shock and diminished ox-
dier, as practiced by the US military medical corps. The authors ygen-carrying capacity at a cellular level was only poorly ap-
are privileged to align with the editorial members of JSOM to preciated and wrapped deep within the predominant thought
introduce a new series of articles that will highlight the his- construct of “wound shock,” which attributed the clinical
tory of military medicine and advances forwarded in the field. manifestations to an underlying disruption of cellular integ-
The focus will be to understand the history of these advances rity rather than oxygen transport deficit. The United States did
with recognition that many of these “in- not enter World War I until late in 1916,
novations” are a renaissance of the work by which time the British Medical Corps
of previous military medics. This first in Those who cannot (aided by their Canadian medical col-
a series of “Lest We Forget” articles is in- remember the past are leagues) had already begun to develop and
tended to examine the seminal advances condemned to repeat it. expand their application of blood transfu-
in care forged in the crucible of combat sion as a primary strategy in the resusci-
casualty care. All too often these lessons, —George Santayana tation of hemorrhagic shock. One of the
“written in the blood of the fallen,” are most visible and notable investigators and
forgotten as hostilities cease and a new generation of medical notable advocates of this strategy was Dr L. Bruce Robertson.
providers shoulder the responsibility of medical care, replac-
ing those who have retired or returned to the civilian arena. Robertson was born in Toronto, Canada, in 1885 and re-
The focus of this series will be to remind all those privileged mained there through matriculation from medical school at
to care for the injured that one must constantly look to the the University of Toronto in 1909. He migrated to the United
past to practice in the present, to be a student of our military States to complete residency education across the fields of pe-
medical history, Lest We Forget. diatrics, orthopedics, and general surgery at Bellevue Hospital
in New York and at Boston Hospital. In 1913, he returned to
Canada to assume a teaching position in pediatrics and general
Introduction
surgery at the Hospital for Sick Children in Toronto. It was
The use of blood transfusion as a therapeutic maneuver was, during this period that Robertson became familiar with the
at best, sporadically used before the beginning of the twenti- technique and practice of blood transfusion via the syringe/
eth century. In the early 1900s, scientific inquiries and discov- cannula technique (see later). As a loyal British subject, Rob-
eries opened the door for the implementation of therapeutic ertson enlisted in the Royal Canadian Medical Corps on the
blood transfusion during the battlefield test bed of World War declaration of war by the British and would be assigned as a
I. Numbering among these discoveries were the description of member of the Canadian Expeditionary Force hospital num-
blood types (A, B, and O) by Landsteiner in 1900, the work ber 14. Robertson traveled to Europe with his hospital group
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of Ottenberg to simplify the testing process, the description by in April 1915 and by fall of that same year was stationed near
Lewishohn in 1915 of the use of sodium citrate as a storage the front, working closely with other British medical units.
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*Correspondence to jay.johannigman@gmail.com
1 Justin Lee Anderson is affiliated with the United States Army Special Operations Command. COL Jay Johannigman, USAR, is affiliated with
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the trauma and surgical critical care department of the Brooke Army Medical Center in Texas.
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