James Blundell: pioneer of blood transfusion

Blundell’s successes had a profound effect on hematology, physiology, obstetrics and surgery.

Though his career was brief, James Blundell was an innovator and pioneer and was distinguished as one of the first physicians to practice blood transfusion in humans. His career as a physiologist, obstetrician, teacher and physician led to great achievements in multiple areas of medicine.

Among those achievements was the ability to transfuse whole blood from human to human — a feat he first experimented with in dogs. He also made advancements in abdominal surgery as well as in surgical strategies for obstetrics and gynecology, including the division of fallopian tubes during caesarean operations to ensure sterility and the removal of the ovaries to alleviate dysmenorrhea.

Early life

Blundell was born in London on Dec. 27, 1790. Aside from Thomas Pettigrew’s “Medical Portrait Gallery” — a book containing biographical memoirs of science’s major influences — little of Blundell’s early life is known.

He received a classical education under the Rev. Thomas Thomason and began his medical education at the United Southwark Hospitals. There Blundell studied anatomy and surgery under Sir Astley Cooper, known for his achievements in vascular surgery. Blundell also studied midwifery and physiology under his uncle, Dr. John Haighton, who had an enormous influence on his medical career.

James Blundell Source: National Library of Medicine

The young physician continued his studies at The University of Edinburgh, Scotland where he was deeply engaged in botany and jurisprudence, which at the time had been paid little attention in London. In 1813, after presenting a thesis in Latin that proved the senses for music and hearing were dependent yet distinct, Blundell graduated with his medical degree.

After graduation, Blundell returned to London where he focused solely on midwifery and physiology. He became a lecturer at the united schools of St. Thomas’ and Guy’s Hospital where he taught jointly with his uncle Haighton on physiology. The following year, 1817, he joined his uncle as a lecturer on midwifery and became the sole lecturer on the two topics after his uncle’s death in 1823. Blundell was named a licentiate of the Royal College of Physicians in 1818 and a fellow in 1838.

Successes

In 1818, Blundell published “Experiments on the Transfusion of Blood by the Syringe” in Medico-Chirurgical Transactions. The important paper discussed his experiences with whole blood transfusion — both in dogs and humans — using a syringe. He addressed the benefits of rapid execution to prevent coagulation, the importance of avoiding air intake in the veins and the incompatibility of heterologous donors.

Shortly after, Blundell introduced two instruments for the purpose of transfusion: the impellor and the gravitator. The impellor was a complex invention consisting of a cup, tube and syringe (see figure). When using the gravitator, blood was injected into the patient via a tube suspended from a vessel held high above the patient. Information on both apparatuses was published in The Lancet in 1829.

Postpartum hemorrhage, extreme malnutrition, puerperal fever, cancer of the pylorus, ruptured uterus and hydrophobia were all indications for transfusion at the time.

Figure 1: Perpendicular section of the Impellor. A.C.B. the inner cup. A.D.B. The outer cup full of water. D.E. The vice. a.b. A line on the inner cup above which the blood should no be suffered to rise. c.d. The upper valve, armed with two or three folds of soft alum leather. e.f. The undervalve, idem. g.h.i.k. The syringe. l. The plug. B. A mark on the piston-rod indicating the elevation to which the plug, l, had been raised. The space covered with dots represents that portion of the instrument which is filled with blood. The space covered with line represents that portion of the instrument which is full of water. m.n. The flexible tube. n.o. The venous tubule. When the piston of the syringe is raised, the blood is drawn from the cup. A.C.B. down pipe C. through the upper value c.d. into the syringe; and the reflux from that part of the instrument which lies below the under valve e.f. is prevented by the closure of the valve. When the piston is depressed, the blood is expelled through the valve e.f. along the pipes m.n.o.; and the reflux into the cup. A.C.B. is prevented by the closure of the valve c.d. Except the plug joint at n. all the joints at which air might enter and mix with the blood are covered with water, by which means the instrument is rendered air-secure. With a view of avoiding complexity, the springs which raise the valves are not represented. Figure 2: The valve with the springs mounted. Figure 3: Spring forceps. Figure 4: The curve of the wire forming the spring which raises the valves. Source: Researches Physiological and Pathological, 1824

Beyond transfusions

Aside from his invaluable work with blood transfusions, Blundell’s discoveries left quite an impression on the field of surgery. By studying the peritoneum of animals, he uncovered the possibility of abdominal surgery, which profoundly advanced the fields of obstetrics and gynecology.

In 1823 and 1824, the Medical and Chirurgical Society published three of Blundell’s articles in Transaction. The first article argued the feasibility of abdominal surgery, including correcting intraperitoneal rupture of the bladder and relieving intestinal intussusceptions by creating a small incision in the abdomen and passing the folds of the small bowel through the fingers. Additionally, Blundell argued the practicability of dividing the fallopian tubes during caesarean sections to ensure sterility and using double oophorectomy to alleviate severe dysmenorrhea.

Despite Blundell’s protest, his lectures on midwifery were published verbatim in The Lancet in 1827, 1828 and 1829. The lectures were taken in shorthand by a writer who served the proprietor and editor of the journal, Thomas Wakley. In 1832, the lectures were published in a volume titled “Lectures in Midwifery and the Diseases of Women and Children as Delivered at Guy’s Hospital.” A larger volume was published two years later titled “The Principles and Practices of Obstetricy as at Present Taught by Dr. James Blundell.” The books, based mostly on his lectures, were approved by Blundell and his recommendations for revisions and rearranging were executed.

Both his practices and teachings in obstetrics offered much insight into midwifery. He advised strongly against unnecessary interference and differentiated between placenta previa and accidental hemorrhage. He recommended the use of strong caution and late interference only in breech presentation, giving precise instruction on the delivery of the head.

Blundell was cautious in his use of forceps but preferred them to be straight, whether long or short. He treated eclampsia with venesection, emetics and purgatives. If his methods failed, he recommended interference by means of rupturing the membranes; though he believed it to be useful, he urged against it in cases of malpresentation and contracted pelvis.

Late life

In 1836, Blundell had an irreconcilable dispute with the administration at Guy’s Hospital and retired. Two years later he became a fellow of the Royal College of Physicians.

Often referred to as eccentric, in his later years Blundell had both interesting and unusual sleeping patterns. He rose midday and saw patients in his home in the afternoon hours. After dining he began a round of house calls as late as 8 p.m. or 9 p.m. He carried many books with him, which he read between calls by the interior light affixed to his carriage.

Blundell retired in 1847 and moved to a large house in Piccadilly, London, where he lived in relative anonymity. He died on Jan. 15, 1878. – by Stacey L. Adams

For more information:

• James Blundell. Public Broadcasting Service website. www.pbs.org/wnet/redgold/innovators/bio_blundell.html. Accessed Jan. 29, 2009.
• Med Hist. 1964;8:159-169.