History of Blood Transfusion

For historical authors, it’s important to know when a medical advancement takes place for novels that include these medical details. While researching a medical question for an author regarding blood transfusion I came across a very good timeline concerning this medical advancement. You can find that article here.  Additional resource found here.

1628: Dr. William Harvey discovers blood circulation.

1655: Dr. Richard Lower performs successful animal to animal blood transfusion using dogs.

1818: Dr. James Blundell performs first person to person blood transfusion. Blundell is a gynecologist and uses blood transfusions to treat postpartum hemorrhage.

1840: Successful blood transfusion of patient with hemophilia.

1901-1902: Karl Landsteiner discovers blood types. This is an important advancement because giving the patient the wrong blood type can well . . . kill them.

1914-1918: Dr. O.H. Robinson finds effective anticoagulant that aids in long-term blood storage. Adolf Hustin is also credited with discovering an anticoagulant as well.

1920’s: Percy Oliver develops donor system for British Red Cross.

1932: Leningrad Hospital houses first blood bank.

1939-1940: Rh Blood group is discovered which is determined to be the cause of most blood transfusion reactions.

1941: Red Cross U.S.A. is started.

1950: Use of plastic bags makes collecting and storing blood easier. Before this they used glass bottles. This I cannot imagine.

1972: Apheresis is discovered which can remove one component of blood and return the rest to the donor.

1983: Stanford Blood Center begins screening donated blood for AIDS.

1985: HIV screening licensed and implemented.

1990: Hepatitis C Screening initiated.

It’s amazing to look back on just how much was accomplished in blood transfusion, blood banking, and ensuring a safe blood supply in the 20th century.

Laurie Alice Eakes: The Midwife Versus The Physician

Physicians Take over the Practice

lady-in-the-mistFor centuries, even millennia, midwives served as the primary practitioners called in to assist in childbirth. Then a family of ?French Huguenots, established as “man-midwives” invented the forceps, an instrument resembling two spoons with a handle holding them together. The Chamberlain family kept this invention a secret for over a hundred years. When it was sold to, or leaked to the public, other physicians began to use it and midwives began to lose their power over child birth, except in rural areas.

At first, midwives shunned the use of forceps. By law in some places and practice in others, they possessed small enough hands to pull out the baby in difficult births. After a while, though, laws changed and Midwives were not allowed to use forceps.  By the beginning of the nineteenth century, doctors were also using opiates to relieve the pain of childbirth.  Unfortunately, opium, as noted In Martha Ballard’s diary, A Midwife’s Tale, tended to prolong and even stop labor.  In the nineteenth century, ether and chloroform replaced opiates, especially after Queen Victoria allowed herself to be sedated during childbirth.

Lying –in hospitals came into practice, especially for poorer women. These were used as training fields for physicians wanting to deliver babies. Although germs were little more than a myth to medical practitioners until Joseph Lister and Louis Pasture proved their existence and harmfulness in the latter third of the nineteenth century, midwives and physicians made the observation that women who gave birth in hospitals suffered from childbed fever more often than did women who gave birth at home.  Women attended by midwives also had a lower mortality rates than did women attended by physicians.  After all, man midwives often went straight from an autopsy to the birthing chamber without washing their hands.

Why physicians strove to take over obstetrical practice is open to speculation.  Evidence, however, leads one to suspect that the motive was for financial gain.  Being men, thus having more power than women at that time, suppressing female childbirth practitioners was all too easy and financially lucrative.

Author’s Note: This article is adopted from a paper I delivered at the 1999 New Concepts in History conference under the title “Women of Power: Midwives in Early Modern Europe and North America”. My sources vary from newspapers, to diaries, to books difficult to obtain outside of a university library system, as many are hundreds of years old. If you wish to learn more, Google Books has some fine resources on childbirth practices in history.

*********************************************************************************************lauriealiceeakesMidwives historic role in society began to fascinate Laurie Alice Eakes in graduate school. Before she was serious about writing fiction, she knew she wanted to write novels with midwife heroines. Ten years, several published novels, four relocations, and a National Readers Choice Award for Best Regency later, the midwives idea returned, and Lady in the Mist was born. Now she writes full time from her home in Texas, where she lives with her husband and sundry dogs and cats.

You can read an excerpt from Lady in the Mist here and discover more about Laurie Alice Eakes at her website.

***This is a repost from December 1, 2010.***

Author Question: When Was Pregnancy Related Anemia Discovered?

Robin Asks:

I’m looking but I can’t find gestational anemia. I need to know if they would have diagnosed that in 1912 and what they might have called it. If it was diagnosed, what treatment might they have prescribed?

Jordyn Says:
blood-1813410_1920
First of all, I’ve never personally heard the term gestational anemia so I started my Google search with “when was anemia first discovered” and then started narrowing it down from there to pregnancy related anemia. I wasn’t having much luck on doing a basic Google search and decided to head over to Google books where I’ve had better luck with historical questions.

There, I found a book called An Antropology of Biomedicine and from that found the following information:

The discovery of the link between macrocytic anemia (a lack of red blood cells in which those that remain are swollen) and folate (a water-soluble form of vitamin B) was first made in India in 1928, when a British scientist Lucy Wills traveled to Bombay to work with “Mohammedan women” who were commonly found to have this particular form of anemia during pregnancy.

So, it looks like the discovery was made after your time frame, Robin.

Sarah Sundin: WWII US Army Hospitals Part 3/3

This is Sarah’s final installment on WWII Army Hospitals. I’d like to thank Sarah for all her hard work on these terrific posts. Click the links for Part I and Part II.

US Army Hospitals in World War II—Part 3

Ruth squatted beside his cot. “Have you ever flown before, Corporal?”

            “No, ma’am. A man’s meant to stay on the ground.”

            “How long did it take you to get to England?”

            “Almost two months, ma’am, zigzagging around them U-boats.”

            “Mm-hmm. Well, tonight you’ll have dinner in New York. You may change your mind about flying.”

a-memory-betweenIn my novel A Memory Between Us, the heroine becomes a flight nurse, pioneering medical air evacuation. If you’re writing a novel set during World War II, a soldier character may get sick or wounded, and you’ll need to understand how patients were evacuated from the battleground to the hospital and perhaps taken stateside.

In my first post,  I discussed the chain of evacuation. In my second post, I discussed more details about mobile and fixed hospitals, and today I’ll cover evacuation of the wounded.

Manual Transport

On the battleground, medics or fellow soldiers could manually carry a wounded man further to the rear for aid. Methods included the supporting carry (walking side-by-side), the arms carry, the saddleback carry (piggy-back), and the fireman’s carry.

Litter Transport

American litters were made of canvas stretched over aluminum or wood poles with stirrup-shaped feet to keep them off the ground. A litter could be carried by two people, but a litter squad consisted of four men, to rotate if traveling long distances and to assist over obstacles. Ideally, litter transport was only used for short distances, but in mountainous or forested or swampy terrain, litter transport was the only available means. Mules were often used in the Mediterranean Theater to carry litters in rocky, mountainous terrain.

Motor Transport

Ambulances were used to transport patients, usually from an aid, clearing, or collecting station to a field hospital, or for transport further to the rear. Ambulances could carry seven seated patients or four patients on litters.

Water Transport

Jeeps were often used, both on the battleground and to transport further to the rear. Rugged and maneuverable, jeeps could cover terrain inhospitable to ambulances. With litter brackets, a jeep could carry two patients. Armored divisions also used light tanks to transport their wounded.

During an amphibious landing, the best way to handle the wounded was to send them back on departing landing craft, which carried them to hospital ships off-shore. Patients could be removed from danger and transported quickly to get needed care.

Hospital ships were used offshore after an invasion to care for the wounded before field and evacuation hospitals could be set up. They also transported patients who needed long-term care to general hospitals further to the rear. Another use of hospital ships was to transport to the US any patients who needed long-term convalescent care or those who qualified for a medical discharge. They carried several hundred patients and delivered full medical care, but transport took a long time and carried the danger of enemy attack at sea.

Rail Transport

Hospital trains were used within theaters of operation to transport patients from one hospital to another. They were used in the continental US, Britain, continental Europe, India, and North Africa. They could carry several hundred patients with excellent medical care.

Air Transport

Medical air evacuation was new and revolutionary, but by the end of the war, it proved successful. Planes can traverse inhospitable terrain or dangerous seas—and quickly. At the front, the wounded were gathered at collecting stations at airfields. C-47 cargo planes carried 18-24 litter patients or a higher number of ambulatory patients further to the rear. A team consisting of a flight nurse and a surgical technician cared for the patients in flight. The larger C-54 cargo plane was used for trans-oceanic evacuation. Danger still existed, both from the inherent risks of flight and also because the planes carried cargo and couldn’t be marked with the Red Cross.

Resources for Research

Office of the Surgeon General. Medical Field Manual: Transportation of the Sick and Wounded. Washington, DC: US Government Printing Office, Feb. 21, 1941 (available free on-line at http://www.ibiblio.org/hyperwar/USA/ref/FM/index.html ). Please note the date—some of the material, especially about air evacuation, became quickly outdated.

For better information on air evacuation, please see:

Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Washington, D.C.: Office of the Surgeon General, USAF, 1955.
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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 17th, 2010.***

Sarah Sundin: WWII US Army Hospitals Part 2/3

This week, I’m pleased to host author Sarah Sundin as she shares some of her wonderful research that served as the backdrop for her Wings of Glory Series. You can find Part I here.

US Army Hospitals in World War II—Part 2

Ruth passed precise military rows of the hospital’s Nissen huts. Redgrave Hall stood to the west, but she headed south across the road the ambulances used and entered a lightly wooded meadow and another world. How could one family own so much land?

          If Ruth had resources like that, she wouldn’t be in a fix.

a-memory-betweenIn my novel, A Memory Between Us, the heroine serves as a US Army nurse based in England. If you’re writing a novel set during World War II, you may need to write a scene set in a military hospital, and you’ll need to understand Army hospitals.

Last post, I discussed the chain of evacuation, today I’ll discuss more details about mobile and fixed hospitals, and on the next post, I’ll cover evacuation of the wounded.

Mobile Hospitals

Field hospitals (400 beds) and evacuation hospitals (either 400 bed or 750 bed) arrived within a few days of an invasion and followed the army, staying about thirty miles behind the front. They were close enough to treat patients quickly and send them back to the front quickly as well.

These hospitals relied on mobility. They usually used canvas tents, but also used schools, barracks, hospital buildings, hotels, Mediterranean villas, and an Italian stadium. A few days before a move, the hospital stopped admitting patients and evacuated their current patients to other hospitals. They packed their equipment and personnel into trucks, advanced, set up, and were ready to admit patients within hours.

When ambulances arrived, triage officers sent patients to pre-op, medical, shock, or evacuation wards as needed. Surgical teams worked twelve hours on, then twelve hours off.

In the European Theater (England, France, Belgium, Germany), the field hospitals stayed closer to the front, with the evacuation hospitals further to the rear. In the Mediterranean Theater (North Africa, Sicily, Italy, southern France), field hospitals and evacuation hospitals were often used interchangeably. Both theaters practiced “leapfrogging” as the front advanced—hospital A would pass hospital B, then hospital B would pass hospital A. This reduced the frequency of moves.

Fixed Hospitals

The station hospitals (250, 500, or 750 bed), general hospitals (1000 bed), and convalescent hospitals (2000 or 3000 bed) were set up far from the front to keep patients safe from danger, but also to keep them in the theater, which made it easier to return the soldiers to duty. In England before D-Day, field and evacuation hospitals waiting for the Normandy invasion functioned as station hospitals to care for patients.

In each theater of operations, fixed hospitals operated in what was called the “Communications Zone.” In the European Theater, the COMZ was originally in England, then as the Allies approached the German border, the COMZ extended to include Normandy and Belgium. In the Mediterranean Theater, Morocco served as the first COMZ, then Algeria. When the Allies invaded Sicily and Italy, North Africa was the COMZ, and as the front advanced, the COMZ was established in the Naples area of southern Italy. In the Pacific, fixed hospitals were first established in Hawaii and Australia, then followed into secured regions.

Fixed hospitals moved less often and occupied more permanent facilities. American units used some standing hospitals in host or occupied countries, but most were a collection of Nissen huts, 20-ft by 40-ft corrugated tin semi-cylinders. In England, these hospital complexes were often placed on estate grounds, and had concrete floors, flush toilets, clean water, and were heated by coal-burning stoves. In the Mediterranean and Pacific, facilities were more primitive but improved over time. In these theaters, mosquito netting was draped over the beds to prevent transmission of malaria.

Fixed hospitals in the Zone of the Interior (continental United States) enjoyed the benefits of modern buildings and facilities. However, shortages of medication, equipment, and personnel were always a problem.

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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 15, 2010.***

Sarah Sundin: WWII US Army Hospitals Part 1/3

I’m so thrilled to have author Sarah Sundin here this week. If you’re looking for information surrounding WWII, check out all of her posts. Recently, she did a series on WWII nursing. They’re an excellent resource.

US Army Hospitals in World War II—Part 1

Lieutenant Doherty wrote on the clipboard while the mercury rose, and Jack glanced around the Nissen hut, which was like a giant tin can sawed in half. Four coal stoves ran down the aisle, with ten beds on each side, only eight of which were occupied. Jack didn’t mind the extra attention.

In the Wings of Glory series, my B-17 pilot heroes keep getting injured and hospitalized. If you’re writing a novel set during World War II, your soldier characters may need treatment, and you’ll need to understand how and where patients were hospitalized.

sarsunwoundsolToday I’ll discuss the chain of evacuation, on December 15th, I’ll discuss more details about mobile and fixed hospitals, and on December 17th, I’ll cover evacuation of the wounded.

The Chain of Evacuation

Wartime medical treatment occurred on muddy battlefields under fire, tent hospitals only miles from the front, and sterile stateside hospitals.

A complex chain moved patients to where they could best be treated. At all points along this chain, decisions were made regarding when to treat, when to return to duty, and when to evacuate further to the rear.

Organic Medical Units

These units were attached to combat units and followed them into battle.

Battlefield: Medics performed first aid and moved the wounded to the aid station, often under fire.

Battalion aid station: About one mile from front. Physicians and medics adjusted splints and dressings, administered plasma and morphine. Soldiers reported to the aid station for treatment of minor illnesses or mild combat fatigue.

Collecting station: About two miles from front, near regiment command post. Further adjustment of splints and dressings, administration of plasma, treatment of shock.

Clearing station: About four to ten miles from front. Treated shock and minor wounds. Grouped patients in ambulance loads for transport to field hospitals.

Mobile Hospitals

These hospitals were assigned to a theater of operations, and could be packed and moved quickly.

Field Hospitals: Within thirty miles of clearing station—were supposed to receive the wounded within one hour of injury. Surgery was performed for the most severe cases.

Evacuation Hospitals: Treated illnesses and less urgent surgical cases. Patients could be reconditioned here to return to the front.

Fixed Hospitals

These hospitals were set up a safe distance from the front, either in the theater of operations or stateside.

Station Hospitals: Usually attached to a military base, designed to treat illnesses and injuries among personnel stationed at that base.

General Hospitals: Large facilities where patients received long-term treatment.

Convalescent Hospitals: Designed for rehabilitation.

Resources for Research

Cosmas, Graham A. & Cowdrey, Albert E. The Medical Department: Medical Service in the European Theater of Operations. Washington, D.C.: United States Army Center of Medical History, 1992.

Wiltse, Charles M. The Medical Department: Medical Services in the Mediterranean and Minor Theaters. Washington, DC: Office of the Chief of Military History, Department of the Army, 1965. (available free on line at http://history.amedd.army.mil/books.html)

Condon-Rall, MaryEllen & Cowdrey, Albert E. The Medical Department: Medical Service in the War Against Japan. Washington, D.C.: United States Army Center of Medical History, 1998.

Links, Mae Mills & Coleman, Hubert A. Medical Support of the Army Air Forces in World War II. Washington, D.C.: Office of the Surgeon General, USAF, 1955.

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sarahsundin2
Sarah Sundin is the author of the Wings of Glory series from Revell: A Distant Melody (March 2010), A Memory Between Us (September 2010), and Blue Skies Tomorrow (August 2011). She has a doctorate in pharmacy from UC San Francisco and works on-call as a hospital pharmacist.

***This content is reposted from December 13, 2010.***

Historical Medical Question: Head Injury 1870s

April Asks:

skull-476740_1920I have a question regarding medicine in the 1870’s.  What would brain/cranial surgery consist of then?

I’ve tried to find some information on this type of operation from this time period, but have had very little luck so far.  In a quick scenario, there’s been a serious buggy accident, and the heroine of the novel has bleeding on the brain. I know one proposed procedure for this was to actually drill a hole into the skull to let out the influx of blood. Was this happening and being practiced in the 1870’s? Also, what would the medical instruments of the day have been to achieve such a surgery?

Jordyn Says:

This could definitely be a set up for a craniotomy (drilling a hole into the skull or creating a burr hole) to be used to relieve pressure within the cranium. The procedure would have been called trephining and was definitely used during your time period. Two resources for the procedure can be found here and here.