Mansfield’s Lucky Day
On May 17, 1917, darkness settled over the Western Front. Lieutenant James Mansfield, leading a small patrol across the scarred expanse of no-man’s-land near Ypres, was struck down by machine-gun fire. Within minutes, stretcher-bearers had carried him back through the maze of trenches to a Regimental Aid Post (RAP), where a medical officer noted his rapid, thready pulse and dusky pallor—signs of shock and blood loss. Over the next several hours, Mansfield passed through the stages of the Allied evacuation chain: the Advanced Dressing Station, the Main Dressing Station, and finally the Casualty Clearing Station (CCS). By the time he arrived, seven hours after being wounded, he was near death.
At the CCS, a young Canadian surgeon, Lawrence Bruce Robertson, examined him. Mansfield’s wounds were severe: a shattered forearm, multiple leg injuries, and a deep penetrating wound of the loin. His blood pressure was dangerously low. Morphine and blankets were administered, but it was clear that standard measures—saline infusion and warmth—would not suffice. Robertson, recalling his training in New York under Edward Lindeman, decided to attempt something radical: direct blood transfusion.
A donor was found among the ranks, a healthy soldier with a minor wound. Using sterilized syringes, rubber tubing, and cannulas, Robertson drew 20 milliliters of blood at a time and injected it into Mansfield’s vein—repeating the process until 1,100 milliliters had been transfused. Within minutes, Mansfield’s color returned, his pulse slowed, and his blood pressure rose from 90/33 to 120/74. Four hours later, he was stable enough to undergo surgery. Weeks later, he was evacuated to England—alive, thanks to the transfusion.
From Harvey to Blundell: The Long Road to Blood
For centuries, medicine had been more concerned with removing blood than replacing it. After William Harvey’s discovery of the circulation in 1628, physicians began to wonder whether substances might be infused into the bloodstream for therapeutic benefit. In 1665, Richard Lower successfully transfused blood between dogs. Two years later, Jean-Baptiste Denis performed the first animal-to-human transfusion in Paris—infusing lamb’s blood into a young boy. The boy survived, but later attempts ended in disaster, and by 1670, transfusion was banned throughout Europe.
Transfusion reemerged in 1818 when James Blundell, a London obstetrician, used human-to-human transfusion to treat postpartum hemorrhage. Working with crude syringes, Blundell transfused small quantities of blood from a donor’s vein to a woman near death. Though she ultimately died of her underlying illness, Blundell noted immediate improvement and went on to perform several successful transfusions. His work inspired others, though the practice remained rare and technically difficult. Clotting, infection, and unpredictable reactions plagued early efforts. By the late 19th century, enthusiasm waned again, replaced by the seemingly safer alternative of saline infusion.
The American Revival
At the turn of the 20th century, George Washington Crile, a Cleveland surgeon, resurrected transfusion as a treatment for surgical shock. Building on Alexis Carrel’s pioneering vascular suture techniques, Crile performed direct artery-to-vein transfusions in animals and later in humans. Though effective, the method was cumbersome and demanded surgical precision. The search began for a simpler, indirect approach that could be deployed more widely.
In New York, Edward Lindeman introduced a syringe-cannula technique that replaced surgical anastomosis with needles and tubing. This streamlined method inspired Robertson, who carried it to the battlefields of Europe in 1915. Meanwhile, scientists were uncovering another key to success: blood compatibility. Karl Landsteiner’s discovery of the ABO blood groups in 1901 explained why some transfusions succeeded while others proved fatal. Still, compatibility testing was rudimentary or ignored altogether in wartime.
The Canadians at the Front
When World War I began, British field medicine relied primarily on saline. Blood was seen as too risky, too complex, and too time-consuming. But a small cadre of Canadian surgeons—trained in North America’s new methods—saw things differently.
In 1916, Robertson published The Transfusion of Whole Blood: A Suggestion for Its More Frequent Use in War Surgery in the British Medical Journal, arguing that saline merely replaced lost fluid, not the vital functions of blood. His compatriot Edward Archibald soon introduced the use of sodium citrate to prevent clotting, allowing blood to be collected and transfused without immediate donor-recipient proximity. Alexander Primrose and Stanley Ryerson further advanced the practice, showing that transfused blood improved coagulation and wound healing.
By 1917, transfusion was gaining acceptance, particularly after the remarkable success of cases like Mansfield’s. In 1918, a Lancet editorial acknowledged that “the war has thrust the importance of transfusion upon us.” The British, once skeptical, now recognized its life-saving power.
Preserving Blood: The American Contribution
That same year, an American physician, Oswald H. Robertson, serving with the British Expeditionary Force, developed the world’s first blood bank. Drawing on studies by Peyton Rous and J.R. Turner at the Rockefeller Institute, he preserved Type O blood in citrate-dextrose solution and stored it on ice for up to a month. In November 1917, during the Battle of Cambrai, he successfully transfused soldiers using stored blood transported to the front in ammunition boxes packed with ice. The concept of a portable, preservable blood supply—unthinkable just a few years earlier—was now a wartime reality.
War as a Catalyst for Medicine
World War I turned transfusion from a theoretical procedure into a cornerstone of emergency medicine. The pressures of mass casualty care accelerated innovation: from the discovery of citrate preservation to the organization of mobile transfusion units and the formalization of donor testing. By 1918, tens of thousands of transfusions were being performed. The Canadian and American physicians who pioneered the technique laid the foundation for modern transfusion medicine.
War, paradoxically, proved to be medicine’s greatest accelerator. As historian Susan Lederer has written, “the blood of war became the blood of life.” Lessons from the trenches soon translated into civilian practice, leading to the establishment of blood banks, component therapy, and standardized donor screening.
The Three Questions of Transfusion: Why, What, and How
Why transfuse? Initially, to replace what was lost—to restore volume and vitality. Over time, physicians recognized that blood did far more: it carried oxygen, supported coagulation, and revived the failing circulation of shock.
What to transfuse? Early transfusions used whole blood. By World War II, advances in plasma separation and fractionation (John Elliott, Edwin Cohn) gave rise to component therapy—red cells, plasma, and platelets—each serving distinct purposes. Today, the pendulum swings back toward fresh whole blood in trauma care, especially in military medicine, echoing Robertson’s simple insight from 1917.
How to transfuse? From artery-to-vein surgery to syringe kits and stored blood bags, each step in technique reflects a deeper understanding of physiology and logistics. The modern transfusion chain—from donor to recipient—traces its ancestry to the improvisations of wartime surgeons working by candlelight in muddy clearing stations.
From Trench to Triage: The Modern Legacy
In modern conflicts like Iraq and Afghanistan, transfusion remains central to combat casualty care. The principles are the same—control bleeding, restore circulation, prevent hypothermia—but the tools have evolved. Medics now carry portable blood products, apply hemostatic dressings, and initiate transfusions within minutes of injury. The “walking blood bank,” first conceived in WWI, has returned as a lifesaving protocol for Special Operations units.
The story of Mansfield and Robertson reminds us that every medical advance has human origins: a wounded soldier, a determined physician, and a desperate attempt to save a life. Out of the mud and chaos of war emerged one of medicine’s quiet revolutions—the ability to replace life’s most essential fluid.
Sources and Further Reading
- Robertson LB. The Transfusion of Whole Blood: A Suggestion for Its More Frequent Use in War Surgery. BMJ. 1916;2:38–40.
- Archibald ED. The Use of Citrate Solution in Blood Transfusion. BMJ. 1916;2:354–355.
- Crile GW. Hemorrhage and Transfusion: An Experimental and Clinical Research. 1909.
- Blundell J. Experiments on the Transfusion of Blood by the Syringe. Medico-Chirurgical Transactions. 1818;9:56–92.
- Rous P, Turner JR. The Preservation of Living Red Blood Cells in Simple Solutions. J Exp Med. 1916;23:219–237.
- Cherry R. Blood Transfusion in the Great War. London: Wellcome Trust; 1996.
- Lederer S. Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America. Oxford University Press, 2008.