Blood loss was one of the major medical challenges of the First World War. Severe wounds caused by artillery, machine guns and shrapnel created an urgent need for effective blood transfusion, while developments in blood grouping, anticoagulation and blood storage gradually made transfusion more practical.
Blood Transfusion in the First World War
Blood transfusion was not a new medical procedure in 1914, but the First World War created an enormous demand for reliable methods of replacing blood lost through severe injury. The scale of industrial warfare meant that large numbers of soldiers suffered wounds that could cause rapid and potentially fatal blood loss.
The development of transfusion during the war depended upon several advances. Doctors needed to understand blood groups, prevent donated blood from clotting, preserve blood for later use and develop systems for collecting and transporting it to where casualties were being treated.
Blood Loss and Battlefield Injury
Artillery and machine guns produced severe wounds, while shell fragments could cause extensive damage to blood vessels and internal organs. Soldiers with major injuries could lose large quantities of blood before reaching medical treatment.
The development of organised medical services and evacuation was therefore closely connected with the development of transfusion. Blood could only save a wounded soldier if medical personnel were able to provide it quickly enough.
Blood Groups
The identification of different blood groups was an important foundation for safer transfusion. Karl Landsteiner’s work before the war had demonstrated that human blood was not universally interchangeable.
This knowledge became increasingly important as doctors attempted to provide transfusions to wounded soldiers. Matching donor and recipient blood reduced the risk of dangerous reactions and made transfusion a more practical treatment.
Preventing Blood from Clotting
One of the major practical problems was that blood removed from a donor would clot. Early transfusions therefore often involved transferring blood directly from one person to another.
Research into anticoagulants provided a way around this problem. Sodium citrate could prevent blood from clotting and allowed doctors to store and transport donated blood rather than relying entirely upon an immediate donor-to-patient transfusion.
This was a crucial development because it made transfusion much more flexible during major military operations.
Blood Transfusion During the War
Blood transfusion was used during the First World War to treat severely wounded soldiers, particularly where major blood loss had occurred.
Oswald Hope Robertson, an American doctor serving with the British Army, played an important role in developing practical systems for storing blood. His work helped demonstrate that blood could be collected, preserved and made available for use when casualties arrived.
The development of stored blood therefore changed the relationship between the donor and the wounded soldier. Blood no longer necessarily had to be transferred immediately from a donor to a specific patient.
Blood Banks
The development of blood storage contributed to the emergence of blood banks. Instead of relying upon individual donors being available when a casualty required treatment, supplies of blood could be collected in advance.
This was particularly valuable during major offensives, when large numbers of wounded soldiers could arrive at medical facilities within a short period.
Blood storage therefore became part of the wider organisation of military medicine, alongside casualty evacuation, hospitals and surgical treatment.
Blood Transfusion and Surgery
Transfusion was closely connected with developments in surgery. Surgeons treating severe wounds needed ways of managing patients who had lost large quantities of blood.
The availability of transfusion increased the possibilities for treating seriously wounded soldiers and carrying out complex operations. It therefore formed part of the wider development of surgery and reconstructive surgery during the war.
Blood Transfusion and Medical Evacuation
The effectiveness of transfusion also depended upon the organisation of medical services. Blood and medical equipment had to reach hospitals and casualty clearing stations, while wounded soldiers had to be moved rapidly from the battlefield to places where specialist treatment was available.
The development of transfusion therefore illustrates how different aspects of wartime medicine became interconnected. Advances in treatment depended upon transport, organisation, medical personnel and the ability to provide care at the right stage of evacuation.
Medical Services and Evacuation in the First World War
Blood Transfusion and Other Medical Developments
Blood transfusion formed part of a wider pattern of medical development during the war. X-rays helped doctors diagnose injuries, surgery developed new methods of treating severe wounds, and medical services developed more effective systems for dealing with large numbers of casualties.
X-Rays and Medical Imaging · Surgery and Plastic Surgery
The Global Development of Transfusion
The history of wartime blood transfusion was international. Research carried out before and during the war involved doctors and scientists from several countries, while medical personnel from different Allied armies contributed to the practical development of transfusion systems.
The First World War provided an environment in which these developments could be tested on a very large scale. The experience gained during the conflict influenced the further development of blood transfusion after 1918.
The Legacy of Blood Transfusion
By the end of the First World War, blood transfusion had become a much more practical part of the treatment of severe injury. The development of blood grouping, anticoagulation and storage had helped overcome some of the major problems that had previously limited its use.
The wartime experience contributed to the development of modern transfusion medicine. Blood could increasingly be collected, stored and administered as part of organised medical care rather than being dependent entirely upon an immediately available donor.
Medicine in the First World War
Blood transfusion was one element of the wider medical response to industrial warfare. The treatment of severe wounds was also transformed by developments in surgery, X-ray diagnosis and organised evacuation, while medical services had to respond to gas injuries, psychological trauma and disease.
This article forms part of the wider Medicine in the First World War section.
Further Reading
- Blood Transfusion, Wellcome Collection — medical collections and historical material relating to the development of blood transfusion and the treatment of blood loss.
- Blood Transfusion in the First World War, Science Museum — material on the development and use of blood transfusion during the conflict.
- Blood Transfusion, National Library of Medicine — historical material tracing the development of blood transfusion, including the scientific advances that made wartime transfusion possible.
- First World War medical services, Imperial War Museums — photographs, documents and objects relating to military medicine, including the treatment of wounded soldiers and the medical services of the First World War.
For the wider history of the conflict, return to the First World War hub.