Blog: The History of Improvement – Communication

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In the first of our 3 part blog series: The History of Improvement, Jess Roberts, Project Manager at Haelo and PhD in history of medicine, talks about the history of blood transfusions and how physicians struggled against public opinion to pioneer this life saving treatment.

While blood transfusions had been attempted since at least the sixteenth century, it was in the nineteenth century that they started to show effective results: not everybody died!

There were, however, a lot of misunderstandings and some blunders along the way. It’s amazing that doctors worked so hard to keep investigating this treatment when it was so unsuccessful, risky, and went against everything medical science believed in up until the nineteenth century.

Early blood transfusions used blood from sheep. Dr. Jean Baptiste Denys, the physician to King Louis the 14th of France, pioneered this treatment in the seventeenth century. His theory was that because of a sheep’s docile nature, the blood would “calm” the human’s constitution and make them well again.

Credit: Wellcome Library

Denys ran into trouble when a canny woman blamed a blood transfusion for her husband’s death, when in fact she had used arsenic to poison him just after the transfusion took place. Denys was cleared of any wrongdoing in court but the transfusion process was tainted in the public imagination.

Because of this scandal and the extremely high rate of failure, general opinion at the turn of the nineteenth century was that blood transfusions were ineffective at best and actually contradicted the entire discourse surrounding the human body at the time.

Credit: from Quinta Essentia by Leonhart Thurneisser, 1573

Before the nineteenth-century, humoral theory was still widely accepted. This was the idea that all sickness and disease was due to an imbalance of the four “humors”: black bile, yellow bile, phlegm, and blood. The only treatments were to either purge these humors using emetics or bleeding, or make potions out of herbs that were said to counteract the humors. The idea that you could open up the body and add more stuff to make somebody better was totally against humoral theory. You just didn’t mess with the messy inside bits.

However, physicians continued to attempt transfusion. There were no ridiculous ideas about sheep this time. In fact, in the far more advanced nineteenth century it was thought it was a horse’s blood that would be of the most benefit to a human. Horses are big and strong, after all!

Physicians eventually began working only on transfusions between humans. The very first successful human to human blood transfusion was James Blundell’s attempt in 1819 when he successfully transfused blood from a husband to his wife during her labour. Doctors started to see that the treatment had real promise: in 1825, one physician said “I have little doubt that [transfusion] will soon be brought into general practice. We need neither be surprised or daunted at its being so opposed; for if we consult the records of medicine, we shall find that the introduction of any new theory or remedy…has always met with the same fate.”

So when did patients begin to accept that the new treatment worked? I think this it was when a new mode of communication of ideas coincided with the increasing success of blood transfusions.

This new medium for disseminating all kinds of information suddenly became popular in the early nineteenth century. Newspapers, journals, and magazines increased in circulation with the advent of the railways. As well as the latest novels and contemporary politics, it was very fashionable for the middle classes to keep up to date with all of the advances in science and medicine, and these were reported on in the press.

The periodical press allowed for knowledge exchange on a national level and part of that conversation was the increasing success of pioneering medical techniques like blood transfusions. As people were paying for their healthcare, medical treatment was very much influenced by public opinion and trends at this time and transfusions were suddenly a popular treatment.

What can we learn from this short history of transfusion?

Doctors continued to work on blood transfusions in spite of the horrific failures of previous attempts. The attempts failed not because transfusion was a bad idea in itself, but because they were going about it in fundamentally the wrong way to begin with: using animal blood to replace human blood. We need to come at improvement from a fresh angle when we aren’t seeing the results that we just know we can achieve. This can be done by getting everybody in the room for a process mapping session or asking people what they think of your driver diagram.

The successful transfusions were then communicated widely via the periodical press, and the public began to see the value of this treatment. Eventually enough success was seen that there was a “tipping point” and transfusion was a legitimate method. Communication is so important in building engagement, and improvement cannot spread or scale up without engagement from key stakeholders: in this case, the paying public.

What do you think?

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