Lower had performed the first blood transfusion between animals. [71] He made a substantial amount of money from this endeavour, roughly $2 million ($50 million real dollars).[72]. The nurse administers the transfusion via an intravenous catheter placed into the vein. Credit: John Martin Rare Book Room, University of Iowa. The Vatican condemned these experiments in 1670. Coga received 20 shillings (equivalent to £173 in 2019) to participate in the experiment. Transfusion inefficacy or insufficient efficacy of a given unit(s) of blood product, while not itself a "complication" per se, can nonetheless indirectly lead to complications – in addition to causing a transfusion to fully or partly fail to achieve its clinical purpose. An antibody panel consists of commercially prepared group O red cell suspensions from donors that have been phenotyped for antigens that correspond to commonly encountered and clinically significant alloantibodies. France, Germany, Austria, Belgium, Australia and Japan established similar services.[83]. Prior to a blood transfusion, blood testing will allow your veterinarian to ensure that the donor and recipient are a good match. Blood transfusion is the process of transferring blood or blood products into one's circulation intravenously. [96] By 2013 the number had declined to about 11 million units, because of the shift towards laparoscopic surgery and other surgical advances and studies that have shown that many transfusions were unnecessary. Credit: Historical Medical Library of the College of Physicians of Philadelphia. In 1845 the Edinburgh Journal described the successful transfusion of blood to a woman with severe uterine bleeding. The Wall Street Journal. the animal has to be sensitized before it will mount an immune response against the transfused blood. Oswald Hope Robertson, a medical researcher and U.S. Army officer, was attached to the RAMC in 1917, where he became instrumental in establishing the first blood banks in preparation for the anticipated Third Battle of Ypres. Similar systems developed in other cities, including Sheffield, Manchester and Norwich, and the service's work began to attract international attention. In setting up a hospital laboratory that preserved, refrigerated and stored donor blood, Fantus originated the term "blood bank". To what extent have we moved beyond our discomfort with blood transfusion, even as the medical use of “body products,” as legal historian Kara W. Swanson terms them, has expanded wildly? Shortly after Lower’s description of transfusion was published in Philosophical Transactions, Robert Boyle released a series of questions about the effects of transfusion on the recipient. In urgent cases where crossmatching cannot be completed, and the risk of dropping hemoglobin outweighs the risk of transfusing uncrossmatched blood, O-negative blood is used, followed by crossmatch as soon as possible. The experiment was troubled from the start. Richard Lower’s apparatus for connected the artery and vein of emmitent and recipient during a transfusion. The 300–400 mL of extracted blood was mixed with 10% citrate solution in a modified Duran Erlenmeyer flask. The most likely time for a blood transfusion reaction to occur is during the first 15 minutes or first 50 mL of the infusion. [38] Although some of the biochemical changes are reversible after the blood is transfused,[39] the biomechanical changes are less so,[40] and rejuvenation products are not yet able to adequately reverse this phenomenon. [45] However, all of these criteria are applied in a universal manner that does not account for differences among units of product. The science of COVID-19 vaccines, the 1957 flu vaccine that controlled that outbreak, eradicating polio in India with oral vaccines, and more. Ask your doctor or nurse why they think you might need a transfusion if you're not sure. Credit: Wellcome Library. In our own day, blood transfusion has become an accepted, relatively uncontroversial medical therapy. Credit: Wellcome Library. On June 15, 1667, the first direct blood transfusion to a human was performed by the physician Jean-Baptiste Denis, when he gave a feverish young man approximately 12 ounces of blood taken from a lamb. The British Journal for the History of Science, The Method Observed in Transfusing the Bloud out of one Animal into Another, Trials proposed to be made for the Improvement of the Experiment of Transfusing Blood out of one live Animal into another. 2 (1666 - 1667), pp. [1] Transfusions are used for various medical conditions to replace lost components of the blood. Transfusions with large amounts of red blood cells, whether due to severe hemorrhaging and/or transfusion inefficacy (see above), can lead to an inclination for bleeding. Based on the reactions of the patient's serum against the donor cells, a pattern will emerge to confirm the presence of one or more antibodies. By the late 19th century, blood transfusion was regarded as a risky and dubious procedure, and was largely shunned by the medical establishment. They debated the procedure on and off throughout 1666 and most of 1667. [6] One may consider transfusion for people with symptoms of cardiovascular disease such as chest pain or shortness of breath. Transfusion never induced an observable transmutation in the animals—or people—subjected to it, and the negative public response put a stop to transfusion research for over a century. Although transfusions of platelets are far less numerous (relative to RBC), platelet storage lesion and resulting efficacy loss is also a concern. The risk of severe bacterial infection is estimated, as of 2002[update], at about 1 in 50,000 platelet transfusions, and 1 in 500,000 red blood cell transfusions. For his discovery he won the Nobel Prize in Physiology and Medicine in 1930; many other blood groups have been discovered since. Veterinarians also administer transfusions to other animals. To Boyle, transfusion promised the transformation of the very substance and being of biological creatures. Blood transfusion is the process of transferring blood or blood products into one's circulation intravenously. To ensure the safety of blood transfusion to pediatric patients, hospitals are taking additional precautions to avoid infection and prefer to use specially tested pediatric blood units that are guaranteed negative for Cytomegalovirus. [97] These specific requirements place additional restrictions on blood donors who can donate for neonatal use. Ultimately, they settled on Arthur Coga, mentally unstable, but educated—he knew Latin, and had spent some time as a clergyman. Transmutationary fears and desires played on existing beliefs in monsters. However, in many species (especially horses and dogs), cross matching is not required before the first transfusion, as antibodies against non-self cell surface antigens are not expressed constitutively – i.e. Can a “fierce” dog be made into a “cowardly” dog? British physician William Harvey discovers the circulation of blood. The first human transfusions were conducted in Paris, by Jean-Baptiste Denis, and in London, by Richard Lower and Edmund King, in 1667. Prior testing of donor blood only included testing for antibodies to HIV. Jean-Baptiste Denis", James Blundell, pioneer of blood transfusion, "A Canadian kept blood flowing in WWI. K+k+), heterozygous (K+k-) expression or no expression of various antigens (K−k−). The experimenter Robert Hooke felt that members of the audience gawked and pointed at him openly during the performance that he attended. [81] He used sodium citrate as the anticoagulant; blood was extracted from punctures in the vein and was stored in bottles at British and American Casualty Clearing Stations along the Front. The rate of hospitalizations with a blood transfusion nearly doubled from 1997, from a rate of 40 stays to 95 stays per 10,000 population. He asked: does transfusion change a dog of one breed into another? The reason platelets are more often contaminated than other blood products is that they are stored at room temperature for short periods of time. In the ancient and medieval world, bodily health was further grounded in a system of humors (blood, black bile, yellow bile, and phlegm). Certain regulatory measures are in place to minimize RBC storage lesion – including a maximum shelf life (currently 42 days), a maximum auto-hemolysis threshold (currently 1% in the US, 0.8% in Europe), and a minimum level of post-transfusion RBC survival in vivo (currently 75% after 24 hours). Shortly afterward, Denis performed another transfusion that also appeared to be successful. He worked out the techniques for isolating the serum albumin fraction of blood plasma, which is essential for maintaining the osmotic pressure in the blood vessels, preventing their collapse. Question: If autologous blood is transfused, can you charge 36430 for the transfusion, 86890 for the autologous blood and a P-code for the particular component (ex. [50][51][52] Of course, restrictive protocol is not an option with some especially vulnerable patients who may require the best possible efforts to rapidly restore tissue oxygenation. Shortly thereafter, Pepys met Coga at a dinner party: he found that Coga spoke “very reasonably, and very well,” though he was “cracked a little in his head.”. Early transfusions used whole blood, but modern medical practice commonly uses only components of the blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets. [7] Other blood products are given where appropriate, e.g., to treat clotting deficiencies. And, "Blood bank revenue is falling, and the decline may reach $1.5 billion a year this year [2014] from a high of $5 billion in 2008." During the years 1825 and 1830, Blundell performed 10 transfusions, five of which were beneficial, and published his results. The blood of the “emittent” dog flowed from its carotid artery into a vein in the recipient’s neck while the recipient’s own blood ran out its carotid artery. However, this method was never used widely, even in the Soviet Union. According to naval administrator Samuel Pepys, also a member of the Royal Society, at one meeting, a gentleman told a story of an old man who lived only on “woman’s milk,” finding that stronger food was too much for him. [3] In cases where patients have low levels of hemoglobin due to iron deficiency, but are cardiovascularly stable, parenteral iron is a preferred option based on both efficacy and safety. [26], Transfusions of blood products are associated with several complications, many of which can be grouped as immunological or infectious. The immunological reaction occurs when the receiver of a blood transfusion has antibodies against the donor blood-cells. Transfusions are used for various medical conditions to replace lost components of the blood. But the choice of a human recipient was more difficult. Credit: Historical Medical Library of the College of Physicians of Philadelphia. William Harvey identified that that blood flowed through the Shows three scenes of transfusion. Red cell transfusions can lead to volume overload when they must be repeated because of insufficient efficacy (see above). He also invented a number of instruments for the transfusion of blood. The end of the tube used to puncture the blood vessels and transfer the blood is at top left. Oldenburg, in publishing Lower’s results and Boyle’s questions, powered an international wave of transfusion research, much of which was coordinated through and reported in the Philosophical Transactions. Credit: John Martin Rare Book Room, University of Iowa. 1 (1665 - 1666), pp. Looked at one way, this episode represents a failure for the early Royal Society. Have a correction or comment about this article? Image: Ulisse Aldrovandi, History of Monsters (Bologna: Nicolai Tebaldini, 1642). Core body temperature can go down as low as 32 °C and can produce physiologic disturbances. The first known blood transfusion is attempted soon afterward. Bogdanov was motivated, at least in part, by a search for eternal youth, and remarked with satisfaction on the improvement of his eyesight, suspension of balding, and other positive symptoms after receiving 11 transfusions of whole blood. [65] He transfused the blood of a sheep into a 15-year-old boy, who survived the transfusion. Image: Richard Lower, Tractatus de Corde item De Motu & Colore Sanguinis (Amsterdam: Danielem Elzevirium, 1669). Usually toward end. In the last third of the 19th century, the obstetrician James Hobson Aveling invented this blood transfusion device, a small india-rubber tube, for emergency blood transfusions. Within a few years, hospital and community blood-banks were established across the United States. All donated blood should also be tested for the. According to Lower's account, "...towards the end of February 1665 [I] selected one dog of medium size, opened its jugular vein, and drew off blood, until its strength was nearly gone. Image: Johann Sigismund Elsholtz, Clysmatica Nova (Brandenburg, 1667). Duran joined the Transfusion Service at the Barcelona Hospital at the start of the conflict, but the hospital was soon overwhelmed by the demand for blood and the paucity of available donors. [66] Denys performed another transfusion into a labourer, who also survived. The patient's serum is tested against the various donor cells. Then, to make up for the great loss of this dog by the blood of a second, I introduced blood from the cervical artery of a fairly large mastiff, which had been fastened alongside the first, until this latter animal showed … it was overfilled … by the inflowing blood." The London Blood Transfusion Service was free of charge and expanded rapidly in its first few years of operation. Both used sodium citrate as an anticoagulant. Opinions vary as to the "best" way to determine transfusion efficacy in a patient in vivo. 1665 The first recorded successful blood transfusion occurs in England: Physician Richard Lower keeps dogs alive by transfusion of blood from other dogs. The world’s first experiments with blood transfusion occurred in the mid-1660s in England. In 1492, blood was taken from three young men and given to the stricken Pope Innocent VII in the hope of curing him. Yet in Lower’s time, it was wholly new, and such experiments—which he was one of the first to perform—were met with fear and controversy, much of which hung on a seemingly simple question: when blood passes from one body into another, what does it carry with it? Credit: John Martin Rare Book Room, University of Iowa. The system should include monitoring, identification, reporting, investigation and analysis of adverse events near-misses and reactions related to transfusion and manufacturing. An improved version of James Blundell’s Gravitator, manufactured by an instrument firm in St. James’s Street, London. Contaminating organisms vary greatly, and include skin flora, gut flora, and environmental organisms. "Top-up" transfusions, to replace losses due to investigational losses and correction of anemia. 1 However, it was not until the early part of the 20th century that blood transfusion became a mainstay of clinical practice. Following Lower’s experiments, researchers were eager to leap forward, to try transfusing blood into a human subject. All Rights Reserved. Background: Transfusion-associated circulatory overload is characterised by acute respiratory distress, tachycardia, increased blood pressure, acute … Replacing breakable glass bottles with durable plastic bags made from PVC allowed for the evolution of a collection system capable of safe and easy preparation of multiple blood components from a single unit of whole blood. Compatibility of ABO and Rh system for Red Cell (Erythrocyte) Transfusion. [92][93], Further extending the shelf-life of stored blood up to 42 days was an anticoagulant preservative, CPDA-1, introduced in 1979, which increased the blood supply and facilitated resource-sharing among blood banks. In 1818 following experiments with animals, he performed the first successful transfusion of human blood to treat postpartum hemorrhage. which reduced breakage and made transportation, packaging, and storage much simpler.[90]. Both instances were likely due to the small amount of blood that was actually transfused into these people. Much of Boyle’s time was occupied with research in this esoteric science, the forerunner of modern chemistry. In the first US blood banks, physicians segregated the blood of black donors from that of white donors, following white Americans’ fears that blood carried with it a force for racial transmutation. Early modern anatomists sought to bring hands-on surgical skills and medical knowledge into closer contact with each other.Image: Helkiah Crooke, An Explanation of the Fashion and Use of Three and Fifty Instruments of Chirurgery, Gathered out of Ambrosius Pareus (London: Michael Sparke, 1634). Blood is most commonly donated as whole blood obtained intravenously and mixed with an anticoagulant. Of the Incalescence of Quicksilver with Gold, Generously Imparted by B.R. Scholarly journals, more generally, have become important tools for advancing knowledge across academic fields. First, if there are multiple units hung and the recipient has a reaction, it's impossible to tell which of the units caused it. With red cells, this can decrease viability and ability for tissue oxygenation. If you transfuse blood from a dog that’s just been fed into a hungry dog, will the hungry dog still be hungry? Blood transfusions fell into obscurity for the next 150 years. In her recent book, Banking on the Body: The Market in Blood, Milk, and Sperm in Modern America, Swanson tells the story of Cook County Hospital, Chicago physician Bernard Fantus, who in 1937 first described a repository of donated blood as a “bank,” setting off an entanglement between blood, markets, and money that has since spread to other body products—milk, organs, semen, and human eggs—and continues to complicate therapeutic uses of these substances and disturb our consciences. In its 350th year, Philosophical Transactions is now the world’s oldest scientific journal. [53], Globally around 85 million units of red blood cells are transfused in a given year. [79] This enables management and investigation of any suspected transfusion related disease transmission or transfusion reaction. The sample is then screened for any alloantibodies that may react with donor blood. 1667: The first blood transfusion involving a human being is performed. Image Credit: John Martin Rare Book Room, University of Iowa. 1 (1665 - 1666), pp. Physicians have adopted a so-called "restrictive protocol" – whereby transfusion is held to a minimum – in part because of the noted uncertainties surrounding storage lesion, in addition to the very high direct and indirect costs of transfusions. Secondly, if a hemolytic transfusion reaction occurs it is best to … In those who were given red blood only with significant anemia infection rates were 12% while in those who were given red blood at milder levels of anemia infection rates were 17%. Given that the procedure usually killed the “emittent,” a human-to-human transfusion was not possible. When complications do occur, they're typically mild. Image: Johann Sigismund Elsholtz, Clysmatica nova (Brandenburg, 1667), plate 1. Metabolic alkalosis can occur with massive blood transfusions because of the breakdown of citrate stored in blood into bicarbonate. He had been called to see his sister after she had given birth. Antigen negative units are then tested against the patient plasma using an antiglobulin/indirect crossmatch technique at 37 degrees Celsius to enhance reactivity and make the test easier to read. JSTOR is part of ITHAKA, a not-for-profit organization helping the academic community use digital technologies to preserve the scholarly record and to advance research and teaching in sustainable ways. Reaction symptoms include: 1. rash 2. itching 3. feve… Red cells, plasma and platelets can also be donated individually via a more complex process called apheresis. White blood cells are not commonly used during transfusion, but are part of the immune system, and fight infections. The first blood bank was established in Leningrad in 1932, and the first blood bank in the United States [23] It takes about 45 minutes to complete (depending on the method used). BLOOD TRANSFUSION PRESENTED BY: DR.PRANALIKA KANOJIYA PG 1ST YEAR OUTLINE: INTRODUCTION HISTORY OF TRANSFUSION INDICATIONS OF BLOOD TRANSFUSION TYPES OF BLOOD TRANSFUSION DONATION AND COLLECTION ADMINISTRATION COMPLICATIONS OF BLOOD TRANSFUSION MASSIVE BLOOD TRANSFUSION INTRODUCTION Blood is a familiar red fluid in the body that contain white blood cells, Red blood … A blood transfusion can replace blood you have lost, or just replace the liquid or cells found in blood (such as red blood cells, plasma or cells called platelets). Such things had been seen before: blood was not the only body fluid with transmutationary potential. - Sep., 1989), pp. Blood transfusion is a common technique that is commonly used in the hospital, especially when the patient is in grave danger. A known relationship between intra-operative blood transfusion and cancer recurrence has been established in colorectal cancer. Before the transfusion, a set of vital signs will be taken determining the patient’s temperature, heart rate, breathing rate and blood pressure. Historically, red blood cell transfusion was considered when the hemoglobin level fell below 10 g/dL or hematocrit fell below 30%. [3], In the United States, blood transfusions were performed nearly 3 million times during hospitalizations in 2011, making it the most common procedure performed. In transfusion research, Boyle saw the possibilities for alchemical transmutations within living beings: when blood was transferred between bodies, he asked, what powers were carried with it? Transfusion was bloody, painful and messy.Image: Johann Sigismund Elsholtz, Clysmatica Nova (Brandenburg, 1667). According to physician Richard Lower, who described the operation in an essay published in 1666 in Philosophical Transactions, the world’s oldest scientific journal, the transfusion came to an end when the emittent dog began “to cry, and faint, and fall into Convulsions, and at last dye [sic].”. 557-559, The British Journal for the History of Science , Vol. The procedure, which was first carried out between dogs, was gruesome: the dogs were tied down, the arteries and veins in their necks The first research into blood transfusion dates back to the 17th Century when British physician William Harvey fully described the circulation and properties of blood in 1628. The blood was stored in a sterile glass enclosed under pressure at 2 °C. In developed countries, donations are usually anonymous to the recipient, but products in a blood bank are always individually traceable through the whole cycle of donation, testing, separation into components, storage, and administration to the recipient. In that year, Oliver was contacted by King's College Hospital, where they were in urgent need of a blood donor. The first transfusion of human blood for the treatment of hemorrhage was performed by Dr. James Blundell in London in 1818. Hypocalcemia can also occur with massive blood transfusions because of the complex of citrate with serum calcium. This can be due to several reasons, such as patient safety, economic burden or scarcity of blood. line so that medication একটি অরাজনৈতিক অলাভজনক সামাজিক যোগাযোগ মাধ্যম ফেসবুক ভিত্তিক অনলাইন ব্লাড ব্যাংক। This can result in a life-threatening infection known as transfusion-transmitted bacterial infection. Landsteiner discovered that adverse effects arise from mixing blood from two incompatible individuals. [2][3] Because each unit of blood given carries risks, a trigger level lower than that, at 7 to 8 g/dL, is now usually used, as it has been shown to have better patient outcomes. This will serve as a baseline during the transfusion. There are a number of tests that are performed prior to a blood transfusion, in order to ensure that the donor and recipient are a match. By 1925 it was providing services for almost 500 patients; it was incorporated into the structure of the British Red Cross in 1926. Loutit and Patrick L. Mollison of acid–citrate–dextrose (ACD) solution, which reduced the volume of anticoagulant, permitted transfusions of greater volumes of blood and allowed longer-term storage. For example, the standard of care reduced the amount of blood transfused in one case from 750 to 200 ml.[62]. Credit: John Martin Rare Book Room, University of Iowa. Bogdanov died in 1928 as a result of one of his experiments, when the blood of a student suffering from malaria and tuberculosis was given to him in a transfusion. In developing countries, the donor is sometimes specifically recruited by or for the recipient, typically a family member, and the donation occurs immediately before the transfusion. In addition, in some countries platelet products are also tested for bacterial infections due to its higher inclination for contamination due to storage at room temperature. O-negative is also used for children and women of childbearing age. The latter is much more common than the former. The recipient was Arthur Coga, "the subject of a harmless form of insanity." [25] In the UK this data is collected by an independent organisation called SHOT (Serious Hazards Of Transfusion). Though the research stopped, the mockery did not. A definite diagnosis of transfusion-transmitted bacterial infection includes the identification of a positive culture in the recipient (without an alternative diagnosis) as well as the identification of the same organism in the donor blood. At the onset of World War II, liquid plasma was used in Britain. ", "Taming the Immune System Through Transfusion in Oncology Patients", "DAMAGE CONTROL RESUSCITATION AND MANAGEMENT OF SEVERE HEMORRHAGE/SHOCK IN THE PREHOSPITAL SETTING", "Blood Industry Shrinks as Transfusions Decline", "The history of peripheral intravenous catheters : How little plastic tubes revolutionized medicine", "This Month in Anesthesia History (archived)", "Red Gold . Agency for Healthcare Research and Quality, Rockville, MD. The mechanism is thought to be due to disseminated intravascular coagulation, along with dilution of recipient platelets and coagulation factors. If a blood transfusion reaction does occur, it is imperative to keep an established I.V. Not all antibodies are clinically significant (i.e. The experimentalist started and stopped the flow of blood by loosening and tightening threads tied with running knots around the dogs’ blood vessels. Minor blood transfusions are used by a minority of nyaope drug addicts in South Africa to economically share the high the drug induces in a practice colloquially known as Bluetoothing, named after the wireless technology of the same name.[104]. This system evolved into the National Blood Transfusion Service established in 1946, the first national service to be implemented. Image: Jan Swammerdam, De Respiratione (Leiden: Apud Danielem, Abraham & Adrian, à Gaasbeeck, 1667). [87] With the outbreak of war appearing imminent in 1938, the War Office created the Army Blood Supply Depot (ABSD) in Bristol, headed by Lionel Whitby and in control of four large blood-depots around the country. Alexander Bogdanov founded an academic institution devoted to the science of blood transfusion in Moscow in 1925. [citation needed]. It was settled that a sheep would be the source of the blood for the Royal Society’s first transfusion into a human subject. [47] In general, there are not yet any in vitro tests to assess quality or predict efficacy for specific units of RBC blood product prior to their transfusion, though there is exploration of potentially relevant tests based on RBC membrane properties such as erythrocyte deformability[48] and erythrocyte fragility (mechanical).[49]. Will a dog with new blood still know its master? Shadwell played on transfusion’s transmutationary possibilities. We treat blood as a commodity, swapping units in and out of bodies as necessary. Prevention should be done with warming the blood to ambient temperature prior to transfusions. The premise of many of Boyle’s questions was that blood transfusion might induce physical, mental, and psychological changes in the animal receiving blood. Far from killing either of the animals, this experiment transformed the healthy bulldog into a mangy spaniel, and vice versa. Credit: Historical Medical Library of the College of Physicians of Philadelphia. [67] Finally, in 1668, the Royal Society and the French government both banned the procedure. The world’s first experiments with blood transfusion occurred in the mid-1660s in England. Yet, if we return to the initial publication of Lower’s procedure, and Boyle’s questions, the episode can also be seen as a success. Credit: John Martin Rare Book Room, University of Iowa. Does it alter a dog’s temperament? If there is no antibody present, an immediate spin crossmatch or computer-assisted crossmatch is performed where the recipient serum and donor rbc are incubated. A few days after his transfusion, Coga reported to the Society on its effects, presenting his remarks in Latin. HCUP Statistical Brief #165. A direct antiglobulin test (Coombs test) is also performed as part of the antibody investigation.[24]. The first step before a transfusion is given is to type and screen the recipient's blood. Canadian doctor and Lieutenant Lawrence Bruce Robertson became instrumental in persuading the Royal Army Medical Corps to adopt the use of blood transfusion at the Casualty Clearing Stations for the wounded. The value of blood transfusion was essentially unchallenged throughout most of this century. Before a blood transfusion is given, there are many steps taken to ensure quality of the blood products, compatibility, and safety to the recipient. And ability for tissue oxygenation research in this esoteric science, the Journal! Less likely to cause HLA, Pathogen reduction treatment that involves, for example, the British obstetrician Blundell... Program was initiated [ by whom? phlebotomist 's skin, and ITHAKA® are registered trademarks ITHAKA., `` the subject of a blood transfusion is the removal of white blood cells releases free into. Could report reliably on transfusion ’ s Street, London Belgian doctor Hustin... 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