THE BLOOD CURE
Canadian doctor’s work saved lives on First World War battlefields,
As British soldiers fought the Battle of the Somme, a Toronto surgeon on the Western Front offered them an idea, hoping to save the wounded.
It was 100 years ago that Dr. Lawrence Bruce Robertson published “The Transfusion of Whole Blood: A Suggestion for Its More Frequent Employment in War Surgery” in the British Medical Journal.
It was a big deal. British physicians, of course, knew about blood transfusions, but they preferred saline when it came to dealing with blood loss. Transfusions in those days were mostly direct artery-to-vein affairs, and they came with difficult surgery, clotting and rejection risks. For many in the British medical establishment, saline was a simple way to replace fluid in a person’s vascular system and improve blood pressure.
Robertson, a tall, brown-haired man, often seen smoking a pipe or cigarette in photos, was known by his middle name, Bruce. He believed saline was only a temporary fix. (Saline dilutes the body’s clotting factors, which meant bleeding would continue.)
Working behind the front lines in 1915 and early 1916, he performed indirect transfusions by drawing blood from healthy-enough soldiers with broken ankles or other fractures. He would then inject the blood into soldiers whose limbs had been shattered by shrapnel and bombs — men having secondary hemorrhages.
Robertson wrote that “the additional blood often carries the patients over a critical period, and assists his forces to rally to withstand further surgical procedures.”
The Americans were at the forefront of surgery in the early 1900s, and Robertson had learned the technique at New York’s Bellevue Hospital. But with the U.S. sitting out the war until 1917, the Canadians were uniquely positioned to bring new techniques to the battlefield.
During the disastrous Somme campaign, thousands of wounded British soldiers were treated with saline, and the British acknowledged in their official history it was “most disappointing,” according to medical historian Kim Pelis, who wrote in 2001 about the history of blood transfusion.
Robertson believed in blood and kept pushing for its use. In 1917, in another article, he noted how transfusions performed in the casualty clearing station near Ypres, Belgium, transformed the pallid, semi-conscious patient with a flickering pulse into a “comparatively healthy,” comfortable, conscious person.
Blood transfusion began to play an important role in saving soldiers who had been seen as hopeless cases from “wound shock,” Pelis writes.
The casualty clearing station’s war diary was effusive, calling the results “little short of marvellous.”
Robertson worked to the point of exhaustion and was endlessly curious, inviting patients to keep in touch, often giving them self-addressed envelopes.
“On the 13th June you took my leg off above the knee, and until I received blood from someone else you considered the betting about 3 to 1 on my pegging out,” one soldier wrote in 1917, in a letter at the Archives of Ontario. “Can you find time to let me know the name and address of the man who gave me blood? I should much like to write to him.”
Another letter, from a curious donor: “I should like to know Sir if the patient (I acted as blood donor for) is recovering alright.”
Through the academic papers, demonstrations of procedures and creating the “resuscitation ward” for men to receive transfusions to combat shock, Robertson and fellow Canadians set the stage for the British acceptance of blood transfusion, Pelis wrote in her 2001article.
Now a writer at the U.S. National Institutes of Health, she says Robertson “leapt off the page” during her research.
“He felt like a man of great integrity and concern and awareness,” she says.
But in the aftermath of the war, the Canadians were mostly forgotten. The American entry into the conflict in 1917 was linked to the acceptance of blood transfusion, Pelis explains, thanks to the seminal 1922 article about transfusion written by British surgeon Geoffrey Keynes.
Robertson wrote to Keynes, not for any credit, but to let him know that it was the Canadian surgeon Maj. Edward Archibald who came up with the idea to use citrate as a coagulant in 1915 — not American surgeon Oswald Hope Robertson in 1917.
“I believe in giving the Americans all the credit due to them, but you know they have a national prejudice against undervaluing their own accomplishments, which is rather too apparent over here, though it may be modified by distance to your point of view,” he wrote.
“Isn’t that gorgeous?” says Suzanne Evans, who wrote about Robertson and his wife in 2013 for Canada’s History magazine. “I love that bit.”
Robertson returned to Toronto in 1918 and continued with transfusion work at the Hospital for Sick Children.
Back in the city, he met Enid Finley, a strong-willed woman later known as the mother of physiotherapy in Canada, who helped create the field and persuaded the government to put physiotherapists in uniform during the Second World War.
Granddaughter Orian Hartviksen has the letters Bruce sent Enid as they planned a life together.
“Dear girl of mine,” he’d write, in his illegible doctor’s handwriting, about the mundane details of shopping for the new home, and his work at the hospital.
In January 1920, he treated a baby who had a “hopeless” case of toxemia. Robertson suggested a blood transfusion from the baby’s father.
“At the end of the transfusion the baby was so far gone that I thought it would barely live for more than a few minutes but it began to pick up a bit and then in the course of a few hours was very much better,” he wrote to Enid.
The couple married and had children, but Robertson died of influenza complications in 1923, only 37. “Brilliant surgeon taken in his prime,” one headline read.
“He was very proud of him, but he really didn’t know him,” says Kathleen Bruce-Robertson, 93, who married Robertson’s son Alan, who was only 2 when his father died.
After his death, Enid changed the surname of the children to the more cumbersome Bruce-Robertson, to keep his legacy and name intact and avoid confusion with American surgeon Oswald Robertson, Kathleen explains, noting it can feel a little long when you’re writing out traveller’s cheques.
Enid later remarried, changing her name to Enid Graham.
Dr. Andrew Beckett, a veteran combat surgeon with the Canadian Forces, says the pendulum has swung back and forth between saline and whole blood since the First World War, but now whole blood is thought to have better outcomes.
Beckett says that when soldiers were dying of shock in Iraq and Afghanistan, surgeons went back to papers written 100 years ago, by people like Robertson.
Because of the continued difficulty in shipping blood products, blood was collected from Canadian soldiers for use — just as Robertson did, with the requisite technological advances.
“In terms of combat casualty care, his work is probably one of the greatest contributions ever made,” Beckett said.