Cold blood and clinical research during World War I.

Therapeutic transfusion was not a common procedure at the turn of the century. Although its safety was enhanced by the discovery of blood groups and preinfusion testing in the decade prior to World War I, techniques and indications remained cumbersome and clinically naive. By 1916, a stable Western Front, an efficient line of transport, and the operative requirements of a large number of wounded demonstrated the futility of pharmacotherapy or saline infusion for traumatic shock. In the same year, Rous and Turner at the Rockefeller Institute developed a preservative solution for whole blood. Rous' student, Dr. O.H. Robertson, arrived in France with Base Hospital 5 in June 1917 during a period of growing recognition by military surgeons that transfused blood was an effective therapy, although a practical delivery system was not available. Over the next 8 months, Robertson clinically tested a transfusion technique using preserved blood in glass jars carried to the front in specially designed cases. The method was accepted immediately, and by the Armistice transfusion was used frequently on the front line or during the perioperative period. The accessibility of preserved blood with an efficient transfusion system reinforced the introduction of "resuscitation teams" attached to Casualty Clearing Hospitals for the specialized management of traumatic shock. Robertson's success at technical innovation during World War I associated with a large clinical population resulted in the development of the indications and procedures for modern transfusion therapy.