The History of Blood Transfusion in Sub-Saharan Africa. William H. Schneider

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СКАЧАТЬ for Africans to support economic activity (e.g., mining), or where there was sufficient development of health infrastructure to reach Africans.

      One example of the knowledge of transfusion and willingness of Africans both to donate and receive blood can be found in South Africa. Although an area not included in this study, conditions were similar enough to illustrate the point early on. In a 1921 paper, J. H. H. Pirie of the South African Institute for Medical Research described testing for blood types that was inspired by the research of Ludwik and Hanna Hirszfeld during the First World War. They had done blood group tests on thousands of troops, including 250 Africans, and found striking differences in the proportions of the ABO blood types depending on country of origin.³⁷ What made it possible for Pirie to verify these results was his observation that “blood transfusion is a procedure which has now become so frequently employed . . . that a brief review of the preliminary tests required in order to ascertain the suitability of the donor’s blood may not be out of place.”³⁸ Pirie did not say whether he used existing blood tests of black Africans receiving transfusions, or if he tested subjects especially for his study, but his article at least demonstrates that blood transfusion was practiced routinely in 1921 at two hospitals in South Africa, where his colleagues provided him access to blood tests.

      Early Transfusion Services in the Belgian Congo

      There is noteworthy evidence of doctors in the Belgian Congo who followed the suggestion to repeat the successful results described in Lejeune’s report of transfusion. Although, there was little European settlement in the colony, Belgian authorities made significant investments in health in the 1920s and 1930s because of business and mining interests and a government expectation of productivity benefits from healthier subjects.³⁹ In fact, there were reports from at least three different locations where transfusion began in this large colony before the Second World War. Although the doctors likely soon knew of each other’s work, the opportunities developed independently, and there was no effort at coordination by the colonial government. Because Belgian colonial administrators took advantage of a variety of sources for medical services, the government increased the number of health facilities but hindered centralization. This same independence probably made the introduction of transfusion more likely because of multiple influences, but expansion was less likely because of limited resources.⁴⁰

      Of the three places where transfusions were reported, the one most similar to other colonies was in the capital of Léopoldville. There the Hôpital des congolais grew into a large general hospital for Africans between the wars, and although postwar plans for a new one never were achieved, additional space and updated equipment were added to serve the growing population of the capital. Unlike Kenya, Nigeria, or Uganda, where new hospitals were built with the latest facilities, including blood banks, transfusions increased at the Leopoldville hospital without much fanfare.⁴¹ For example, as early as 1939 a doctor in the pediatric service of the Hôpital des Congolais began transfusions for severely anemic infants from a variety of causes including (malaria, worms, malnutrition, and syphilis).⁴² He had previously done the procedure in Rwanda. By 1956 over seven thousand transfusions were done annually for these cases.⁴³ The Queen Astrid Laboratory, which serviced the hospital, reported the preparation of test sera for determining blood types as early as 1947, and by 1954 it reported doing over sixty-four hundred blood group tests.⁴⁴ The initiative for a more central blood collection and processing service started only in 1953 and from a facility in Léopoldville with outside connections: the Congo Red Cross. In fact, this outside association provoked a conflict with the Hôpital des congolais, which had its own recruitment of donors.

      One of the doctors at the Hôpital des congolais who did blood transfusion after the Second World War was Joseph Lambillon, the head of the maternity service. He had first done transfusions in Africa shortly after he went to the Congo in 1938 to work in the eastern Kivu region at a hospital in Katana that was supported by the University of Louvain. Fresh from two years as an assistant in one of the top surgery services in Belgium, Lambillon was eager to introduce modern medical practices that were appropriate for the Congo. In 1940 he published an article, coauthored with the other doctor at the hospital, entitled “Étude de l’organisation d’un service de transfusions sanguines dans un centre hospitalier d’Afrique.”⁴⁵ The report, in fact, referred to only thirty transfusions, but Lambillon was less interested in claiming credit for a new procedure than he was eager to demonstrate, like Lejeune before him, the viability of transfusion in the African setting. He concluded, “This note has no pretensions of innovation. But it permits us, in the end, to underscore that in the colonial setting blood transfusion is very easily done, thanks to the large number of chronic patients that are in all the native hospitals who can serve as donors. Transfusion has the very big advantage of being a striking treatment that above all is not costly, a fact which is of great importance in native medicine.” Lambillon thus showed it was not lack of donors, nor Africans’ rejection of the value of blood transfusion that stood in the way of using the lifesaving procedure. Doctors simply needed to use it.

      The one place where Lambillon’s efforts most likely had an impact was at another hospital run by the University of Louvain in Kisantu, at the other end of the colony in Lower Congo. As late as 1934, this hospital reported no transfusions, despite its unusual link back to a major medical faculty in Europe. It was in the same year Lambillon’s article appeared (1940), however, that doctors at Kisantu began to treat severely anemic infants with blood transfusions. Once they had begun, they did so in a very systematic and extensive way. Throughout the 1940s and into the next decade, Kisantu Hospital treated over six hundred infants, most under a year of age, with over twenty-two hundred transfusions annually by 1949.⁴⁶

      The most unusual and earliest report of transfusions in the Belgian Congo, however, was in yet another location with unique resources and opportunities to do blood transfusions: the medical service of the Union Minière du Haut Katanga. In 1924 doctors at the African hospitals at Panda and Elisabethville (later, Lubumbashi), in Katanga Province, published the results of studies using transfusion therapy for African workers with pneumonia. This was a cross between serum therapy and transfusion, since blood was drawn from convalescing pneumonia patients and then given to patients with active cases of pneumonia. An initial test on forty-five patients was followed by a larger study of 238.⁴⁷ The results, however, were not definitive. Although doctors recognized the risk of introducing different pneumonia strains, they concluded, “comparing our results overall, this method is the best that we have a chance to use. Compared with various other treatments and colloid therapy, . . . it represents serious progress.”⁴⁸

      An even more innovative transfusion technique was reported in a 1934 note by Dr. George Valcke about an autotransfusion he practiced on an African woman in Katanga who had hemorrhaged after giving birth. He withdrew blood from her abdominal cavity, filtered it, and then reintroduced it to her as a transfusion. Valcke, who served in the Congo for over twenty years before returning to Belgium in 1933 to head the Leopold II Clinic in Antwerp, indicated he had learned the technique from Professor Joseph Sebrechts of the Catholic University of Louvain, one of the most famous Belgian surgeons, who gave a demonstration in Elisabethville in 1930.⁴⁹ Valcke’s brief 1934 note responded to a lengthy article on the work of the obstetrical clinic at Kisantu Hospital, which made no reference to transfusions.⁵⁰ The doctor in charge, Antoine Duboccage, mentioned that among several cases was a severe hemorrhage ending in death. Valcke noted that Duboccage should have used the autotransfusion method. Despite this suggestion, it took a change of personnel at the Louvain hospital and the report of Lambillon’s work before transfusions began in Kisantu for anemic infants.

      An indication of how widespread transfusion was practiced in the Belgian Congo, and possibly other colonies in sub-Saharan Africa by the Second World War, can be found in a thesis written at the Prince Leopold Institute of Tropical Medicine in Antwerp in 1950. In it the author (listed only as L. Kok) described giving over a hundred blood transfusions in the Belgian Congo “to natives as often as possible over a dozen years.” That this was not unusual is made clear in the opening sentence, which bore out the prediction of Lejeune thirty years earlier: СКАЧАТЬ