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JAMA Dermatology a Century Ago
November 2014

Society Transactions

JAMA Dermatol. 2014;150(11):1144. doi:10.1001/jamadermatol.2014.379

The first credible description of syphilis was in 1494. Blundell successfully performed human-to-human blood transfusion in 1829. Yet, amazingly, Dr Dade’s casual observation was the first report of transfusion-transmitted syphilis. Certainly in the early days of transfusion therapy, catching syphilis might be one of a recipient’s lesser concerns. The most catastrophic complication of transfusion was largely solved in 1900 when Landsteiner isolated the major blood compatibility groups (A, B, and O). The discovery of the last major blood group, AB, in 1902 and the beginning of blood typing in 1907 helped abate this greatest impediment to donor-recipient matching. Inadequate sterilization technique could easily lead to site infection or even sepsis. This risk was somewhat ameliorated in 1913 when Lindeman invented a much simpler needle puncture technique that moved transfusion out of the surgical suite. Beginning in 1914, the use of sodium citrate as an anticoagulant removed the last major technical obstacle from direct person-to-person transfusion. Ironically, all these advances in technique allowed transfusions to become more commonly used, and in the pre-penicillin era, when it was estimated that 1% of the US population was syphilitic, it was just a matter of time until syphilis found a new, nonvenereal mode of transmission. Neither was the risk merely confined to the blood recipient: with donor and patient directly connected by the transfusion apparatus, cases occurred of reverse transmission of lues from the patient to the blood donor. Landsteiner and Wiener’s isolation of the Rh factor in 1940 essentially eliminated incompatibility issues. Now the potential for getting syphilis from a transfusion was the patient’s worst fear!

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