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: “Today blood transfusions are done on a large scale everywhere and have even become part of regular practice.” Admitting that this was not the case “at interior posts where conditions are not always favorable,” Kok nonetheless gave as the principal reason for the wide use of transfusion “the efficacy of the procedure, the simplicity of instrumentation, and the lack of specialized and expensive medicines during the war.”51
The thesis provided few details about location, except for one reference to Katanga. It concentrated instead on practical techniques such as obtaining donors, in which case Kok went first to the immediate family or friends of the patient, with a preference for young females “who agree more voluntarily than the men,” and if unavailable then made a request to infirmary personnel. Compatibility testing was done by the simple mixing of blood drawn from donor and patient. Wasserman tests were done if time permitted, and 250 cc of blood was typically drawn into a mixture with sodium citrate. Blood was given to the patient in the sickbed, and the author stated, “in over a hundred blood transfusion done in ten years I never encountered serious shock.” He described the risk of transmitting various diseases, with some (e.g., tuberculosis, sleeping sickness) being more serious than others. By taking precautions such as examining potential donors, he concluded that “the danger of transmitting illness by blood transfusion is not very serious.” As to the illnesses most frequently and effectively treated by transfusion, the first was anemia, the most common cause of which was hemorrhage during a difficult childbirth; next was toxic anemia from worms; and, behind that, anemia from advanced cases of malaria. The author’s ultimate conclusion: “Blood transfusion, despite the difficulties inherent in the native setting, . . . can be used more with very satisfactory results.”52
Early Transfusion in the British Colonies
There was far more variety in the number of British colonial holdings in sub-Saharan Africa, but like the Belgian Congo there was a similar pattern in how new health facilities were developed. This development included initial investments before the First World War that followed colonial interests at ports, capitals, and business enterprises. Medical missionaries were also active, but unlike the Congo, there were significant settlers in Kenya and southern Africa.53 Beginning in the 1920s the expansion of hospitals and European-trained doctors followed a policy to move health facilities out of the capitals to rural areas where missionaries had mostly been providing Western medical care. “A government hospital is a tangible sign of Government activities which is understood by every native,” argued J. L. Gilks, principal medical officer for Kenya in his 1921 annual medical report.54 “It is a fact which cannot be gainsaid, that the provision of medical attendance,