Origins of the PRP Plasmolifting Method (Part 2)

The fact that auto-hemotherapy is usually not considered a form of vaccine therapy seems to be largely due to the difference in their historical origins. As just explained, the former developed out of "serum therapy," an intravenous injection of "immune serum" obtained from an immunized person, and is said to transmit "passive immunization." The latter, however, attempts to directly immunize the patient, thus being termed "active immunization." This difference leads to the conclusion that one and the same procedure cannot be both serotherapy and vaccine therapy.

After this digression, we return to the historical narrative. In 1901, before the works of Spiethoff appeared, Valentin Jez reported on the subcutaneous reinjection of autologous serum taken from a patient's vein, in the regime of treatment of erysipelas. It is also documented that in 1905 August Bier used it to treat pneumonia, not relying on results of previous uses of autologous blood. However, despite the documentation of these and other earlier results in autohemotherapy, the French dermatologist Paul Ravaut became known as the pioneer in this method. In an essay published in 1913, he describes auto-hemotherapy as an effective method of treating dermatoses. Ravaut's article appeared in a French journal only a few months after Spiethoff's report on similar use of autologous serum that was published in a German journal. Spiethoff attempted to show that the credit belonged to him, not Ravaut, by calling attention to his report of the introduction of not only autologous immune serum but also autologous blood. His insistence that his discovery predated Ravaut's fell on deaf ears.

We turn, then, to Ravaut's better-known methods and justifications. He used the term "auto-hematotherapy" to describe his "simpler" method of reinjection of autologous whole blood; his data pointed to a significantly lower risk of infection during auto-hematotherapy than through the use of autogenous serum or heterologous blood. He further concluded that it was advisable to administer whole blood with the rationale that all possible beneficial elements in the blood were thereby supplied to the body. He also postulated that reabsorption of blood introduced under the skin would induce the body to produce more antibodies.

Spiethoff was not alone in refusing to give priority of discovery of auto-hemotherapy to Paul Ravaut. For example, Wien et al. wrote that auto-hemotherapy developed upon the basis of the research of many scientists. They cited the following researchers who had published results before Ravaut: Naswitis (who had published results of the use of frozen then thawed blood); Dold (who had successfully applied autologous blood for the treatment of eczema), and Fauvet (who had received favorable results in the treatment of cases of furunculosis, carbuncle, mastitis, eczema, strophulus and pruritic erythema). Additionally, Wien et al. cited researchers and doctors who had used autologous blood at the beginning of the 20th century to treat infectious diseases, influenza, typhoid, scarlet fever, measles, atrophy, gynecological, venereal (gonorrhea and syphilis) and oncological diseases and even African trypanosomiasis.

One of the first to use auto-hemotherapy in Russia was the military surgeon Archbishop Valentin Felixovich Voyno-Yasenetsky. During the Russo-Japanese War, he treated soldiers with auto-hemotherapy, and in 1934 published his essay Sketches of Purulent Surgery, in which he described the indications and procedure for the use of auto-hemotherapy and auto-serotherapy. Other Soviet doctors and researchers also contributed greatly to the development of auto-hemotherapy. Many scientific papers were published in the mid-20th century on the application of auto-hemotherapy in dermatology, cardiology, ophthalmology, obstetrics and gynecology, surgery, pulmonology, and other fields of medicine.

The history leaves open the reasons for the wide range of applications of auto-hemotherapy. There have been several versions explaining the corresponding mechanism, albeit under varying terminology.

A number of authors adhered to the generally accepted opinion that the "invader," i.e., a pathogenic microorganism, is absorbed by oxygen when exposed to air, enters the coagulating blood, and then loses oxygen when reintroduced into the tissue. Then the body can detect the death of the pathogen, "determine its identity" and then establish a system-wide protection. In this version, then, the blood contains some suitable antigenic form of the pathogen. In other words, auto-hemotherapy acts as a pathogen-specific "vaccine." This is consistent with studies of Burgess (1933), who suggested that "the blood of these patients may contain antigens, so that the injection of blood or serum thus leads to desensitization."

Ellis B. Freilich and George C. Coe surmised that "the blood, after being removed from the body, in the short time that elapses before reinjection, goes through some change, as yet unknown, and becomes a heterogeneous foreign body. It must be stressed that the substances which give the blood the characteristics typical of the heterogeneous protein are not present in the circulating blood but are formed during the exteriorization of the blood."

Leonard T. Saxon, based on ten years of research into this subject, argued that "curative effect in this therapy is the blood serum, which contains all the protective bodies – whatever they may be..."

It is worth making specific mention of Charles Duncan's input: in 1916, he described his own method of treatment with autologous blood. His techniques were similar to the autoserum therapy that Gilbert conducted with serous fluid from a pleural effusion: "... the writer has cured infections by simply puncturing a vein with a hypodermic needle, drawing the blood into the syringe that already contains sterile physiological salt solution, and then withdrawing the needle till it is just beneath the skin and inject the contents there."

Duncan noticed a possible connection between this procedure and some cases of spontaneous remission. He stated that "the probable efficacy of a trauma that results in extravasation of blood into the subdermal tissues in a patient suffering with some chronic infection is apparent." In a follow-up to that article (1916), Duncan also observed that in systemic infections "or those in which the pus pocket is not accessible, cure will result from the subcutaneous injection of small doses of the patient's own blood diluted with physiological salt solution." He argued that subdermal injection of a large amount of fluid, such as isotonic solution, sterile water, etc., "must necessarily rupture some minute blood vessels, and therefore produce some extravasation into the tissues. The toxins would now be diluted with a physiological salt solution within the loose cellular subdermal tissues where we know the greatest amount of antibodies are developed."

Despite the differences in hypotheses designed to explain the mechanism of autologous blood action, most authors agreed that auto-hemotherapy is an extremely effective, yet simple and safe method of treatment and that it represents an ideal first response for many diseases. A frequent remark was that auto-hemotherapy has never violated the promise in the Hippocratic Oath, "Primum non nocere" ("First, do no harm").

References to the safety of intramuscular injection of autologous blood are frequently mentioned in the corresponding literature. As an example, Logan Clendening wrote that "the greatest advantages of autohemotherapy are its simplicity and safety." The only risk that this literature has highlighted was that associated with repeated intravenous administration of blood. Turning to more current sources, the assessment of auto-hemotherapy by the American Association of Blood Banks (now known as the AABB) is very eloquent: "Autologous blood and components are the safest transfusions a patient can receive. The absence of risk of alloimmunization to erythrocyte, leukocyte, platelet, or plasma protein antigens significantly reduces the risk of adverse reactions."

Despite the obvious advantages of such treatment, its use has steadily declined; references in the medical literature to the "classical" practice of auto-hemotherapy have almost completely disappeared.

The "information explosion" has overloaded the medical education system, leading it to regard auto-hemotherapy as a "relic of the past." Thus, doctors simply had no access to the corresponding knowledge. The glut in the 1940s and 1950s of "miraculous" medicines reduced the need for the auto-hemo-therapeutic treatment, leading it to be less valued. The subsequent gross commercialization of the field of medicine did not make things better. There was no longer any place for auto-hemotherapy in the world of modern medicine.

Despite these factors, a convincing argument could be made for the potential of auto-hemotherapy to act synergistically with other techniques of modern medicine. In any case, it deserves recognition as a landmark achievement of 20th-century medicine, and one which, albeit in a modified form, continues to serve mankind in the 21st century.