Human history is full of blood, and it has not only been spilled on battlefields and in dark alleys. Blood itself has had an active part in world events. In his fascinating book Blood: A History of Medicine and Commerce, Douglas Starr explains, among other things, how American expertise in blood banking helped the Allies win World War II in Europe and how controversy over a shady plasma bank in Managua, known locally as the casa de vampiros, sparked the Nicaraguan civil war in the 1970s.
Blood, the book, contains many images of squeamish fascination: about “sixteen million gallons of blood and plasma are collected annually worldwide,” Starr informs us, “the equivalent of thirty-two Olympic-size swimming pools.” Later, he describes how a doctor “sliced through the skin with a scalpel, snipping through a layer of glistening pink connective tissue and exposing the tiny vein, matchstick thin with a reddish-blue tinge.”
If these images make you queasy, you are not alone. Fear of blood is a common reaction, an ancient, evolved response to threat, and red is the universal symbol of danger. There is nothing irrational about this. We have every reason to be afraid of it. Starr’s book is the story of blood, but it is also the story of money, and the dance of death the two of them have lately been doing.
The story really begins in the seventeenth century when William Harvey discovered how circulation works, and how the heart pumps blood in one direction, from arteries through capillaries to veins and back to the heart. It would be some time before the real function of blood, to carry oxygen and other nutrients around the body and to help defend it against disease, was clearly and widely understood, and even longer before anything useful could be derived from this knowledge. This did not stop physicians from at least trying to use blood to treat a variety of afflictions, both physical and spiritual. Bloodletting, for example, is perhaps the most ancient and international medical art. Starr tells us it
originated in the ancient civilizations of Egypt and Greece, persisted through the medieval, Renaissance, and Enlightenment periods, and lasted through the second Industrial Revolution. It flourished in Arabic and Indian medicine….
Doctors bled patients for every ailment imaginable. They bled for pneumonia, fevers, and back pain; for diseases of the liver and spleen; for rheumatism; for a nonspecific ailment known as “going into a decline”; for headaches and melancholia, hypertension and apoplexy. They bled to heal bone fractures, to stop other wounds from bleeding, and simply to maintain bodily tone…. And yet there was never any evidence that bloodletting did any good.
One of the most famous American practitioners of bleeding was Benjamin Rush, a signer of the Declaration of Independence and a great, although misguided, humanitarian. It was during a yellow fever epidemic in Philadelphia in 1793 that he became convinced of how well bloodletting worked. He went from house to house with his bloody lancet, draining liters of blood from hundreds of yellow fever sufferers into bowls or onto the floor. Many of his patients died, but many also survived. In fact yellow fever is not always fatal, and Rush gave himself credit for curing those cases that almost certainly would have subsided anyway. The number of dead was undoubtedly higher than it would have been had he simply advised people to rest.
At the time, however, many doctors swore by bloodletting, which in the days before modern medicine was one of the few treatments they could offer. “Bleed in an upright posture to fainting” was the arrogant or simply ignorant, but widely administered, prescription of the day. It is not known how many people died from the procedure. In 1799, General George Washington, suffering from strep throat, was bled to death by a team of well-meaning Virginia medics. At around the same time, the esteemed British physicians’ journal The Lancet was named for the preferred bloodletting instrument. It wasn’t really until doctors started counting the number of patients who died from it that bleeding went into decline. Statistics was surely, along with antibiotics, vaccination, and open-heart surgery, one of the most important life-saving techniques ever invented.
Doctors would not only take blood out; they also liked to put other fluids, most commonly animal blood, back into the circulatory system and watch what happened. Rudimentary transfusion techniques were invented in the mid-seventeenth century. At the time it was supposed that souls and character traits might also be transferred through blood. The French transfusion pioneer Jean-Baptiste Denis wrote that “sadness, Envy, Anger, Melancholy, Disquiet…corrupt the whole substance of the blood.” He prescribed transfusions of the “mild and laudable blood” of animals. Calf’s blood was transfused to make madmen sane, lamb’s blood to calm the souls of sick children. When foreign substances like animal blood enter into the human circulatory system, the immune system reacts by sending the body into a state of shock. Circulation of the blood comes almost to a halt, blood pressure falls dangerously low, the kidneys clog up with dead calf’s blood cells, and a high fever develops. Even though death was common after animal blood transfusions, the treatment remained popular for nearly two centuries.
There must have been something appealing about the idea that blood carried some profound, if hard to define, power distinguishing classes, families, and races and the personalities thought to go with them. Vitalism, or the belief that blood serves more than a mere mechanical function, may sound old-fashioned, but even in the late 1950s it was a misdemeanor in the states of Louisiana and Arkansas for a doctor to transfuse blood from a black donor into a white person without the recipient’s permission. Scientists knew at the time that the blood of blacks and whites was technically indistinguishable, so it is not clear, although one can guess, on what grounds black blood was deemed to be dangerous to whites.
Transfusion of human blood was in fact a great medical advance. Without enough blood to nourish their cells, our organs suffocate and die. Wounded people or people undergoing operations need new blood to replace what they have lost; hemophiliacs need concentrates derived from blood that will cause clotting—“clotting factors”—because they don’t have the genes to make their own and would otherwise bleed to death; people at risk of infectious diseases need extra gamma globulin to boost their immune systems.
A major figure in the discovery of blood transfusion was Alexis Carrel (1873-1944). Carrel, Starr tells us, was a technically brilliant surgeon who trained in his native France and was able, through the expert teachings of a seamstress named Madame Leroudier, to stitch even tiny arteries and veins together. After emigrating to the US in his early thirties, he made his first dramatic attempt to save human beings with his techniques during the early hours of a Sunday morning in 1908 in an apartment on West 36th Street in New York. There a newborn baby was dying, and her father, also a doctor, believed that a blood transfusion would save her. Carrel stitched one of the father’s arteries to one of the child’s veins and the ashen baby, who had seemed about to die, suddenly began to glow and wail. The baby survived, the tabloid newspapers made Carrel a hero, and the new age of blood transfusion dawned.
Carrel was not only a brave and wise scientist, but also a confirmed believer in faith healing and mysticism. His ideas formed a link between past and future, between the mystical view of the body as a symphony of diverse and erratic humors and the prosaic modern view of the body as something more like a car, with components that sometimes need replacing. At the same time blood came to be seen less like the soul and more as a commodity, like tires or brake pads, that could be bought and sold.
Unfortunately, as soon as blood became a commodity, squalor accumulated around it. Blood and blood products now save many thousands of lives every year. There is no question that blood technology is a great gift to mankind, and that we owe the scientists, doctors, engineers, and even the businessmen who have helped create it tremendous gratitude. However, as Starr’s story shows, the history of blood transfusion has been at times ugly and frightening.
My only criticism of Mr. Starr is that sometimes he seems too nice a man, excusing some of the darker figures in his story. For example, Starr tells us about the Japanese blood transfusion doctor Ryoichi Naito, who during World War II was an advisor to the notorious Japanese Army Unit 731, which carried out atrocities in the occupied city of Harbin, Manchuria. There prisoners, resistance fighters, and civilian Russians and Chinese, including women and children, were used
to study frostbite and starvation, allowing the conditions to progress until death. They tested such new weapons as flame-throwers on the prisoners—and new forms of transfusion, such as emptying their circulatory systems and refilling them with horse blood. Most important, however, was the use of these people for the development of microbial weapons. Each time the researchers devised a new way to spread lethal pathogens, they would infect the prisoners with injections or aerosols, with contaminated feathers brushed under their noses or bacteria poured into their food, and then observe the progress of the disease…. Alternatively, [the] staff would dissect the subjects of the experiment—whether or not the prisoners were still alive.
After the war Naito, in Starr’s opinion, changed. He became a Roman Catholic, retreated to the countryside, and became “a humble, devoted, and honorable” doctor, bicycling from one patient to another in the small village where he settled. According to Starr, this new style of life was a way of coming to terms with his deep sense of humiliation about Japan’s defeat in the war. Remaining obscure may also have been a way of avoiding retribution for what he had done during the war. Whatever the reason, he did not remain in the village for long. “Working among the poor,” says Starr, “he saw how desperately they needed transfusions, and how all too often they could not receive them.” Naito later founded the Japan Blood Bank, subsequently renamed the Green Cross, which became Japan’s biggest blood bank, worth, at its peak, $1.5 billion. Starr believes Naito’s blood-banking ambitions arose from a quiet but profound change of heart, brought on by his work among his defeated nation’s poor. There is perhaps another interpretation. In war, as well as in peace, perhaps Naito knew an opportunity for power when he saw one.
Naito, like virtually everyone else in the postwar blood-banking business throughout the world, was reluctant to admit the dangers of blood transfusion. Hepatitis B is a viral infection that causes jaundice, nausea, and fever and can never be fully cured. In many people who carry the infection, the liver is eventually destroyed or becomes cancerous. Much of the world’s blood supply was infected with the hepatitis B virus in the 1960s. It was particularly common in blood banks, like Japan’s, that purchased blood from their donors, rather than relying on freely given donations. This is so because people who donate blood voluntarily tend to come from the middle class, and do so out of a sense of charity. On the other hand, those who earn money from donating blood tend to be those who have nothing else to sell. Commercial blood banks often attract a disheveled clientele consisting of drug addicts, drunks, criminals, and the destitute, whose blood is dangerous because they have much higher rates of many infections, including syphilis, hepatitis, and HIV.