I went to the ASJA writing conference last year and met Holly Tucker, a dynamic Vanderbilt professor who has joint appointments in the department of the history of medicine and the department of French and Italian. When she heard I was a medical writer, she eagerly told me about her upcoming book, Blood Work: A Tale of Medicine and Murder in the Scientific Revolution. I couldn’t wait for it to come out!
In the book, the history of blood transfusion is wrapped around a historical murder mystery involving a French physician, Jean-Baptiste Denis, whose experimental transfusions were as much about trying something new, as it was making himself rich and famous. Denis had a fair number of detractors who wanted the transfusions to end.
Denis began transfusing animal-to-animal, finally working up to animal-to-man transfusions. The two transfusions he did on mentally ill man ended in his death (for the record, it was calf blood). Denis was accused of killing him, though it turns out to have been murder via poison.
Who did it and why? I’ll let you read the book. But I thought about that a lot because Tucker told me how excited she was when she found the actual documentation (in France) of the murderer’s identity.
What I loved about the book, aside from Tucker’s beautiful writing, were the details she threw in about the times and the history. It’s been awhile since I’ve studied Europe in the 1600s, and this was enlightening. Tucker paints a picture of what the crowded Paris streets were like, with the mass of humanity, “the grey and polluted waters of the Seine,” the “heavily perfumed prostitutes who strolled along the bridge in décolleté dresses by day, and men of all persuasions fulfilled their passions under the bridge by night.”
From early times, scientists and physicians thought that blood was cooked in the digestive tract and filtered in the liver. Circulation was not well understood. The heart produced heat and burned the blood like fuel. Breathing was a way of releasing the fumes from the heart. This explains the practice of bloodletting (practiced by the barber-surgeons; get a shave and a boil lanced at the same time). “Modern-day barbershops commemorate the early origins of the profession. Now quaint and certainly less macabre, metal-capped red-and-white striped poles, displayed prominently outside barbers’ doors, evoke the bloody bandages and bowls of earlier days.”
Bloodletting was thought to release the bad humors in the blood, and to cool off the body. Then again, Tucker notes that they also avoided bathing back then, reserving water to clean only the face and hands. They’d use perfumes over the body to cover up the stench, and to “purify the disease-causing corrupt air with which the person came in contact.”
Tucker notes that in Egypt around that time, they’d export mummies, where “small bits of dried mummy flesh, ingested either whole or powdered, were believed to cure a wide range of ailments.” If that’s not bad enough, the mummy exporters would find any dead bodies they could, including those with leprosy, plague, or smallpox.
You can appreciate how difficult early transfusion would be, without modern equipment (or anesthesia) to move blood from one creature to another. They used quills and rudimentary ways to try to measure how much blood was transfused. The animals were often bled to death. Before the blood transfusions, experimenters transfused milk, water, alcohol and other substances into the animals.
You have to remember that anesthesia really wasn’t available then. Tucker notes that when doctors went to remove bladder stones, they often did so through the penis, or by making such a large cut in the perineum that the surgeon could insert his whole hand. It took four men to hold the patient down during the procedure. Surgery and medicine then were barbaric and their medical knowledge was so much more limited than now.
The concern over transfusion was this: people in the 1600s worried about the effects of merging animal and human blood. Would the human turn into an animal? Take on animal characteristics and behaviors? Would the human lose its soul to the animal? Tucker points out that the Red Cross went through something similar starting in the 1940s. They segregated blood of blacks and whites, so a different race’s blood wouldn’t “corrupt the purity of bloodlines for generations to come.”
While there are animal welfare activists who protest animal experiments today, the scientific world today has a much higher standard. Scientists have to get permission from institutional review boards for their animal (and human) work, doing the experiments in the most humane way possible. Back then, they grabbed an animal (or a human – willing or not), strapped it down, and began to work.
Word of the transfusions (and also political news) was sent by couriers, because there was legitimate concern about postal censors and royal spies. They sent their words in code, bound letters in books, or used invisible ink (even urine) to disguise their writing. They diluted the ink with special substances and had antidotes that could make it readable again. And for good reason. Tucker tells of one man who was thrown in jail (the infamous Tower of London) after his letters were intercepted. Jail guests had to pay their own way for the privilege.
Denis was acquitted from killing his patient, but the French government took the opportunity to ban blood transfusions for another 150 years. It was only when an English physician saw one too many women die in the hospital that he wondered what more could be done to help.
A timeline (taken from the book):
1665 – the first animal transfusion in England (dog-to-dog)
1667 – Denis begins animal-to-animal transfusions, then transfuses a 15 year old boy with lamb’s blood. Later that year he transfuses Mauroy (the mentally ill man), who dies after a few weeks (of arsenic poisoning).
1669 – France bans transfusion
1818 – an English surgeon performs a successful human-to-human transfusion
1908 – an Austrian doctor discovers the three blood types in humans (A, B, O). AB is discovered in 1909.
Methods to prevent clotting, anticoagulants for blood storage and blood banks came later.
You can listen to Tucker talk about her book and blood transfusion history on Science Friday (April, 2011). Look in the upper left corner for the “listen” or “mp3″ buttons.