‘The Blood is the Life’
Dracula. A novel by Bram Stoker.
There seem to be few, if any, publications about blood transfusion, after it was banned by Pope Innocent XI in the 17th century. Then an English obstetrician, James Blundell, (1790-1878) carried out blood transfusions for post-partum hemorrhage early in the 19th century. In his publication in the Lancet in 1829, he writes: ‘…and therefore it seems right…to confine transfusion…to those in which there seems to be no hope for the patient, unless blood can be thrown into the veins’.1 He also made the prescient observation that blood transfusion might be used to save the lives of wounded soldiers. Prior to his introduction of blood transfusion and its use on human patients, he experimented on dogs. He noted that small amounts of air, injected into veins during blood transfusion, were unharmful and also stated: ‘only human blood should be employed’.2 Unfortunately, others did not agree. Milk transfusions were used up to 1880 in the believe that it could be converted into white blood cells.
Robert McDonnell carried out the first human-to-human blood transfusion in Ireland, in April 1865 at The Charitable Infirmary, Jervis Street Hospital, Dublin. A young girl was brought in after a workplace accident in which her arm was torn and lacerated. McDonnell drew 350 milliliters of blood from his own arm, stirred it, strained it and syringed it back into the patient.3 The girl improved, only for a short time, but died the next day. McDonnell had stirred and strained the blood to remove fibrinogen (a protein in the circulation necessary for blood clotting), a method that became popular during the 19th century.4
In keeping with Blundell’s and McDonnell’s attempts, novelists, as is often the case, showed an interest, if not a full understanding, of medical matters.
The most widely known story about drinking blood is surely, the vampire myth made famous by Dubliner, Bram Stoker in his novel, Dracula, published in 1897.5 This Gothic horror novel, in which the vampire gains sustenance from drinking human blood, was widely read and inspired numerous films, plays, books and television series.
There are many editions of the book but the one I favor is: ‘Dracula’, first published 2003. Stoker was undoubtedly influenced by fellow Dubliner, Sheridan Le Fanu’s story ‘Carmilla’ and the legend of Nosferatu.
A lesser-known story is that of Countess Elizabeth Báthory de Ecsed (1560-1614), who was reputed to have drunk and bathed in the blood of virgins to retain her youth. Bram Stoker may have been influenced by her story and some claim that she served as a model for the wicked queen in the Grimm Brother’s fairy tale ‘Snow White’.
In the novel, Dracula, blood transfusion was recommended for anemia and blood loss. Professor Van Helsing was summoned and decided, with the local doctor John Seward, that; ‘There is no time to be lost. She (Lucy) will die for sheer want of blood to keep the heart’s action as it should be. There must be transfusion of blood at once’. Stoker understood both the possibility of heart failure from severe anemia and the technique of blood transfusion when he says of Arthur, Lucy’s fiancé; ‘He is so young and strong and of blood so pure that we need not defibrinate it’. Stoker, however, was not aware of the possibility of severe and fatal transfusion reactions, since on a number of occasions he used different donors for Lucy. In spite of his medical knowledge and scientific training Van Helsing also said; ‘A brave man’s blood in the best thing on this earth when a woman is in trouble’. Like many, before him Stoker believed that the ‘character’ of the donor was in some way present in blood, and a brave man’s blood was different to that of a coward..
It may seem strange now that scientists, physicians and the public held these strange views in spite of scientific advances in our understanding of blood. Of course, a number of problems confounded attempts at blood transfusion, including clotting of the blood during the transfusion process, sepsis and lack of knowledge of blood groups. It was biochemists rather than hematologists who solved the blood clotting problem, Louis Pasteur and Lister who introduced sterilization measures and Landsteiner who discovered blood groups in 1900. A number of other physician/scientists developed nomenclatures for blood groups but Landsteiner’s eventually became predominant.
In spite of advances in our understanding of blood, blood transfusion was not widely practiced in World War I, in spite of the carnage. Two men, who unfortunately had the same name, Captain Oswald Hope Robertson from Harvard Medical School and Major Lawrence Bruce Robertson together with George W Crile, made major contributions to blood transfusion. However, the conservative attitudes of the medical profession prohibited its widespread use until the end of the war.
Public attitudes, on the other hand, began to change, and in 1921 members of the British Red Cross volunteered to give blood at King’s College Hospital, London. A librarian, Percy Lane Oliver, and his wife, organized a panel of donors. Attitudes changed, but not totally. In 1926 Alexander Bogdanov (1873-1928) persuaded Joseph Stalin to provide funds for an institute of blood transfusion. He realized that blood transfusion could save the lives of wounded soldiers but also believed that blood could halt the ageing process .6
The Spanish civil war was the first major conflagration involving civilian casualties. Two important names associated with blood transfusion, during that war, are Frederick Durán-Jordà and Norman Bethune in Barcelona and Madrid respectively. Jordà and Bethune organized blood donation on a large scale and believed that casualties should be transfused at the ‘front’, before being moved to a hospital. Jordà, a Spaniard, and Bethune, a Canadian, both died prematurely. Jordà died from leukemia in the UK in the 1950s and Bethune died from septicemia, in China, where he had joined Moa Zedong’s army as a surgeon. I am always interested to know why some people are lionized by historians and some are not. Neither are mentioned in the American Society’s ’50 years in hematology’ even though Bethune has a statue erected to him in Montreal (he was a communist!).
World War II resulted in many military and civilian casualties. The public’s attitude to blood donation/transfusion was again tested. Although many advances were made, including Edwin J Cohn’s method of fractionating human plasma, the specter of racial prejudice raised its ugly head. Charles Drew, an African-American physician directed a campaign, ‘Plasma for Britain’ but had to battle with the Red Cross to prevent blood or plasma being labelled as coming from a black donor, to prevent it being transfused into a white recipient. Writing to Eleanor Roosevelt, the chairman of the American Red Cross, Norman H Davis, admitted that segregating blood was “a matter of tradition and sentiment rather than of science”, but didn’t stop doing it until 1950. Louisiana only banned the segregation of blood in 1972.7
The idea that human blood contained racial characteristics gained some traction after Francis Galton coined the term ‘eugenics’ in 1883. Its relevance to blood reached a climax when the Nazis promulgated the idea that the ‘pure’ Aryan race had a specific blood group. Research into blood groups had been prominent in Germany in the first half of the 20th century and the idea of transfusing blood from a female into a male had some opponents. Thankfully ‘eugenics’ and all its attendant pseudo-science has become totally discredited since WW II and today more sensible attitudes to blood and blood transfusion prevail.
Another cataclysmic event that took place during World War II was the Manhattan Project, located in Los Alamos, New Mexico. Under the direction of Leslie Groves, the project was designed to develop an atomic bomb, as it was believed that the Nazis were doing the same. Under the direction of Robert Oppenheimer, the bomb was developed, but the project had the unexpected result of opening a ‘Pandora’s box’ of stem cell biology which eventually led to hemopoietic stem cell transplantation (HCT). It suffices to say here that many scientists and biologists contributed and the eventual result was a publication by Professor E Donnall Thomas and colleagues in 1979 which led to the adoption of HCT world-wide.8 Thomas was a co-recipient of the Nobel Prize in Physiology or Medicine in 1990.
So, our understanding of blood and its therapeutic uses have come a long way since the Enlightenment. Further advances are contributing to safer child-birth, surgery, chemotherapy, however blood as a biological fluid should always be treated with the utmost respect, remembering that any biological fluid can transmit harmful agents as well as great advantages.
About the author
Shaun Richard McCann received his M.B. from University College Dublin. He became a Member of The Royal College of Physicians in Ireland (MRCPI), by examination, in 1973. He was a specialist medical fellow at the University of Minnesota from 1974-76. The main focus of his research then was red cell structure and function, especially in hereditary spherocytosis. Click here to learn more.