Pint for Pint
- Blood: An Epic History of Medicine and Commerce by Douglas Starr
Little, Brown, 429 pp, £20.00, February 1999, ISBN 0 316 91146 1
Aids – or, more specifically, the lawsuits, criminal prosecutions and political recriminations that followed the transfusion of whole blood or blood products wittingly or unwittingly tainted with HIV – has renewed our interest in the sanguinary, and Douglas Starr has now set this interest in context. He describes his book as ‘the story of blood – the chronicle of a resource, the researchers who have studied it, the businessmen who have traded it, the doctors who have prescribed it, and the lay people whose lives it has so dramatically affected’. The ‘scandals that killed thousands of haemophiliacs and recipients of transfusions’ form the story’s dénouement. The moral, according to Starr, is that the safe use of this ‘precious, mysterious and hazardous material’ depends on a successful resolution of two sets of questions.
The first seems to be formulated by Richard Titmuss in The Gift Relationship: From Human Blood to Social Policy. Titmuss draws a distinction between Britain, where all fresh blood donation was voluntary, a gift to the community and hence an expression of concern with the general good; and the United States, where a high proportion of blood was procured from paid donors – a commodity and hence emblematic of an excessively individualistic culture. So is blood, ‘this most human of commodities’, ‘a gift of charity or simply a pharmaceutical’? And if it’s both, ‘what are the safest and most ethical ways to manage it’? It is not clear from what Starr writes how an answer to the first question will help to resolve the second. (There are no ambiguities in Titmuss.) Sometimes he seems to be suggesting that the commercialisation of blood, its being something to be bought like oil or golf-clubs, leads to a callous disregard of both donors and recipients – Japan is the case in point here. At others he appears to be saying that the more blood becomes an item of commerce, the greater the likelihood of its being safely processed: the collecting agency can make more stringent demands on those whom it pays. Tort liability maintains a certain standard of care.
The gift v. commodity question seems to map – I’m not clear how – onto a distinction between the ‘mythic and moral symbolism’ of blood, on the one hand, and what Max Weber might have called ‘disenchanted blood’, on the other. Some of the time Starr seems to think that the more disenchanted blood is, the more it is purged of its cultural baggage, the better. To take one example, ‘mythic and moral symbolism’ clouded ‘professional judgments and public perceptions of the Aids scandals’ and made officials, ‘faced with the necessity of refusing blood from certain people’ – homosexuals, prisoners – in order ‘to minimise the spread of disease’, unwilling to do so for fear of offending their ‘cherished donors’. On the other hand, it was disenchantment which led to the monumentally exploitative blood market of the Seventies and to the depredations of the drug companies in the Eighties as they dumped their outdated, unsafe blood products on unsuspecting consumers – Starr is rightly indignant about this.
Starr’s is a tightly circumscribed history, but perhaps it had to be. There are more than five hundred separate subheadings under blood in the University of California Library Catalogue and the word finds its way into 10,250 quotations in the OED, where two full pages map out its literal and figurative linguistic field even before we get to its adjectival and compound forms: blooded, blood-guilty, blood money, bloodshed, bloodhound, life blood etc. And then, on the shelves of my office, sit Blood Magic – an anthropological study of menstruation, which reminds us that there exists a quite other and relatively new blood market, that sells products which absorb, hide and dispose of a substance whose freight of meaning generally interests us only in other tribes; Bad Blood, the term the United States Public Health Service appropriated to represent syphilis to the largely illiterate black men who were about to become the unwitting subjects of medical observation in the notorious Tuskegee experiment; Paul Goodman’s Of One Blood (the phrase is from Acts 17.26), about the abolitionist response to St Paul’s pronouncement that the whole human race has a common origin; Barbara Ehrenreich’s Blood Rites, about the origins of warfare – and more.
And this is to say nothing of the medical and more general biological history of blood that does not directly affect its life as a product. Blood had moved from ‘the magical to the biological’ long before it became recognised in the early 20th century as ‘a therapeutic liquid transferable from one creature to another’. Lamery discovered in the late 17th century that it contained iron, the first episode in a long story of blood chemistry; Hewson’s An Inquiry into the Properties of the Blood in the late 18th century established among other things its coagulative properties; the absorption and release of oxygen and carbon dioxide in respiration was firmly established early the next century.
The field is vast but Starr focuses on that strand of blood’s history which winds most directly to the beginnings, in 1982, of the Aids crisis. His Part I, ‘Blood Magic’, thus takes the story quickly from magic and mystery to the early 20th-century achievements of Karl Landsteiner, who identified the ABO blood groups; Richard Lewisohn, who discovered that sodium citrate would keep blood from coagulating; and Alexis Carrel, whose brilliant suturing of a father’s artery to the tiny, delicate vein of his infant daughter’s leg saved her life. Together, these pioneers laid the foundations for the widespread use of whole blood and for much else besides. Blood groups, for example, were almost immediately used for forensic purposes – for sorting out mixed-up babies in hospitals, or bloodstains on the clothes of an accused murderer.
The second part of the book, ‘Blood Wars’, begins with the early days of transfusion, when it was done ‘on the hoof’ – i.e. when donors were hooked up to recipients as needed – because there was no institutional structure for storing blood. It goes on through the founding, in the Twenties, of transfusion centres and of the world’s first centre for transfusion research by Alexander Bogdanov in the Soviet Union, which inspired a Chicago doctor to establish the first ‘blood bank’ in the US in 1937, and ends with the remarkable mobilisation of blood resources, largely by the US and its allies, during World War Two. Bogdanov’s story is remarkable. He got into blood only when Lenin got the better of him in the pre-Revolutionary rivalry between the two men. A committed collectivist he pooled his own blood regularly with that of his students – shades of the end of Stoker’s Dracula – and apparently felt revitalised by each exchange. On the 12th such occasion, however, he developed an incompatibility reaction and died, though not before carefully narrating his own death. His colleague Serge Yudin, meanwhile, began large-scale experiments with blood from corpses, draining healthy accident victims for the use of the living. (Shades here of the post-colonial African belief that fire-engines were driven by vampires.) All this was part of a much larger project which imagined that, at the dawn of the new Communist era, the body and medical science generally could be remade to fit them for socialism. People were injecting all manner of hormones to stop ageing and extend life; a Stalinist endocrinology went side by side with Stalinist blood-collecting.
War was the mother of invention for blood as for so much else, and the heroes of ‘Blood Wars’ are the men and women who figured out how to collect, store, process and ship blood or its derivatives to the battlefronts of Europe and the Pacific. One of them, Janet Vaughan, a British doctor (in later life Principal of Somerville College, Oxford), warned blood banks to prepare for injury on a massive scale and gave her name to the modified milk bottle in which donated blood was stored. Another, Charles Drew, Columbia’s first African American medical graduate, built the infrastructure for plasma collection in the US for shipment to the various theatres of war. At a time when black blood was acceptable only when specifically labelled pint by pint, and was excluded altogether from plasma pools because there segregation was impossible, Drew developed procedures which made it possible to get the product from the arm of a donor into a can and out again without contamination. Established procedures – doing things carefully, methodically, predictably – would become the heart of a safe system of blood use and exchange in the postwar world.
Drew died in his prime at a North Carolina hospital after a car accident and it is a sign of the state of American race relations that the story – untrue, it turns out – of how he was refused what might have been life-saving Caucasian blood, persists today. In fact, not since the 18th century has anyone argued that blackness resides somehow in the blood; the American Red Cross acknowledged that ‘black blood’ was indistinguishable from any other sort but in deference to Southern sensibilities continued up into the Seventies to identify it in its blood banks, on grounds – it argued – of consumer choice. Louisiana and Alabama passed blood segregation laws in the late Fifties: I wonder how they were justified in a public forum.
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