Blood-letting

Blood and the Most Odious Demon

Blood Transfusion, 1800s

Blood is the giver of life… and legends. It’s prominent in fairy tales, detective stories, myths,  medicine and our business of hemophilia. It’s a favorite for dressing up costumes at Halloween time, like now. Blood holds such a fascination by us humans, so it’s natural that there are misconceptions. I’m currently rereading the classic Dracula and was amused to read how Dr. Van Helsing, a professor from the Netherlands and expert on the nosferatu, wants to help young lady Lucy, a victim of Dracula’s nightly blood draining, by giving her a transfusion of blood. “Is it you or me?” he asks Dr. John Steward, about which one of them should roll up their sleeve to donate; Steward who replies, “I am younger and stronger, Professor. It must be me.” Steward offers his blood based on the concept of vitalism, that blood contains the traits of the being in which it flowed—a concept that was unchallenged for fifteen hundred years. Later in the book, Van Helsing says to Lucy’s fiancé Arthur, “John was to give his blood, as he is the more young and strong than me…. But now you are here, you are more good than us, old or young, who toil much in the world of thought. Our nerves are not so calm and our blood so bright than yours!”

So Arthur becomes the better blood donor because he is calm and not scholarly! Of course, this is nonsense, but author Bram Stoker fell for the widespread belief in vitalism when he wrote his book in 1897. Dracula isn’t so picky; he pretty much would drink anyone’s blood.

Douglas Starr tells us in his landmark book Blood that the Egyptians saw blood as the carrier of the vital human spirit, and would bathe in it to restore themselves. Roman gladiators were said to have drunk the blood of their opponents to ingest their strength. “Our own culture attaches great value to blood, with the blood of Christ as among the holiest sacraments, blood libel as the most insidious slander, the blood-drinking vampire as the most odious demon.”

And blood becomes a problem when someone has hemophilia or von Willebrand Disease. A microscopic protein is either missing or malfunctioning. In the 1970s and 1980s, doctors would replace the missing protein with products made from human blood. But widespread contamination with HIV led to the nation’s blood supply being destroyed. While scientists eventually produced recombinant blood-clotting products in 1992, the damage was done. An estimate 10,000 with hemophilia would die—50% of the US hemophilia community.

Rather than secure eternal spiritual life by consuming wine that has been transformed into Christ’s blood during Christian Mass, Dracula drinks human blood to extend his physical life through the centuries. We now use ultra-safe, genetically-engineered blood-clotting products to clot blood that does not clot on its own, to extend our physical life… and enjoy Halloween, vampires and all!

You Should Donate Blood (But Not Like This)

I missed promoting National Blood Donation Week, which was September 1-7. And International Plasma Awareness Week (IPAW) just ended and was held October 3-7. This is promoted by the Protein Plasma Therapeutic Alliance (PPTAglobal.org), which is also involved in hemophilia. There are still factor products made with human plasma, so it’s always good to donate!

But don’t think it’s like the following donation story!  I love reading about medical history, especially about the men and women who discover cures and breakthroughs. One of my favorite stories is the history of blood, particularly how physicians and researchers employed it and through research and trial and error, learned how to properly transfuse. And since I wrote about vampires and vitalism (sort of like a blood transfusion!) last week, let’s visit this story.

Blood letting

The ancient Greeks saw all phenomena as the result of the interaction of four elements: air, fire, wind, earth. In the body, this manifested as “humors”: phlegm, choler, bile, and blood. The Greeks believed good health meant maintaining a balance in the humor, so draining blood (“blood-letting”) and purging the digestive system should help restore balance.

One of the first human blood transfusion first took place in Paris, in the 17th century. It took a wild and undiagnosed insane man, Antoine Mauroy, to help change the course of history.

One night in 1667, in a frenzy, he stripped off his clothes and ran through streets of Paris, setting fires. Dr. Jean-Baptitste Denis, physician to king Louis XIV, had been experimenting with transfusing blood from animals into humans. He had his “aha” moment: let’s try this on Mauroy.

He infused ½ cup of calf’s blood into the mentally besieged man. Why calf’s blood? He believed that since the calf was a calm animal, its blood would be calm. Infusing it into Mauroy should calm the wild man.

Dr. Jean-Baptitste Denis

This belief was called “vitalism,” that the blood somehow carried the essence of the creature. A stag’s blood carried courage; a horse’s, strength. A calf, calm. 

Prior to this experiment, other physicians had dabbled in transfusions with animals. Richard Lower, an English physician, tried transfusing blood from one dog to another: he figured out how to infused from an artery into a vein and it worked. His findings about the transfusion of blood are often ranked among the most important discoveries in medical history. And he is still remembered one of Oxford’s finest doctors. The English medical community worked on transfusions a year before Denis.

Dr. Denis had also tried transfusions in humans twice before, successfully.

So back to the madman. Unfortunately, Antoine Maury eventually died after the third infusion. Dr. Denis was accused of murder, and later acquitted, but it turned out that Maury’s wife poisoned Maury! He wasn’t the only wild one in that family. Human transfusions were stopped, and another 150 years would pass before they were attempted again.

And since it’s almost Halloween, I would add, unless you include vampires.

The Beginnings of Transfusions


This week I am off to the National Hemophilia Foundation meeting in San Francisco, and I thought an historical look at blood might be in order. I can’t think of a better story about blood than one that starts with a madman running naked through the streets of Paris in the 17th century. True.

Chapter 1 of the wonderful book Blood by Douglas Starr starts with poor Antoine Mauroy, who suffered “phrensies.” From time to time, he would take off his clothes, run through streets and set fires. Eventually, doctors experimented on him to try to cure him. Mauroy became the guinea pig in an experiment that forever changed medicine. In 1667 Jean-Baptitste Denis, physician to king Louis XIV, transfused half a cup of blood from a calf into Mauroy. He hoped the “gentleness” of the calf would infuse as well. Despite the discoveries of the Renaissance and the advances made in science, doctors still believed the blood somehow carried the characteristics of the creature, a concept known as “vitalism.” For example, a stag’s blood carried courage; a calf gentleness. Since the ancient Greeks, the body was not yet viewed as a system, and doctors knew nothing of hormones, genes or viruses. It would be 200 more years before they discovered that water transported disease! In the 17th century, doctors believed that in the “humors”: phlegm, choler, bile, blood. The Greeks believed that good health meant maintaining a balance of the humors in the body, so draining blood and purging digestive system should help. This is where blood-letting as a medical treatment evolved.

Blood– it has a colorful past! And worth reading about. Be sure to read Blood by Douglas Starr.

Other doctors and researchers dabbled in finding out the secrets of the blood. William Harvey found valves in blood vessels, which led him to think that the body might be a system, more mechanical. Christopher Wren (the famous architect whose beautiful cathedrals I just glimpsed when I was in London last week) and Robert Boyle, founder of modern chemistry, dabbled in circulation. Richard Lower tried transfusing blood from one dog to another: he discovered how to transfuse from an artery into a vein and it worked.

What happened to our madman? Antoine Maury died from the procedure. What doctors didn’t know is that proteins in the blood from one animal–even from another person– are not always accepted by the body. The immune system may attack the foreign proteins. Dr. Denis was accused of murder. He in turn sued Antoine Mauroy’s widow in 1668 for slandering his reputation. Turns out Mauroy actually died from arsenic poisoning– by his wife! Still, the French Parliament’s banned all transfusions involving humans. Similar actions follow in England and Rome. And 150 years would pass before it was tried again.

Of Bloodletting and Leeches


Blood has held a fascination for humans, at once revered and feared. One of the earliest known medical treatments has been phlebotomy, or bloodletting, believed to originate in ancient Egypt and Greece, and lasting through second Industrial Revolution. Think about this: the germ theory is only 130 years old; transfusing blood is only 75 years old; but blood letting is 25000 years old! In ancient Greece, Hippocrates passed the technique on to Aristotle, who then passed it on to Alexander the Great, who then spread it throughout Asia. The second medical text ever printed on Gutenberg’s press? A bloodletting calendar in 1462. In the Middle Ages the Church had great authority and the Pope prohibited the clergy from blood letting, and physicians were afraid to do it. So it moved into hands of barbers, who then cut hair and veins. They used a tool called a lancet, and customers would even bring their own bowls. Some were decorated and some even became heirlooms! Leeches also used. “Leech” derives from the Anglo-Saxon word loece,”to heal” (medieval doctor called themselves leeches). Leeches were often used to bleed patients in hard to reach places–you can use your imagination on that one.

In 1883, French doctors alone imported 41.5 million leeches for bleeding!

The foremost American bleeder (not meaning person with hemophilia here) was Dr. Benjamin Rush, called the “Prince of Bleeders.” He was a scholar, humanist, social reformer, and signer of Declaration of Independence. He spoke out against slavery, capital punishment, and cruelty to children, and wrote the first American textbook on mentally ill. He served as a surgeon general to the Continental Army, was supervisor of US Mint, founded the Society for Protection of Free Negroes. Rush believed all disease arose from the excitation of blood vessels, which bleeding would resolve. He taught that body had about 25 pounds of blood, 20 of which could be safely drained. But the body actually holds less than half that! In 1793, an outbreak of Yellow Fever in Philadelphia killed patients at a rate of more than 100 a day. Many people fled in panic, but Rush stayed to care for the sick. He treated them by bleeding them, and bled more than 100 patients a day. While totally selfless, he actually did more harm than good. During this time, even George Washington was bled, and later died of blood loss.

Eventually phlebotomy was abandoned. A typhus epidemic in England in the 1830s, showed that even removing a little blood caused fainting, and the practice was eventually suspended. The rise of the germ theory also helped put an end to the questionable practice of bleeding.

Adapted from Blood, by Douglas Starr

Photos: Lancet used for bloodletting (http://www.medicalantiques.com/medical/Scarifications_and_Bleeder_Medical_Antiques.htm);  an illustration of a bloodletting, circa 1675. WELLCOME LIBRARY, (https://www.nationalgeographic.com/science/article/bloodletting-is-still-happening-despite-centuries-of-harm)

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