Blood

The Beginnings of Transfusions

Laurie Kelley October 26, 2009


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.

The Price of Blood

Laurie Kelley September 15, 2008


There is an ever constant debate throughout the worldwide blood community about whether blood donors should be paid or voluntary. There are all kinds of implications. I found the history of blood donation fascinating, as blood developed from a charitable service to a global industry. Here’s a snippet of what I read in Douglas Starr’s excellent and must read book Blood.

In the early 1900s, transfusion of blood was a clumsy, laborious process. No one stored blood in a blood bank. When a patient needed blood, he himself had to find a donor (this must still be the the case in some countries). One day in 1921, Percy Lane Oliver of the British Red Cross got an emergency call to find a donor. He realized this was stressful and inefficient, trying to find random donors when someone was already in trouble. So Oliver decided to create a registry of volunteers. More astonishingly, he ran it from his home! Oliver became a man on a mission, obsessed, and his idea was a stroke of genius. He worked seven days a week, recruiting, filing paperwork, and phoning people. Everything he did was free. His services were in so much demand, he could never get away even for a day. (You can imagine there was so much joy in being able to help when no one else could) Oliver even changed doctors’ practice of slicing open the arm and exposing the vein to insert a needle: all they needed to do was insert a needle now! Eventually, Oliver registered 2500 donors, all of whom were unremunerated. Britain led the way: soon donor panels were started in other countries. Dr. Arnault Tzanck established the Emergency Blood Transfusion Society in France. And he was also an energetic, tireless, and positive thinker. He wrote: “The man is truly poor who does not know how to give.”

Americans adopted the blood transfusion services, too, but were different: remuneration was ok. So paying for blood began in America. And Oliver? The man who created the idea of a registry of blood donors, who worked endlessly, helping to save countless lives, never received any recognition in his lifetime! Thanks to Starr, he is now recognized as revolutionizing blood transfusion services.

(I’m headed for England next week, a country with many medical firsts, especially in any fields related to blood. I’ll blog from there next Sunday)

Of Bloodletting and Leeches

Laurie Kelley July 14, 2008


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)

Those Very Special Inhibitor Families

Laurie Kelley March 3, 2008


Inhibitor families are a special lot and my admiration for them just continues to grow. For the past six months I’ve been interviewing parents and patients for my new book on inhibitors and I have learned what amazing hardships they face, and with such courage. Though I helped facilitate the Novo Nordisk Consumer Council for the past two years, I still didn’t have a full appreciation of their lives. This past week in New York City we inaugurated a new group of parents and patients for the Consumer Council, and I feel better able to represent their needs by knowing more about the medical care, parenting concerns and social issues they face.

We had a wonderful time on Friday. Meeting at the Westin Hotel Times Square for a full day, the marketing team at Novo Nordisk and I presented questions and listened to nine consumers share their experiences, thoughts, suggestions and concerns. None of them had ever met one another, as inhibitor patients are pretty rare and in a country as big as the US, it is hard for them to meet. The Novo Nordisk Inhibitor Summits brought inhibitor patients together for the first time two years ago, and yes–for all who are reading this–there are going to be two more this year.

We had breakout groups, exercises and ice breakers. One ice breaker–meant to help us get to know one another–asked each participant to identify themselves with an animal. Everyone chose different animals, from a kangaroo to a dog to a lion. But Schlander chose an ant–unusual because almost no one in these types of exercises ever chooses an insect. Why an ant? Because though small, they are strong in groups and can accomplish something that seems impossible, given their size. Given that this group will be together for two years, it was a perfect animal to choose to highlight what a small team of dedicated people might and will accomplish.

Great Book I Just Read: Blood: An Epic History of Blood and Commerce, by Douglas Starr. Four stars! This book took me a while but it was well worth it. Fantastic overview of the history of blood. It starts with the story of a madman running naked through the streets of Paris… reads like a novel but is packed with information about the meaning of blood in society, medicine and business. Learn about its incredible importance during World War II, and how much we advanced our knowledge of blood because of the war. Fully half of the book is devoted to the hemophilia holocaust, and I read with sadness and pride about our community, and its fight to bring safer measures of blood treatment and justice to the victims. It was startling and impressive to read about the leadership and courage of people like Bruce Evatt of the CDC, and Corey Dubin and Dana Kuhn of COTT, true heroes in our midst even today. I had read the history of the HIV infection before, and even watched the HBO movie about it, and still see Corey and Dana at events. But.. time goes on, and being human, we all tend to forget the past. This book reminded me of how privileged we are to have these warriors; how lucky my son and anyone born after 1985 are because they benefited from their perseverance to get a settlement from the government and drug companies, and have safer measures. And they still persevere in protecting our blood supply even today. Blood is required reading for anyone involved in the hemophilia community on any level.

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