Blood (4 page)

The French court finally decreed that no further transfusions were to be carried out without the consent of the French Faculty of Medicine. Shortly thereafter, both France and England banned human transfusions outright.

James Blundell, the nineteenth-century English obstetrician, carried out the first successful human-to-human blood transfusions. In 1818, he used a syringe to extract four ounces of blood from a husband and transfuse it into his wife, to treat postpartum hemorrhage. She survived, and Blundell went on to carry out another ten transfusions between 1825 and 1830, five of which proved beneficial.

Many patients died in early human-to-human blood transfusions. Looking back, we now know that many such deaths occurred because of mismatching blood types between donor and recipient.

The path toward safe blood transfusions became much more promising in 1901, when the Austrian Karl Landsteiner discovered three blood groups: A, B, and C (later called O). The very next year, Landsteiner's colleagues identified a fourth blood group: AB. The blood groups A, B, and AB are incompatible with each other. The blood type O, however, is compatible with the others. Within half a decade of Landsteiner's discovery, Reuben Ottenberg at Mount Sinai Hospital in New York performed the first transfusion by matching blood types. He went on to perform more than a hundred other transfusions without the problems that had resulted previously from mixing incompatible types.

Initially, blood transfusions required the volunteer donor to be placed next to the recipient so that their veins could be hooked up together. This was known as “blood on the hoof.” You can imagine how impractical it must have been to always require donors and recipients to be together, but people were amazingly creative in addressing the challenge. For example, in 1921, under the supervision of a man named Percy Lane Oliver, the Red Cross in London, England, set up a list of people who promised to be available, at any hour of the day or night, when donors were needed. These volunteers underwent medical exams ahead of time, including tests for blood type and syphilis. Their telephone numbers were recorded. At its height of activity in the 1930s, people on this list responded to nine thousand calls a year. Although the process of lining up donor with recipient must have been cumbersome, the emotional connections between the two people surely heightened the understanding of the value of the gift for both parties.

But blood on the hoof diminished as a medical necessity as the science of blood storage moved forward. Sodium citrate was identified as a means to prevent stored blood from clotting; refrigeration was discovered as a safe means to prolong the shelf life of blood; and the looming tragedy of war drove us to discover the possibilities of blood banks so that massive amounts of blood could be moved to the front lines to save the lives of injured soldiers. The first blood depot was used in World War I, in 1917, when the U.S. army doctor Oswald Roberston used a citrate-glucose solution to store type O blood, to be used for British soldiers returning injured after fighting the Germans in the Battle of Cambrai in France. Use of the citrate-glucose solution made it possible to store the blood safely for a few weeks.

The Canadian surgeon Norman Bethune entered the picture during the Spanish Civil War. On the side of the leftist Republicans, Bethune established a mobile blood service in Spain in 1936. Following the example of a Spanish hematologist working in Barcelona, Bethune travelled to Madrid and set up the service, which brought blood in bottles to Republican soldiers who had been injured at the front. Using a kerosene-­powered refriger­ator and sterilizing equipment, Bethune's Canadian Blood Transfusion Service was soon making use of 4,000 donors, 100 staff members, and five trucks to deliver blood for 100 transfusions a day. Essentially, Bethune created an early model of the Mobile Army Surgical Hospital (or
MASH
, for short) units that were later employed by the American army during the Korean War in the early 1950s.

In 1940, the African-American physician Charles Drew — who had studied medicine at McGill University — responded to a blood shortage in Britain during the Second World War. The United States had not yet entered the war, but working for the Presbyterian Hospital in New York, Drew devised a safe system to process, test, store, and ship plasma overseas to Britain. (I will discuss Drew in more detail in the next chapter.) After he directed the Blood for Britain program, the United States entered the war and had to see to its own blood supply needs. The American Red Cross organized a civilian blood donor service and collected some thirteen million units of blood over the course of the war.

The science of transfusion continued to advance, thanks in part to new breakthroughs such as the discovery of the Rhesus blood system (more on this later), the use of better anticoagulants to enhance blood storage, and the use of plastic bags for blood collection. Today, some 92 million blood donations are collected each year worldwide, many of them to be used for transfusions. As a noble and selfless gift, blood is in an entirely different class than money. Dollars from your bank account can be directed to the charity or person of your choice. And you expect, usually, to be thanked and recognized for a cash gift. If you give enough money, you may even get a bridge or building named after you. But for the most part, you have no idea who will receive your blood. You give it on principle. You and the recipient will never meet.

It is not surprising that the evolutionary turning points in the science of transfusion culminated around the major wars over the course of the twentieth century. Blood donations became the ultimate symbol of the gift of life, from civilians to soldiers. Individuals helped save individuals, but also sought to protect an entire generation. But as we will see in the next chapter, blood donation has also come to reflect our deepest discriminations and prejudices, when philanthropy collides with politics and our very worst selves overcome our best selves.

WHILE BLOOD IS UNIVERSAL
in its nature and functions, it is also a marker of the gender difference between men and women. I'm sure that I was in no way unique when, at the age of thirteen or so, I walked into the bathroom in our Toronto home and gasped to see blood in the toilet. I knew that my sister, younger by one year, had just been in the same bathroom, and I ran to tell my mother that Karen was bleeding. I was astonished, and intrigued, by the firmness and quickness with which my mother flushed the toilet, told me not to worry, said everything was under control, and dismissed me. Earlier, she had told me about women's menstrual cycles, and later, I believe, she repeated the message. But in the moment, her job was to get me out of the way and show me that what I thought was a major event deserved no attention whatsoever.

Typically, men associate the spilling or the sight of blood as the by-product of accident, sport, or war. Blood, for men, is often romanticized and likened to ritual, honour, and a sign of one's masculinity and courage. When a woman bleeds during her monthly cycle, it is a symbol of coming of age, of fertility, a sign of her sex. We honour people who spill blood in defending their cause or their nation, yet since time began we have found the most curious, inventive, and offensive ways to vilify women for shedding their monthly blood — the same blood that they have needed before or will need again to build the very beginning of a nest inside the body for the earliest promise of human life.

Men in ancient Greece, and surely beforehand, seemed befuddled by women's blood. They knew that they — men — would be in serious trouble indeed if they bled like women did. If men bled for days on end, it was surely the result of illness or injury and they would likely perish. So how could women bleed so profusely and regularly and still not die? This apparent imperviousness to mortal weakness might have been taken as a sign of women's power, or of magical qualities barred to men, or of some sort of gender superiority. But for the most part, men found a much more self-aggrandizing theory: monthly bleeding was proof of women's inferiority.

In the fourth century
BCE
, the Greek philosopher Aristotle noted in his treatise
On the Generation of Animals
that men's blood was superior to that of women. In the human body, Aristotle wrote, heat transformed nourishment into blood. Males, who had sufficient heat, were then able to embark on an additional step: they could “concoct” (or transform) the blood into semen. On the other hand, Aristotle claimed, women were colder and thus lacked sufficient heat to produce semen. Aristotle's exact words were that “the woman is as it were an impotent male, for it is through a certain incapacity that the female is female, being incapable of concocting the nutriment in its last stage into semen in women.” Because women lacked this ability, Aristotle said, they ended up with extra blood in their blood vessels and had to expel it during menstruation. Aristotle's meditations about the blood of men and women helped entrench notions of male superiority and female inferiority that have lasted more than two thousand years.

We can't blame sexism on Aristotle alone, nor can we suggest that he was the first to obsess about women and blood. In
The Curse: A Cultural History of Menstruation
, Janice Delaney lists a litany of other theories by classical Greek and Roman male philosophers about the fundamental problems associated with the blood of women. In the fifth century
BCE
, Empedocles, best known for theorizing about earth, water, air, and fire, said women evacuate blood because their flesh isn't as dense as the male's. In the same century, Parmenides — founder of a school of philosophy and author of the poem “On Nature” — said women are hotter than men (this in opposition to Aristotle's later theory about women being cold) and thus produce an excess of blood, but that they gradually get colder until they reach menopause. Galen, the celebrated Greek physician and surgeon, theorized in the second century
BCE
that women menstruate because they are idle, live continually at home, and are not used to hard labour or exposure to the sun. Other theorists in the eleventh and seventeenth centuries
CE
speculated that through menstruation, blood escapes from the weakest point of the woman's body, essentially describing the womb — as Delaney notes — as a “defective barrel.”

I so wish that these classical philosophers had been around today. Imagine the expression on Aristotle's face if he were disinterred, reanimated, and required to travel — let's send him by Greyhound bus — to Marymount Manhattan College. Why? In June of 2013 at that august institution, he would have been exposed to “Red Howl Moon” — dubbed as the world's first menstrual poetry slam. Today, many people will appreciate the organizers' intentions to, as they say, “bring down the red tent of shame.”

Alas, the biological differences are unlikely to change, and for me, one of the most fascinating things about it is how thoroughly clued out, for the most part, men are with regard to the monthly cycles of women. It wasn't until I started researching this book that I learned of the psychologist Martha McClintock's 1971 paper for the journal
Nature
, in which she put forward her theory of menstrual synchrony — that women who live together tend to menstruate at the same time. When I asked my wife and daughters about this later, they replied, “Larry, how could you not know this?” and went on to say that my own ignorance was typically male.

WHILE THE CLASSICAL PHILOSOPHERS
used menstruation as a way of calcifying the idea that women are the “weaker sex,” religion has further advanced patriarchal notions by focusing on the notion that women's monthly bleedings indicate a lack of cleanliness or purity. In a 2008 issue of the
Internet Journal of World Health and Societal Politics,
co-writers Mark A. Guterman
,
Payal Mehta, and Margaret S. Gibbs argue that the world's five major religions — Judaism, Christianity, Islam, Hinduism, and Buddhism — all place restrictions on menstruating women. The article, “Menstrual Taboos Among Major Religions,” notes that each religion makes statements about menstruation and its negative effect on women, leading to prohibitions on physical intimacy, cooking, and attending places of worship, and sometimes requiring women who are having their periods to live separately from men.

In the Old Testament, in Leviticus 18:19, we find the following prohibition about menstruation: “You shall not approach a woman in her time of unclean separation, to uncover her nakedness.” This rule, which influences Christian thinking as well, underpins the “Laws of Family Purity” in the traditional Jewish code of law
.
These laws forbid physical contact between males and females during the days of menstruation and for a week thereafter. Physical contact means passing objects between each other, sharing a bed, sitting together on the same cushion, eating directly from the wife's leftovers, smelling her perfume, gazing upon her clothing, or listening to her sing. Although these ancient rules have contributed to contemporary prejudices and negative assumptions about menstruation, it must be said that Conservative Judaism has modified the laws of menstrual purity, and Reform Judaism has abolished them as irrelevant, archaic, and offensive to women.

The article's authors note that most Christian denominations do not follow rules about menstruation, but that Western civilization — which is predominantly Christian — has a history of menstrual taboos. Menstruating women have long been believed to be dangerous. In 1878, the
British Medical Journal
postulated that a menstruating woman would cause bacon to putrefy. How that was determined, I would like to know. Bacon has always done a pretty good job of putrefying on its own — particularly before the advent of refrigeration technologies.

Two vivid examples of the isolation of menstruating women were circulating online recently. In June 2013, the
New York Times
reported that the old Hindu tradition of
chaupadi
(requiring a woman to leave home to stay in a shed, stable, or cave while she is having her period) is alive and well in western Nepal. In addition, in April of the same year, female and male Cambridge University students in the U.K. took to the streets in a campaign called “I Need Feminism Because . . .” One of the students had herself photographed carrying a poster that obscured her face, and said: “I need feminism because my family wouldn't let me attend my grandad's memorial because MY PERIOD made me UNCLEAN.”