Blood Work (2 page)

 

“B
lue blood,” “true blood,” “blood brothers”: In any era blood gets to the heart of who we are, or at least, who we want to believe ourselves to be. Perhaps nowhere is there a better example of the obsession with blood and identity than in the
1940s, when the rhetoric underlying American racial segregation made its way to the blood banks.
⁹
In November 1941 the American Red Cross—mirroring the social divisions prevalent at the time—announced that it would not accept blood from African American donors for use in its blood banks. Two months later, in January 1942 and in the wake of considerable criticism, the Red Cross agreed to collect and store the blood of “colored” donors. However, the organization also made it clear that the blood would be segregated. In the absence of clear scientific evidence to support their decision, blood segregation appeared to work largely as a way to calm cultural fears of contagion. In one of thousands of letters addressed to U.S. senators and representatives, for example, an anonymous writer expressed concern about what multiracial transfusion would mean for white men returning from World War II. The blood of another race might not have a visible effect on the recipient himself, the writer worried, but it would corrupt the purity of bloodlines for generations to come: “How many white men, having a choice, would rather die there on the battlefield without plasma than run the chance of coming back to be the father, grandfather, or great grandfather of a brown, red, black, or yellow child?”
¹⁰

Such deeply felt debates on blood and race continued to rage for another two decades—and exploded in 1959, when the physician John Scudder and his colleagues presented the case study of a white man who had died, they claimed, from a blood incompatibility reaction following open-heart surgery. By all appearances the patient had received blood from a white person that was perfectly compatible with his own. But the man's death, they argued, could be traced to an earlier transfusion—in which he received blood from an African American donor.

The donor's blood contained an antibody (Kidd negative,
JK
^a
) that researchers believed occurred more commonly in blacks
in whites.
¹¹
The first transfusion caused a reaction to the Kidd-positive antigen in the man's own blood, so that the result was deadly when additional Kidd-positive blood was transfused into the recipient from the second, white donor. “If a white donor had been selected for the first transfusion,” the researchers explained, “the chances of our patient receiving Kidd negative would have been three times less than if blood from a Negro donor had been used, as was the case.”
¹²

The researchers argued for a race-based triage protocol when selecting suitable donors. The best blood, the Scudder group argued, was one's own. If that was not possible, then blood from a twin sibling or a blood-group-compatible family member was best. Still absent this, only “compatible blood from donors of the patient's race” should be used. A year later Scudder and his colleague W. D. Wigle argued for a “new philosophy in blood transfusion…‘Unto each his own.'”
¹³

Although the United States was in the thick of intractable segregationist social policies, physicians and researchers were vocal in their disagreement with Scudder's claims. In the pages of the
New York Times
seven physicians from Columbia University scolded Scudder and his colleagues: “The so-called ‘new philosophy' [of blood transfusion] serves no useful purpose except to reinforce the old ‘philosophy' of race prejudice.” The newspaper bolstered the Columbia group's message by publishing, on the same page, a report from a South African Red Cross official who explained that interracial blood transfusions had been performed for more than twenty years in that country without adverse effects.
¹⁴
And a year later Dr. Eloise Giblett of the Central Blood Bank in Seattle presented a quantitative refutation of Scudder's conclusions at the next American Association of Blood Banks meeting, stating that the data gave no “support to the alleged advantage of intra-racial over inter-racial transfusion.”
¹⁵
Despite these and other scientific
calls for desegregation, however, blood grouping according to race continued well into the early 1970s in several southern states.
¹⁶

The American Red Cross has long since adhered to strict, non-discriminatory practices in its blood and biomedical services. Relying on the goodwill of over 4 million blood donors each year, the Red Cross is the largest supplier of blood and blood products in the United States. And the need is great. The national organization estimates that every two seconds someone in the United States requires a transfusion. From patients with sickle cell anemia to those suffering devastating injuries, a safe supply of blood can mean the difference between life and death. Through both its disaster relief services and blood services, the Red Cross fulfills daily and in countless ways its mission to provide neutral humanitarian care to those in need.

This book does not explore in depth the triumphs and tragedies of modern blood transfusion. It is, instead, about the blood science in the seventeenth century—its discoveries and its deadly politics. However, as mid-twentieth century concerns surrounding race so clearly suggest, to narrate blood's past is also to reveal the core concerns of a society at a given moment in time. It would be hard, I think, to read this book and not consider the ways in which early medical history is also suggestive of the debates that swirl furiously around biomedical innovation and the contours of human identity today.

As I write this, intense debate continues to brew over whether or not scientists should be allowed to pursue certain lines of research if public response to that research is mixed or even hostile. Perhaps nowhere is this more evident than in the most recent controversies surrounding human embryonic stem-cell (hESC) research. Because hESCs are pluripotent, they have the potential to develop into any of the hundreds of different types cells found in the human body. Pluripotent cells, scientists argue, may one
day hold the cure for myriad diseases, from cancer to Parkinson's disease. For others, hESC research—even on embryos slated for destruction in fertility clinics—constitutes an affront to the dignity and sanctity of human life. In late August 2010, the U.S. District Court for the District of Columbia put a temporary hold on federal funding of hESC research. The court cited the 1996 Dickey-Wicker Amendment in its decision, which prohibited the use of federal funds for “research in which a human embryo or embryos are destroyed, discarded, or knowingly subjected to risk of injury or death greater than that allowed for research on fetuses
in utero
.” The ruling has been appealed by the Obama administration, and signs look good that the issue will soon find its way to Congress, which will decide whether to discard, rewrite, or let the amendment stand. Conversations, at once measured and frenzied, about hESC as well as other hot-button issues such as cloning and interspecies chimerism echo many of the same tensions between scientific innovation and the cultural and religious “push-back” that took place during the first blood transfusion trials some 350 years ago.

Alan Leshner of the American Association for the Advancement of Science argues that “for many scientists, any such overlay of values on the conduct of science is anathema to our core principles and our historic success. Within the limits of ethical conduct of science with human or animal subjects, many believe that no scientifically answerable question should be out of bounds.” However, as Leshner and others also recognize, when research begins to touch on “the essence and origins of human life,” it becomes more important than ever that science and society find ways to interact with one another in open and rational dialogue.
¹⁷

The past, I would argue, offers an excellent starting point for discussions about the future. Worries about science and its impact on what it means to be “human” are not the domain
solely of our genomic age. Scientific hopes and high-pitched social fears swirling around early blood transfusion suggest in many ways the tensions of our own day. Though blood transfusion is now a commonly accepted practice, its history provides not only insights into past clashes between science and society but also cautionary lessons on how to navigate them. I will return briefly to this idea in the epilogue. For now I simply ask readers to keep two questions in mind as they enter the teeming streets and cluttered laboratories of seventeenth-century Paris and London: Should a society set limits on its science? If so, how and at what price?

Paris, December 19, 1667

T
he French capital was cloaked in a dense and sooty haze as Parisians kept fires burning in chimneys and in the streets to stave off the icy gusts of wind blowing across the Seine. The winter of 1667 was one of the coldest on record; warmth had been difficult to come by.
¹
The price of wood skyrocketed, fresh food was nearly impossible to find, and survival was a daily challenge for the penniless multitudes that inhabited the lower rungs of French society. In this city of four hundred thousand, death had become part and parcel of the human experience. Corpses—the product of unrelenting cold, hunger, and violence—filled dark corners of the city's labyrinthine streets. Masses of Parisian citizens, near-corpses themselves, were left to huddle together in a desperate attempt to survive.

Jean-Baptiste Denis stepped out of his home on the Quai des Grands-Augustins and nodded with feigned entitlement in the direction of a waiting carriage. Across the river the gothic spires of Notre Dame Cathedral reached into the gray winter skies. The shivering coachman hovered attentively over the short and
stocky Denis as the young man settled comfortably into his seat, warmed by heated bricks. It was getting late, and Denis needed time to double-check that all the necessary preparations were in order for his history-making experiment.

The coachman crossed from the Île de la Cité to the Right Bank by way of the Pont-au-Change bridge rather than the Pont-Neuf. Drivers for well-heeled Parisians did what they could to avoid the riffraff that congregated on the city's oldest bridge—the snake-oil dealers and charlatans, switch-and-bait artists, street actors, and bevies of other shady characters. The Pont-Neuf was also the erotic center of the capital. Heavily perfumed prostitutes strolled along the bridge in décolleté dresses by day, and men of all persuasions fulfilled their passions under the bridge by night.
²
It was not a place for an upstanding gentleman to be seen; there were other, more discreet ways to pursue such interests.

Unlike the Pont-Neuf, the Pont-au-Change had long been associated with restraint and nobility. Since the late Middle Ages the original timbered bridge had been the preferred route of French kings, who made their solemn processions from their home at the Louvre to Notre Dame and back. When the wooden bridge burned down in the late 1630s, it was replaced by a beautiful one in stone.
³
And in a city where dirt and grunge coated the streets, the Pont-au-Change still felt crisp and new.

As the carriage bearing Denis rumbled across the bridge, he could not see the river. Five-story homes and shops obscured the view. This was of little matter; the shops were infinitely more interesting than the gray and polluted waters of the Seine. The windows of Mademoiselle de Tournon's exclusive boutique presented an extraordinary display of sparkling brooches, necklaces, and rings; Messieurs Poirion and Vaugon offered discriminating buyers a stunning array of devotional books, meticulously
engraved and illustrated by the best artists in the city; and then there was Monsieur Cadeau—literally “Mr. Gift”—whose ornamented sabers and swords made many men in Paris nostalgic for the good old days at the turn of the seventeenth century, when dueling had not yet been outlawed by the king.
⁴
There was no way that Denis could afford such luxuries, at least for now. Yet he settled into the comfortable velvet interior of the coach that had been sent for him, certain that one day soon all this—and more—could be his.

Unlike the men among whom he now circulated, Denis' birth sometime in the 1630s had gone unnoticed and undocumented. His father had been a man of modest means—just one of any number of faceless artisans who toiled in hot and smoky metal shops to craft the tools of science that others designed. The elder Denis was a
pompier
by training; his specialty was the water pump that was being increasingly put to a wide range of uses: from rudimentary hand-pumped sprayers used in firefighting to the more elaborate systems that powered fountains in royal gardens.
⁵

Despite his family's humble origins, Denis had proved himself to be one of those very rare men who could break through France's brutally static class system. Driven and perennially optimistic, Denis was able to insinuate himself into the world of wealth and high society in order to become, against all odds, a doctor. But while he would certainly have been loath to admit it, Denis was still something of a novice. Barely thirty, he had received his medical degree from the University of Montpellier a few months earlier and had returned north to Paris to seek his fame. Once there Denis was characteristically impatient and eager to distinguish himself. His father may have made the tools that put out fires, but the younger Denis yearned to set the medical world ablaze.

Horses' hooves beat rhythmically on the square stones that lined the streets. Denis' carriage pushed forward onto the main road that led toward the city hall and the large square that fronted it. The Place de Grève would become fully synonymous with death during the Revolution of the next century, when the guillotines turned the streets red. But now the open space was congested with the usual daily chaos. It was full of the carriages and pedestrians who fought to traverse the city, from the universities on the Left Bank where Denis now lived to the blue-blooded Marais district to which he aspired. The carriage inched into the bustling mass. The physician could hear the boisterous taunts of coachmen, his own included, as they challenged one another in their common struggle to pass through walls of pedestrians. As many noblemen would have, the bourgeois Denis ignored the sounds of beggars who pounded on the doors of his carriage, hoping for a handout.

Once Denis was clear of the Place de Grève, the undeveloped banks that lined this section of the river came into view. The marshes had proved difficult to build on and provided a surprising vista of farmlike land along the Seine. Haystacks documented the hard work of fall—and the brutal winter that had followed it—as shivering laborers loaded their wooden boats with feed for the horses and livestock that populated the courtyards of homes up and down the river. Yet the quarter that drew its name from these marshes, the Marais, was hardly bucolic. Not far from the fields on the riverbanks, narrow streets teemed with life. Each linked to the next, imposing noble homes—
hôtels particuliers
, they were called—towered over a warren of tightly clustered streets. Here there were no sidewalks; there was no room for them. Despite laws on the books about how far into the streets the walls of these outsized homes could extend, owners and their builders had found clever ways to add an inch here, an inch there,
in a city where space was forever at a premium. The streets below were shadowy, roofless tunnels filled with horses, carriages, merchants, vegetable hawkers, flower girls, pickpockets, and courtesans jockeying for room as they expertly dodged dirt and dung. The more cautious pedestrians pressed against the walls in the hope that they would not be knocked down, or, worse, run over by the constant flow of carriages.
⁶

 

H
aving successfully navigated the rivers of humanity that flooded the streets, Denis' carriage approached the twenty-foot-high, fortresslike doors of Henri-Louis de Montmor's city estate at 79 rue Sainte-Avoye.
⁷

Few men had demonstrated a better understanding of the rank and privilege offered by money than Montmor. Born to wealth, he never questioned whether he deserved the luxuries that he lavished on himself and those who surrounded him. His family had been part of the Parisian social fabric for nearly two centuries. Henri-Louis' father, the elder Jean Habert, was the Master of Requests for Henri IV, the illustrious grandfather of the current king, Louis XIV. A lawyer by training, Jean was responsible for preparing documentation for the legal cases that were regularly brought before the king's council.
⁸
Over time Jean's work expanded substantially to include full oversight of the war treasury, which earned him the name
Montmor le Riche
—and a well-deserved reputation as an embezzler. Ever resourceful, the elder Montmor once famously swindled a certain Gallet, a wealthy financier known for his love of gambling as much as for his love of building elaborate homes for himself. In an effort to steer clear of his vices, Gallet gave all his gaming money—some one hundred thousand francs—to Jean to hold. A desperate Gallet showed up one day on the steps of Montmor's house and begged his friend to give him some of the stash—just a little—promising
that he would wager only this small amount and nothing more. “My dear Monsieur Gallet,” replied Jean, “you are dreaming. Your losses have troubled your brain. I have nothing of yours.” It was said that he confessed the whole episode to his priest but claimed to the very end that his intentions had been pure. The priest, eager to calm the dying man's spirit and persuaded by Jean's show of contrition, confirmed that he had done a very noble deed. He had saved his friend from damnation; it was certainly better that the money went to him rather than to the devil. Jean died shortly afterward, convinced that he was on his way to heaven.
⁹

Like his father, Henri-Louis had found ways to take advantage of the great wealth that flowed freely into the family's coffers. As Jean's only son Henri-Louis wanted for nothing. The same doctors who served the king were regularly called to the Montmor residence at the child's slightest sniffle or cough. The honor of serving Lord Montmor, and the generous compensation they could anticipate for their good deeds, had caused a few fistfights among eager physicians.
¹⁰
Jean's money also assured the younger Montmor's access to the same royal power brokers who had established his father's career. By the age of twenty-five Henri-Louis had been named councilor at parliament and, at thirty-two, became Master of Requests as his father had been. His work in this position was hardly stellar. As one of his critics at court wrote, “He expresses himself with difficulty and is slow, timid, and does not apply himself.”
¹¹
But money and connections were what opened doors, not talent; and Henri-Louis rarely found a door that he could not open.

Denis' carriage pulled up to Montmor's imposing home. The presence of four guards, two on each side, sent a clear message that entry was by invitation only. Yet this did little to keep street folk, especially the beggars in their torn and dirty clothes, from
swarming the entrance with every carriage that arrived. As the huge doors swung open, the guards leaped into action. Truncheons in hand, they clubbed those who would make so bold as to infiltrate this sacrosanct space—men, women, children, healthy and infirm alike. The coachman led the horses through the imposing and distinctive porte cochère that served as a transition between the rude streets and grand taste. Once the coach arrived safely inside, a smartly dressed valet in a wool overcoat, tight-fitting trousers, and polished boots opened the carriage door. Bowing, he greeted Denis, who returned the show of respect with a practiced nod.

The valet swiftly guided Denis from the courtyard to the main entrance of the residence. Denis' heeled shoes clicked with force as he scaled the pristine marble risers of the estate's central staircase. He entered the room with confidence, ready for what would be—he was sure—his greatest moment and a certain confirmation of his talent. The vaulted ceilings reflected the warm glow of what looked like a bonfire burning in the enormous stone fireplace. At one end of the room stood the graying Montmor, who held court with a group of elite guests who had been handpicked to witness this latest triumph of medical science. The nobleman's lively blue eyes engaged each of the men with both comfortable familiarity and studied aloofness. Glancing up briefly to find young Denis standing awkwardly near the door, Montmor offered him a warm greeting and confident assurances that all was moving according to plan.
¹²

In the center of the room the surgeon Paul Emmerez was emptying his wooden toolbox and carefully placing his surgical instruments on a nearby buffet: knives and scalpels crusted with blood, clamps of various sorts, scissors, thread, muslin drop cloths stained rust brown, and several large bleeding bowls.
¹³
Just steps away a local butcher was straining to lift a young calf to the
large central table with the help of Montmor's stablemen. Moaning, the animal struggled until it was subdued by blows, the men working quickly to restrain the calf on its side.

Then, as if on cue, there were loud shouts, and the room's heavy wooden doors flew open as several watchmen dragged in an unwilling and clearly deranged Antoine Mauroy. The dirty and unshaven man continued to resist, leaving marks from his bare and calloused feet on the cold stone floor as he struggled. The butcher and his team quickly finished their work on the calf and rushed to help shove the screeching Mauroy into a chair. A few quick loops of a rope followed by a tight tug: Mauroy, like a tamed animal, now had no choice but to submit to the gruesome experiment soon to come.

Standing at a distance from the fray, Denis recalled the first time he saw Antoine Mauroy. It had been summer. The madman was stomping ankle deep in the mud on the marshy banks of the Seine. Naked but for the few rags held around his body with straw rope, Mauroy muttered incomprehensibly and reached up frequently to center a tattered little hat on his head. The homeless Mauroy attracted crowds of schoolchildren who followed him along the river. Normally oblivious to the world around him, the man stopped from time to time and stood still for several seconds. Turning his filthy face suddenly toward the children, he would let out a howl and flap his arms wildly. The children ran, shrieking with delight, and Mauroy retreated into his delusions.
¹⁴