Medicine, Murder And The History of Transfusion
IRA FLATOW, host:
You're listening to SCIENCE FRIDAY. I'm Ira Flatow.
Up next, a tale of blood, I guess is how you might say it. If you've ever gotten a blood transfusion, you know that it can be a lifesaving medical treatment, but it must be done very carefully because if you give somebody the wrong blood type, you can cause a deadly immune reaction. So there are checks and double-checks to make sure that those A's and B's and O's, well, they all match up.
But centuries ago, long before anyone ever heard of blood types of immune systems, scientists in France and England were experimenting with blood transfusions. They were giving animal blood to people even.
Amazingly, some of those people survived, and of course some of them didn't. And the story of one man who didn't make it, we'll get into the why of that later, is at the center of a new book about the early history of transfusion.
The book is called "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution." The book tells us the tale of how the evolving science of blood transfusion was intertwined with religion, superstition and ego. It doesn't seem like much has changed these days, does it.
Here to talk about it is Holly Tucker. She is associate professor in both the Center for Medicine, Health and Society and in the Department of French and Italian at Vanderbilt University in Nashville. She is here today in our New York studios. Thanks for coming in today, Dr. Tucker.
Dr. HOLLY TUCKER (Vanderbilt University): Hi, Ira, it's great to be here.
FLATOW: Blood work - what made you decide to write a book about the history of blood transfusions?
Dr. TUCKER: You know, I stumbled on it quite literally when I was teaching a course on early medicine and had to prepare a lecture on William Harvey, who discovered blood circulation in the 1620s.
And as any good professor would, as I needed to get some ideas together and read around what was happening and stumbled on the cases of blood transfusion, I was surprised that it was happening in the 17th century and was even doubly surprised when I learned that the first transfusions were animal to human.
Dr. TUCKER: Uh-huh.
FLATOW: Animal to human...
Dr. TUCKER: Uh-huh.
FLATOW: That must have caused some sort of uproar to hear that you're taking blood from animals and putting it into people.
Dr. TUCKER: It depends on where you were, whether you were in England or whether you were in France. The English were very interested in this idea. Right after Harvey and his discovery of blood circulation, they moved to animal models in which they were taking anything from water, beer, wine, opium, and injecting it into dogs to see what would happen.
And from there they started to wonder: Well, if we can put that into animals, perhaps what we can do is trade blood of animals. And they were getting very, very close to performing experiments in humans with blood transfusion when the French scooped them, essentially.
And a physician in Paris performed the first transfusion on a young boy with sheep blood. It was a success. The boy didn't die, which was the main criterion for success at the time. And then the next transfusion, he used a butcher who was healthy and who likely provided the sheep for the first transfusion. He was a very colorful figure.
FLATOW: Oh, he was there watching what was happening, right?
Dr. TUCKER: Yeah, he provided the sheep, and he even asked the transfusionist: Hey, you know, what are you going to do with that sheep now that it's dead. Can I take it?
So that went well. The only frustrating part for the French transfusionist was he was walking the streets of Paris after the transfusion, and he had paid the butcher to be a subject in this experiment, and he saw the butcher in a tavern, and he was furious.
What is my patient doing in this tavern? He was drinking with his buddies, came in to start yelling at the butcher. And then he says: Wait a second, all of these other people want a transfusion too. They want to be paid, right?
Hmm, the guy's alive. It must be okay. It must be a great success. And then he reached for a third patient, and that ends up being the focus of my research about what happened to that third patient, because it was not successful.
FLATOW: Tell us.
Dr. TUCKER: Well, Jean-Baptiste Denis was a upstart physician trained in Montpelier in the South of France. And he was an outsider to the French medical community because if you wanted to be an illustrious physician in the 17th century in France, you needed to train in Paris.
He didn't, and he was not also a nobleman, right? He was of a very low class but still decided he was going to make a name for himself. So he decides that he's going to reach for transfusion, which enraged the French elite.
Unlike the English - the English were very interested in this idea - the French didn't believe in blood circulation. They were highly attached to very early models of medicine: Hippocrates, Galen. And the whole idea of blood transfusion was distasteful.
So this upstart physician performed these first experiments in sheep on the young boy, and then the butcher starts to decide: I need to make a bigger splash.
So he reaches for the most famous man in Paris, a mentally ill man who roamed the streets of the most elite area of the capital, naked, yelling and screaming. The man's plucked off the streets and transfused with calf's blood.
The first transfusion went well. Again, he didn't die. The second one was fine, and by the third one, the man was dead. And the transfusionist was called up on murder charges.
FLATOW: Wow, pretty serious.
Dr. TUCKER: Pretty serious stuff.
FLATOW: And did he - tell us, did he get the guillotine?
Dr. TUCKER: No. What's very interesting is Denis actually was exonerated in the court case, and that's where I came in on this research, because the court case said he didn't do it. The court case also said that from here on out no human blood transfusions can happen in France without the express approval of the Paris Faculty of Medicine.
But then there were two elements in the court case that were fascinating that historians had not spent a lot of time looking at. First, it was determined that the patient was murdered, not by the blood that may or may not have flooded his veins but rather by...
FLATOW: Someone else. We won't give it away.
Dr. TUCKER: I can tell you this.
(Soundbite of laughter)
Dr. TUCKER: I can tell you this.
FLATOW: No spoiler alerts here.
Dr. TUCKER: Is that he it may he may have - the patient may have been murdered by arsenic.
FLATOW: Oh really?
Dr. TUCKER: The patient had been actually poisoned with the help of three unnamed physicians whom Denis, who is the transfusionist, later called enemies of the experiment. And nobody had really looked at who they were or why they would have tried to frame this physician. And the answers are fascinating, yeah.
FLATOW: It's interesting. It's a great book. It's called "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution." Holly Tucker, the author, is here. Our number is 1-800-989-8255.
Why were they interested? I mean, was there some disease they wanted to cure? I mean, people just volunteering to have blood transfusions, was this sort of the rage after the first one started? Did they think mental illness you could cure from blood transfusion?
Dr. TUCKER: In the case of the young boy that was transfused with sheep's blood, it was - he had been suffering from fevers for quite a long time. And animal blood - actually, it makes sense that they were reaching for animal blood because animals don't drink, they don't swear, right. They live a purer life than humans.
Their blood, particularly a sheep or a cow, their blood is cooler because the animals are calmer than humans. And so the young boy who was suffering from these intense fevers, it was thought that if they moved cooling sheep's blood into his veins, it would help temper the fever.
And for the third now, the second patient, the butcher, it was purely experimental, no therapeutic intentions. But the third one, the mentally ill man, it was precisely because mental illness was considered to be a result of blood that was overheated. And the vapors in the blood would reach the brain and trouble the mind.
So they transfused him with calf's blood in the hopes that - you know, we look at cows in the pasture, they're very calm - that it would somehow calm the hallucinations of the man.
FLATOW: You know, one of the things that strikes me about this period of time, in the 1600s or 1700s, is how these natural philosophers, they're surgeons and barbers at the same time, sometimes architects. They could just do anything they wanted when it came to experimenting, right? Animal, people, homeless people.
Dr. TUCKER: Uh-huh. Well, there was no such thing as an institutional research board, right? And so much of the types of bioethical checks that we have now come as a result of very painful and unfortunate moments in history in which vulnerable populations were not taken care of.
FLATOW: How were you able to reconstruct that period of history so long - 400 years ago?
Dr. TUCKER: It was fascinating to me because as a researcher I've written other books on 17th-century France, but I knew this was a story I wanted to be able to tell in the way that readers would be able to hear, see and actually smell, which is not a very pretty thing in the 17th century, it's to be catapulted back into that moment. And so that meant different types of research than I had done before as an academic. I ended up finding for all practical purposes what we'd call the yellow pages of 17th century France, that...
FLATOW: The phone book.
Dr. TUCKER: A phone book, exactly. And it told me where certain stores were in Paris, who the owners were and what they sold, so that I knew that not far from the transfusionist's home there was a woman selling fish on the banks of the Seine.
Well, what would that area of town smell like? Well, it would be stinky, right? Other details - did they have windows in their carriages or curtains? Well, that makes a big difference.
If you're describing this historical figure moving through the streets of Paris, and you're trying to think about what they would see through the window, you need to know those details. So I did spend a lot of time researching the teeny tidbits, and I think that does make a difference to tell a compelling a narrative when you move back in time.
FLATOW: Yeah. And you do - yeah, you do a very good job with the details. It makes the story come alive. And talking about blood must not be an easy thing to get used to, right, or to deal with and -especially, I know you have - how many kids do you have?
Dr. TUCKER: I have a daughter.
FLATOW: You have a daughter.
Dr. TUCKER: Mm-hmm.
FLATOW: And she got into some of your research?
Dr. TUCKER: She would walk into my study as I would work and she would see these anatomical plates opened on my desk and other types of descriptions. She'd walked into, ooh, mommy, mommy, mommy, mommy. And, you know, I'm also an animal lover. And we're talking about some very brutal experiments that were done on dogs and also humans before centuries, before anesthesia, before antisepsis. And I was writing some of these transfusion scenes using primary documentations and the natural philosophers, as scientists were called at that time, were very detailed. So in a way, it was translational, but it was also very hard to have those scenes and writing those scenes when I have my own dog in my own feet.
(Soundbite of laughter)
FLATOW: You know, one of the things that you reveal in the book that I really did not realized that much is that, while we take blood circulation for granted today, a few hundred years ago, there was thought that the blood was burned in the heart, right?
Dr. TUCKER: Mm-hmm. Right. Right. The heart was a furnace. It was a fire. So what - how blood was understood is not a circulating, rather it was understood as a system - part of a system of what they called humors for fluid; blood phlegm, black bile and yellow bile.
And so the body was almost just an envelope of liquid. And to create blood, it was all through the digestive system. So you ate. It was mooshed(ph) around your stomach. Concocted was the word they used. Then moved to the liver, where it was purified into the life force, blood, then it made a one-way trip up to the heart, where it's burned off.
Now, they didn't know about the action of breathing, the pulmonary system and the circulatory system. And it was really just thought that you breathe in as the way to stoke the fire. And you breathe as way to get rid of some of the fumes. So you can imagine blood circulation, the discovery of blood circulation was really revolutionary.
FLATOW: Yeah. And so, I imagine - and so, if you - if your heart is burning the blood, does that creating the body heat that we have?
Dr. TUCKER: Absolutely.
FLATOW: And so, if you have a fever, then you have too much body heat?
Dr. TUCKER: And you have too much blood, right. So that's why we get bloodletting, right, and with the leeches and the lancets. And that's another reason why blood circulation was at pivotal moment in the story of blood transfusion, because we can't imagine transfusing, that is putting blood into a human being or an animal, at a moment that -really, the first course of action is not to reach for, as I do, ibuprofen, if I'm sick or whatever. Actually, your first course of action will be to take blood out. So it takes a radical sea change of thought to move from taking blood out to putting it in.
FLATOW: Talking to Holly Tucker, author of "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution" on SCIENCE FRIDAY. I'm Ira Flatow. 1-800-989-8255.
Let's see if we can get a phone call here before the break. Hi, Peter in Oakland. Hi, Peter.
PETER (Caller): Hi.
FLATOW: Hi there.
PETER: I was just calling because my question is, what were the procedures like in the days exactly? What type of equipment do they use? And how much blood was transfused? Was it 100, first 100 of patient's blood?
FLATOW: Good question. Thanks for calling.
Dr. TUCKER: That is a really great question, Peter. In fact, that helps us to explain why we don't see radical blood incapability reactions, because there are three things that would determine the extent to which a patient would have a response. First, is how fast the blood goes in. Second, is how much. And third, if there's been previous exposure.
Now, keep in mind that they were using really primitive methods. They were using goose quills. So they were tied together - yes, goose quills.
FLATOW: That's what they punch through their veins with, goose quills?
Dr. TUCKER: Well, they would puncture with a lancet. They would do a cut down, and then they would slide a goose quill into...
FLATOW: Let's move on.
(Soundbite of laughter)
Dr. TUCKER: Are you squeasy.
FLATOW: No, no. I was just joking. A goose quill?
Dr. TUCKER: Right.
FLATOW: And then they would drain how much of the blood out?
Dr. TUCKER: Well, we don't know for sure, because so much of it would clot, right, or would drip around the goose quills.
FLATOW: Yeah. Right.
Dr. TUCKER: Later on, they had a more elaborate system using silver pipes. And still there, the transfusion - these records are - which are really quite detailed. There would always be this moment of, is it going to clot? In fact, in one case report, as they were sitting there for nearly a minute after they had inserted the tubes into the donor and the recipient, and it didn't look like they were going to get much. And so, what they would do is, oh, the room is getting too cold. Let's stoke the fire. Oh, let's rub the patient, right? So we really don't know.
They had an elaborate system in the Paris Academy of Sciences to answer just that question that Peter asked. They put two dogs on scales, the old-fashion scales with weights, right?
Dr. TUCKER: One dog was on one scale. One dog was in the other. They transfused blood and they were watching this delicate dance between the scales to get an idea of how much they put in. We can't know for sure.
FLATOW: But it was very crude and just totally experimental.
Dr. TUCKER: And think about it. This is hundreds of years before they discovered blood types, in 1900, right? So they really don't know what they're doing. But sometimes it seems by pure chance, we know now, it worked.
FLATOW: Well, some say - even in our history is not - you know, we don't know what we're doing sometimes. You write in the preface of your book that the Red Cross wouldn't take donations from black people all the way into the 1940s.
Dr. TUCKER: That's right. In fact, blood gets at questions of who we are and, as I say, who we think we want to be. And there are moments, very difficult moments, for example, the Red Cross - and I've been a long-time volunteer, a huge supporter of the Red Cross - is in the very early years, the Red Cross did, particularly in the height of segregation, they did segregate blood. In fact, there was a moment in which they refused blood from African-Americans. And then in response to resistance, they said, all right, we'll collect blood, but we'll still segregate it.
And we know that that was not based on scientific evidence, that the blood of races isn't necessarily distinct, right? And blood segregation continued, actually, until the 1960s in different Southern states. And so there are dark moments in blood. And I think, again, it gets always to this question of identity.
FLATOW: We're going to come back and talk a little bit more. Holly, can you stick around a little bit longer? Holly Tucker, author of "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution." Our number, 1-800-989-8255. You can also tweet us: @scifri. Or you can join our discussion at our website or on our Facebook page, Facebook/scifri. Stay with us. We'll be right back after this break.
I'm Ira Flatow. This is SCIENCE FRIDAY from NPR.
(Soundbite of music)
FLATOW: You're listening to SCIENCE FRIDAY. I'm Ira Flatow, talking with Holly Tucker, author of "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution." Our number, 1-800-989-8255. Let's see how many phone calls we can get before the break. Bob in Saugatuck, Michigan, hi.
BOB (Caller): Well, good afternoon. What an interesting program.
FLATOW: Thank you.
BOB: I've got a question in regard to the young boy that was transfused with sheep blood. We know the how that he did survive, correct?
Dr. TUCKER: That's right.
BOB: But the why, why did he survive? Because I would have thought that the sheep blood would have contaminated his system and triggered, you know, a shock of the system.
FLATOW: All right. Let's...
BOB: Why did he survive?
FLATOW: Okay. Thanks for calling, Bob.
Dr. TUCKER: Well, again, it's a question of how much blood really got in there. We can't be sure. In fact, my sense of things is really not a lot. And if you don't have a lot of blood - it doesn't come in all that quickly and there's not previous exposure there - you talk to an immunologist, the body can withstand, actually, quite a bit.
FLATOW: Let's go to Frank in Columbus. Hi, Frank.
FRANK (Caller): Yes. Ms. Tucker, you've written a fascinating book and I must rush out and buy a copy. You've drawn a contrast between attitudes in England and France. And what I wanted to ask you is how much of the opposition in France to transfusion or perhaps even to the idea of blood circulation itself was based in religion?
Dr. TUCKER: Actually quite a bit. Now, you won't find explicit references to that in the documents, the scientific documents themselves. But the context is, of course, the English are Protestants, and they have a long tradition, by the 17th century, of pushing against tradition. The English, right, are Catholics, and they have a long tradition of pushing against those who have pushed against tradition. So you find that there's a greater open...
FLATOW: You meant the French are Catholic. French are Catholic.
Dr. TUCKER: Did I - oh, French are Catholic.
FLATOW: All right.
Dr. TUCKER: Yeah. Okay, thank you. So the English are Protestant, the French are Catholic. Thanks, Ira.
FLATOW: Right. It's okay. I would have said it wrong myself.
(Soundbite of laughter)
Dr. TUCKER: So what you do find is that the English are very open to these - more open to these ideas. In fact, Samuel Pepys, who is this fantastic diarist of the 17th century, starts to speculate, hmm, could this be interesting? Maybe we could transfuse an archbishop with the blood of a Quaker. What might happen then? And in France, they're terrified by the idea that blood could actually create a change in species, could create even a change in faith. So religion is not anchored in the scientific texts themselves, but it's in every aspect around those scientific texts.
FLATOW: You write it was on Europe's battlefields that blood transfusion effectively pushed its way to the forefront of medical practice. When did that happen on this?
Dr. TUCKER: Well, we're at the height of scientific revolution. So the French and the English are using science, actually, as a way to promote nationalist aims. So that's what's happening in this battle of blood transfusion. In fact, John-Baptiste Denys, the transfusionist who did the first human transfusion, enraged the English. Not only was he taking their methods, he was also scooping them because the English were so very close to doing the very same thing.
FLATOW: Mm-hmm. You also talk about the Spanish Civil War as being a turning point.
Dr. TUCKER: Well, you know, all - everything is up for grabs in Europe, right? The English are battling the, you know, with the French, the French and the Spanish. At the same time, you have these natural philosophers who are unlocking the secrets of nature for the very first time. You have extraordinary egos, and that's definitely at play. Jean-Baptiste Denys, the transfusionist, is out there trying to make a name for himself by essentially enraging the more traditional Catholic physicians in France. And he's enraging the English because he's taking their methods and not giving them credit for it.
FLATOW: Fascinating. Fascinating book and very well-written. I recommend it to everybody. Go out and get a copy. Thank you. Thank you, Holly.
Dr. TUCKER: Thanks, Ira.
FLATOW: Holly Tucker, author of "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution."
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