We are linked by blood, and blood
is memory without language.
--?Joyce Carol Oates
In his Jan. 21, 2006, State of the Union address, President George W. Bush called for "legislation to prohibit the most egregious abuses of medical research [including] creating human-animal hybrids." Bush's proposal grew out of cultural and religious concerns raised by human embryonic stem-cell and genomic research.
This speech echoed historic concerns about medical experimentation. In response, Holly Tucker, Ph.D., decided to tell the story of a similarly heated cultural struggle: the dispute over blood transfusion in 17th century France and England.
In her meticulously researched book, "Blood Work: A Tale of Medicine and Murder in the Scientific Revolution" (Norton, $25.95), Dr. Tucker explores the scientific revolution of the 1600s and the tension between science and superstition in a vivid account of the first blood transfusion experiments. Her book follows the career of a self-promoting French physician, Jean-Baptiste Denis, who performed the first animal-to-human blood transfusions in 1667. Denis drew the ire of fellow scientists who wanted to perform the first successful transfusions as well as powerful conservatives who believed that Denis was irreverently tampering with nature in ways that might create monstrous human-animal hybrids or even lead to divine retribution.
In late 1667, Denis transfused calf's blood into a well-known mentally ill Parisian. The man did well initially, but died within a few days of a third transfusion. Denis was accused of murder. Dr. Tucker solved this 350-year-old cold-case homicide with evidence that transfusion detractors were complicit in the death of the patient. In her book she ponders why the threat of transfusion drove some to murder, and how the Denis affair ended transfusion research for 150 years.
"Blood Work" has been praised for engaging writing and careful research, and the book earned a starred review in "Publisher's Weekly." Dr. Tucker is an associate professor at Vanderbilt University's Center for Medicine, Health & Society and Department of French & Italian. She also wrote "Pregnant Fictions: Childbirth and the Fairy Tale in Early-Modern France," and her articles have appeared in "New Scientist," the "Wall Street Journal," and more, in addition to many scholarly articles. She lives in Nashville, Tenn., with her husband and daughter.
Did you discover this story of 17th century blood transfusion when you were teaching the history of medicine?
The short story is that I [did]. I was prepping for a class on William Harvey's discovery of blood circulation [in 1628]. I stumbled on a reference to the first animal-to-human transfusion by Jean-Baptiste Denis, and that led me to look at the tense relationship of the French and English around blood and the doubly tense relations that Denis had with the French medical elite: the Paris faculty of medicine and the French Academy of Sciences.
Then I also looked at the third case of [animal-to-human] transfusion that Denis performed, which was the lethal case. Much of this story of blood transfusion is well known among medical historians, but what caught my attention is that Denis's patient died after the third transfusion.
There were rumors that Denis was responsible for the death. Denis was exonerated and the widow [of the patient] was convicted of poisoning her husband with arsenic. The court records said, "Yes, the wife did it," but she had help from unnamed physicians. I wanted to know who these people were and why they were so against blood transfusion that they were willing to resort to murder. That set me off on five years of research. I spent a couple years knowing I had a good story and knowing the names had never been revealed. I spent weeks and weeks at the Archives of the French Academy of Sciences trying to find anything I could.
I was about to give up on the book, but I was inventorying my research at home, and came across a stack of documents that I hadn't really looked at. I found a letter by a lawyer at Parliament indicating that he was nervous for Jean-Baptiste Denis, the transfusionist. He had every right to be nervous because Person X and Person Y had already shown they were willing to take radical steps to stop transfusion. That gave me the names that I needed.
So you returned to the Archives in Paris?
Yes. They were hiding in plain sight. When I was sure I had them, I called my husband. He said, "What's up?" And I started to sob, "I found them. I found them." He said, "What are you talking about?" "I found the murderers."
That's a remarkable story. It seems the conservative French resisted Harvey's theory and other discoveries while the English willingly experimented and tested tradition.
It's true that the English were more adventurous and more willing to imagine other possibilities and the French were more traditionalist and looking at the past as a matter of fact and faith. We see those same dynamics now. Change is scary. We know Harvey was right now, but when you're in the middle of it, how can you be sure? The resistance in France to transfusion was fascinating, but we can't judge them by our modern criteria.
Didn't the English begin with animal experiments before Denis?
Yes. Harvey was doing his experiments in the 1620s. In the 1650s, Christopher Wren and Richard Lower were doing infusion trials in animals, injecting fluids whether water, milk, wine, beer or opium -- into the veins of dogs. And in the 1660s, Lower and Robert Boyle were very close to performing the first animal-human experiment when the French scooped them.
And Denis had also done animal-to-animal experiments and then used animal blood to transfuse humans because it was "purer" than human blood?
That's not Denis' idea. That's also coming from the English. Denis is fascinating because he's a big copycat. He replicates all of the English animal-to-animal experiments. The one difference Denis adds is that he starts putting in new species like a fox and a dog, and a cow and a dog.
For Denis, it's all for self-publicity. After he does these animal-to-animal experiments in his home [in] Paris, all of his experiments were conducted in a carnival atmosphere. Denis takes it out of the Academy and does it on the banks of the Seine. In the way he describes those public experiments it is clear he was at it for the excitement and entertainment value.
Before the transfusions of the mentally ill man, Denis treated two other recipients. Wasn't the first patient a child with a seizure disorder?
The child had a long history of fevers of unknown etiology. Denis transfused him with lamb's blood, and the child didn't die, which seemed to be the criterion for success. The second transfusion was on a butcher who provided the lambs for Denis' first experiment. That was purely non-therapeutic and experimental because there seemed to be no illness they were trying to cure.
Then the English transfused Arthur Coga with lamb's blood. Coga was mentally ill. Then Denis transfused his own mentally ill man, Antoine Mauroy.
Why did Denis use calf's blood on Mauroy rather than lamb's blood?
I couldn't find any clear rationale, and all the other experiments with humans were done with sheep. That makes sense with the "Lamb of God, blood of Christ." And of course, the sheep is very calm. The only thing I think about is a cow in a pasture, and the cow is a mellow creature.
How did anyone survive these transfusions before any knowledge of blood incompatibility or the need for antiseptic conditions?
I tried to figure this out also. In the end, it boils down to three simple criteria: how much blood gets in, how fast it gets in and whether there has been any previous exposure. For how fast and how much, they're using goose quills, and the problem with goose quills is that not a lot of blood is getting in. Also, the blood is clotting so fast that we don't know how much is getting in. We can only speculate very little, if any [was transfused].
Some scientists in this era believed that transfusion could cure madness, and English scientists recruited the mentally ill Coga.
One of the explanations for mental illness in this time was that the blood would become overheated, either by illness or passion, and vapors would rise to the brain and trouble the mind. One of the first courses of action was bloodletting to reduce the heat of the body by reducing the amount of the blood, or dunking in very cold baths to cool the body and reduce the vapors. My sense is that they [used] animal blood [in transfusions], and particularly lamb's blood, because it was considered purer and more cooling than human blood. They hoped that could actually cool down Coga's humoral complexion and reduce his frenetic behavior.
Weren't mentally ill people used as subjects because they were a vulnerable population and less likely to object to experimentation?
Look at the patients [Denis] had: A young boy, a butcher of a lower class and a mentally ill patient. You have primary definitions of vulnerable populations.
Why did the transfusion experiments stop for 150 years not only in traditional France following the Denis case, but also in progressive England?
That was a mystery I have not found a satisfying answer to. The only thing I can figure out is that they were waiting to see the outcome of this highly publicized case, and then were distracted by other things.
And what prompted the resurgent interest in transfusion and James Blundell's human-to-human transfusions in about 1818?
That's another instance where history is unsatisfying and we can't find clear cause and effect. In 1818, James Blundell, an obstetrician in Guy's Hospital in London, sees new mothers hemorrhaging to death and wonders if there's something he can do. He first injects human blood into animals and the animals die, and he realizes that interspecies blood transfusions may not be the best way to go. He then begins the first human-to-human transfusions with the husbands of these women or staff members. That sets off a line of questioning about the possibility of blood transfusion and how to stave off clotting.
That will continue throughout the nineteenth century and will end up with the discovery of blood types by Karl Landsteiner in 1900, 1901. It's a sublimely simple experiment and he finds patterns in coagulation and proposes the idea of blood groups. And in 1914 they discover sodium citrate as an anticoagulant on the battlefields of World War I. The anticoagulant discovery allowed them to administer blood remotely so you don't [need] the donor and patient hooked up together. Then, in the 1930s, you have the first blood banks established.
You also discuss the segregation of blood supplies by race, which lasted in the South until the 1970s, representing a fear by some that transfusion recipients might take on the characteristics of another race.
That's a sad but classic example of the conflicts between science and society. It's my understanding that at no time was there any clear-cut scientific evidence that would show differences between races but, for social reasons, it was considered necessary to separate the blood of whites and African Americans. Some of it was to help transfusions to be more accepted because there were fears about racial contagion, and better to segregate that blood to get rid of that fear, even if it is an unfounded fear.
In the end, science and society are often at odds, and when it gets to questions about blood, it gets to deep, deep questions about identity and how blood allows us to define who we are and who we are not. In the end, those definitions are quite fluid, and just as fluid as the blood itself.
Your writing is very vivid. Who are your influences as a writer?
The historians who have done a great job writing narratively are Natalie Zemon Davis, David Kertzer, Carl Ginsberg, Jill Lepore and Jane Kamensky, who do compelling research and also tell great stories that bring you into this past world. I outlined other nonfiction books like "Seabiscuit" [by Laura Hillenbrand] and Debbie Applegate's Pulitzer Prize-winning "The Most Famous Man in America," about Henry Ward Beecher. I figured out how they brought readers into the narrative, how the narrative pacing worked, how the stories opened.
You bring a fascinating background to this book, with a doctorate in French, and then experience teaching medical history.
My graduate work has come in handy in writing a book like this, [such as] the ways to shape and pace a narrative and establish a voice.
Also, my [ten-year-old] daughter became something of a writing partner for me. When I was approaching the book deadline, I was getting nervous. She looked at me and said, "Mommy, you need help." She asked, "How many pages do you have to do? And how long do you have?" And she went off into another room and came back about a half hour later with a calendar and told me how much I had to write each day. And every Sunday night, she would write me in her grade school handwriting a contract that I would have to sign. I kept careful records [and] she would review my progress and then write me a new contract. So, she kept me on task.
You wrote that your book was prompted by a 2006 speech by President Bush in which he warned against preventing medical research abuses and mentioned an old fear of human-animal hybrids.
We're in the thick of discussions now about the relationship between society and science. Should science be allowed to move unhindered in its work to unlock natural mysteries, and to what degree are members of society stakeholders in those efforts?
All of this gets back to how society responds to biomedical technology. Blood transfusion was so frightening in the seventeenth century that physicians would be accomplices in a murder to make it stop. Now it's part and parcel of medical procedures. You can't find a physician now who could imagine modern medicine without the benefits of blood transfusion. I wonder what history will say about us at 50, 100, 150 years from now as we try to navigate this rocky landscape of our own biomedical innovation. I just hope history will be kind to us.