The crimson liquid that courses through our veins has taxed science for centuries. Helen Lowe tells the gory story
Do you know your blood group? Are you O-positive, or maybe a much rarer AB-negative? It could be a life-or-death question. We take it for granted that blood of the right type is readily available if we need it, and that there will be safety checks to minimise the risk of infection. But the possibility of this provision only became a reality after centuries of experimentation and trial and error.
In 1665, London physician Richard Lower redefined the term "bloodhound" when he carried out the first recorded blood transfusion. It wasn't from a healthy and willing human donor to a gravely ill patient, but from one dog to another. A year later, Samuel Pepys witnessed a demonstration of this experiment at the Royal Society - the donor animal died, but the one receiving the transfusion was "very well and likely to do well". Lower followed this with transfusions of blood from animals to humans, as did the French king's physician, who carried out several transfusions of blood from animals to people, as a treatment for mental illness. He believed that blood from a docile animal could calm a troubled mind. Four patients survived but, after a fifth died, the procedure was banned.
This spirit of ambitious experimentation came in the wake of the discovery by the English physician William Harvey of blood circulation, the publication of his discovery in 1628 revolutionised the theory and practice of medicine. The crude early procedures may have had little in common with today's clinical research trials, but they did signal the start of centuries of trial and error, leading to the possibility of successful blood transfusions that would save millions of lives.
It wasn't until 1818 that a London obstetrician, James Blundell, became the first to record a successful human-to-human transfusion. He used the procedure in patients who were dangerously haemorrhaging following childbirth, and about half of those treated in this way survived the procedure. The treatment continued to be used as a last resort - for example for patients with haemophilia - but without the knowledge of different blood groups, death was quite often the result. It was a further 83 years before an Austrian doctor, Karl Landsteiner, discovered the different blood groups (see page 11), for which he would later win a Nobel Prize in physiology or medicine. His discoveries led to the testing of all patients and donors to ensure compatibility and enabled a great expansion in the use of blood transfusions as a medical procedure.
By 1915, a safe anticoagulant (a solution of sodium citrate) was found, allowing treated blood to be stored for brief periods using refrigeration, which was then coming into widespread use for food preservation. The first blood depot was set up at a British casualty station during the First World War, blood being donated by individuals who happened to be present when it was needed. In 1921, a British Red Cross worker in London set up the first official panel of volunteers, listed according to blood groupings, who would be summoned by a police officer when their blood was required.
In most centres, donors were unpaid, but could claim expenses. In some places a payment was made, for example, in Manchester in 1930 a donor would get three guineas. Direct transfusion from donor to patient was still the most common practice at this time, but by the late 1930s some blood banks were operating in the US and the USSR.
During the Spanish Civil War, Federico Duran-Jordan, a physician from Barcelona, organised a blood bank that stored blood only from Group O donors, which could be used for patients of any blood type. Coming to London as a refugee in 1939, he helped establish the first blood banks in preparation for the expected war with Germany.
Giving blood during the Second World War was seen as part of the war effort, with more than three quarters of a million people answering the call for civilian donors to help the casualties of battle and bombing. The government opened blood depots around the country, administered by the Medical Research Council. There was a sense of being part of a great community of donors - in one session, the Princess Royal was followed in the queue by a factory worker and a city clerk.
Routine surgery in the new National Health Service after the war came to depend increasingly on a reliable supply of donated blood. The National Blood Transfusion Service (now the National Blood Service) was set up in 1946, based on the depots established during the war, with the philosophy that blood donated by the people was a resource for the people, and donors would give on a free and voluntary basis. But in the 1950s British soldiers who were called upon to give blood - usually by a superior officer - felt they had little choice. Their reward was a bottle of Guinness and a packet of crisps.
Internationally, the British system soon became a shining example of one that was not only morally better because it encouraged altruism, but medically more effective because there was less risk of infected blood being used. As blood banking became established around the world, the "gift relationship" often prevailed, but in many countries donors were paid, and in others, eg the Communist regimes of eastern Europe and China, compulsion was used in factories, prisons and the armed forces.
In Shanghai, quotas imposed on business enterprises and universities still account for 50 per cent of blood used locally. In France, prisoners were encouraged to give blood because it was felt this would have a humanising influence, a practice which fuelled a major scandal in the 1980s about the use of blood infected with the HIV virus. In the UK, the new Freedom of Information Act, which came into force at the beginning of this year, has revealed that blood was still being taken from prisoners in Scottish jails as recently as 1983, although it was well known by then that there was a high risk of such blood being infected by serious diseases.
As a medical procedure, blood transfusion has always attracted controversy.
As well as religious objections from groups such as Jehovah's Witnesses, it has been influenced by racial politics. All blood types are found in all races, but their relative distribution varies in different racial groups.
In the Nazi era in Germany, type B blood was used as a marker for Slavs and Jews. The German army received blood only from certified "Aryan" donors.
In the US, too, blood was segregated according to race, with the American Red Cross refusing blood from black donors for adding to pooled plasma.
Some states segregated blood by race right up to the 1960s - and in the 1950s it was a misdemeanour in Louisiana for blood from a black donor to be given to a white patient without the latter's consent.
These ideologically based policies persisted in the face of scientific knowledge that a blood transfusion of the wrong type from a member of one's own family could have fatal implications, while that of the right type from someone of a different race could save your life.
Although blood transfusions have saved many lives, some people have died as a result of receiving one, for example by contracting a fatal disease. With the medical profession constantly vigilant for blood-borne viruses such as hepatitis A and B and HIV, it is no surprise that there is a great deal of interest in autologous blood donation, whereby people's own blood is stored for future personal use.
There are ever intensifying efforts by many companies to develop a safe, effective artificial blood substitute. Doctors in Stockholm in 2003 announced the first successful use of artificial blood - a powder, developed in the US, made from real blood, with chemicals added in a secret process. The powder could be mixed into liquid form when needed and was suitable for patients of any blood type. This synthetic blood was also shown to transport oxygen around the body more effectively than real blood.
But until artificial blood proves to be cost-effective and becomes widely available, we will continue to rely on human donors.
Rituals and rites
Blood has long played a role in social and religious rituals and taboos in all human cultures, often being associated with sacrifice or uncleanness.
Consuming blood is forbidden in some religions, including Judaism and Islam, and allowed in others - for example, the Maasai people of southern Africa mix blood and milk in a sacred drink, while in Christianity the blood of Christ is symbolically consumed in the Eucharist.
In some religions, menstruating women are viewed as unclean, in need of purification through washing rituals or separation from the rest of the community in a "menstruation hut". Philosophers in ancient Greece also had trouble explaining women's periods: Aristotle believed that the glance of a menstruating woman could take the polish off a mirror and bewitch anyone who looked at it.
Ideas about blood play an important role in social relationships and family ties. Blood is thicker than water, it's in the blood, blue blood, good or bad blood, cold-blooded murder or hot-blooded temper - all these notions are rooted in a culture which sees each individual's characteristics as coming from the blood, and being inherited in the family's blood-lines, from a time before the discovery of genes and chromosomes.
In popular culture, rare steak might be a favourite in more up-market restaurants, but traditional blood pudding ranks alongside fish and chips as a long-time favourite in many parts of the UK. Bull's Blood wine is enjoying a revival, while braver souls will try a glass of "pirate's blood" - a potent cocktail of rum and raspberry juice.
Many people still relish the killing moment in "blood sports" of various kinds, filling their leisure time with active participation in fox-hunting or hare-coursing, or as spectators at fights between man and bull, or between fighting cocks or dogs. Watch any boxing match on television and see the excitement of the crowd mount if blood is spilled.
Throughout history, images of blood have had a powerful effect:, from brutal representations of hunting on ancient cave walls and more modern canvases, medieval imagery of Biblical scenes and paintings depicting the killing fields of wars. In recent times, blood itself has become a medium for some artists. A Canadian artist, Nina Leo, uses her own blood in her artworks, stating that "each droplet of blood is physical evidence of her own existence". And, "in recognition of the monthly renewal process", Vanessa Tiegs paints in her own menstrual blood and posts the pictures on her website (www.livejournal.comusersspiralingmoon). Meanwhile, a recent attempt by two Scottish artists to cook a "blood pudding" made from their own blood as an act of outrageous art was abandoned after environmental health officers stopped the event at the Royal Scottish Academy in Edinburgh.
Blood has always been interpreted as a symbol of purity and impurity, the sacred and the profane, life and death. Beliefs and practices involving blood have been with us for thousands of years - perhaps this is why Bram Stoker's Dracula has had such a lasting cultural impact.
* International World Blood Day is on June 14, the anniversary of the birth of Karl Landsteiner. For information on becoming a blood donor, visit www.blood.co.uk
A comprehensive website about blood and its role in medical history: www.pbs.orgwnetredgold
The Gift Relationship: From Human Blood to Social Policy by Richard M Titmuss, original edition with new chapters. LSE Books, pound;14.99