Blood Work (23 page)

Martinière's writings continued to take on a dark and menacing tone. Martinière depicted himself as a noble warrior and left
no doubt that his next target would be Denis himself. “Allow me to tell you, Sir,” Martinière wrote directly to Denis, “that Satan reveals himself through your work.”
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He made it clear that he viewed himself as “a spirit that will not fail to arrive at our goals, by giving [the transfusionist] a fatal strike.”
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Mauroy's death, he explained, would be only a prelude to Denis' own: “We read in the book of Judges that the King of the Canaanites, who killed several kings by cutting their hands and feet off, was sentenced to die of their same death. And it is written in the New Testament that whoever kills by the sword, dies by the sword. Be careful,” Martinière warned Denis, “that…you are not yourself visited by the Furies, who as principal guardians of the law, will perform endless transfusions on you with the help of their little minions from the underworld. Or [perhaps you should be] careful that you're not transmutated into a calf [as] Lucian was in the Golden Ass, sentenced to hard labor and beaten with sticks.”
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Martinière's ravings were not, it would appear, just the innocuous outbursts of a man who believed deeply in the righteousness of his claims. As the lawyer Basril noted, “Monsieur Denis is very prudent to keep silent.”

Martinière was outraged when he became aware of Basril's letter naming him in the plot. “This,” he wrote indignantly, “is my reward for having worked to suffocate the transfusionist monster in his cradle”—a phrase that Lamy, coincidentally, used as well in one of his own letters.
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The angry doctor quickly went on the defensive and, in doing so, spilled yet more ink as he sent handfuls of letters far and wide in order to proclaim his innocence. Among these letters was one addressed directly to Mathieu Molé, the man assigned to judge Denis' appeal in parliament. Martinière urged the judge to take a stance against transfusion's unholy corruption of the human race. “Knowing that you are the Judge of the Transfusors,” wrote Martinière, “I have taken the
liberty to put my hand to plume in order to show you the horror of the operation, which is directly to the contrary and opposite of God's wishes, because it destroys His living images.”
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Martinière continued his writing campaign at the highest of political echelons—going so far as to address Prime Minister Jean-Baptiste Colbert himself. “Knowing that you do not approve of this so-called operation of blood transfusion,” Martinière declared, “I know that you will not be surprised to hear that there are some men who are so feeble minded to believe that it is an effective remedy against a variety of illnesses.”
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Martinière warned Colbert of the bloodbaths that were sure to happen should the transfusionist be allowed to continue his work. “Denis,” Martinière explained, “is hoping that the doctors of the Faculty of Medicine will allow the deaths of seven to eight million men before they bring themselves to condemn the procedure.”
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Martinière begged Colbert to step in and offered a suggestion for a suitable punishment for Denis: “The innovators whose inclination is to pull and push blood…should be sent to the Caribbean and sacrificed to the idols.”
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In his letter to the prime minister, Martinière reiterated his belief that his actions had been fully warranted and asked for Colbert's help against those who would seek to punish him for his action. Placing his fate in the prime minister's hands, he pleaded: “Your Goodness, I finish here by asking for the honor of your protection and by begging you to stop the case [against me], because I never intended to hurt anyone, I only wanted to ensure that this cruel and disgusting science would not endure.”
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There is no formal record of Colbert stepping in, yet one thing is certain: Martinière was never put on trial. And without another word Martinière disappeared. In the years following his involvement in the Denis affair, he quietly published two lengthy mem
oirs of his travels as a young man on the high seas. Yet not a single one of his works addressed medical issues, nor did he ever discuss transfusion again. Between the parliament ruling and his death in 1676, biographers have found only fleeting traces of Martinière in Amsterdam and Dublin.
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This leaves us to question whether there could have been a gentleman's agreement of some kind that recognized his usefulness in putting transfusion to rest, while at the same time removing the uncontrollable and explosive Martinière from the Paris medical community.

Denis' supporter Henri de Montmor also slipped from sight following the trial. According to Jean Chapelain, once a regular attendee of the Montmor Academy, the nobleman fell into a deep depression after 1669—the year of the parliament trial. “He was,” wrote Chapelain, “obliged to sell his title as Master of Requests [at parliament] and there was some talk that he lost his mind a bit, or even fell into suicidal despair. For eight days, they had to force him to eat to stay alive.”
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It took a visit from the archbishop of Paris to persuade Montmor to let his family and his doctors care for him. And for at least a year after the trial, “he lived only on milk and did not involve himself in any domestic matters, nor did he speak to anyone or accept visitors.” Giving up his hopes of a private academy for good, Montmor spent the next six years removed from the world in a state of disillusioned stupor.
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Meanwhile his eldest son handled all family affairs, and soon the once-legendary family was bankrupt. Montmor died in 1679.
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As for Denis, he returned to his home on the Left Bank, where he gave paid lectures to students as he had done before transfusion catapulted him into the public eye. The experience had changed him, it seemed—or at the very least had taught him to temper his ambitions. One of his first conferences after the parliament hearing focused on “judicial astrology,” or the ability to tell the future from the stars. “There is nothing so common as
to see people who are infatuated with the folly of astrology, who brag about being able to predict various events that will happen in their lives,” Denis explained, with some disappointment and perhaps newfound wisdom in the wake of his losses. “Anyway, if a prediction that good things will happen does actually come true, it would be a disservice. Predictions will always keep you in a state of suspense, in a state of impatient hope, and this hope will deprive you of everything that is good and agreeable in life.”
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Yet Denis' endeavors later in life may just prove to be one of the greatest of history's frequent ironies. Four years after the final trial at parliament, the former transfusionist set himself on the most unlikely of research paths. Denis—the man who boldly championed transfusion against all odds—invented styptic, which is now found in medical cabinets around the world and used to stop mild bleeding.
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If he was not able to ensure his legacy by making blood flow, he would do it by making blood stop entirely. Denis died in 1704 at the age of sixty-nine.

 

A
nother one hundred and fifty years would pass before blood transfusion returned to the early-medical landscape. In late 1817, James Blundell walked briskly down the halls of the maternity ward at Guy's Hospital in London. The twenty-six-year-old doctor had been called to the bedside of a new mother who was hemorrhaging. By the time Blundell arrived, the bleeding had stopped but the woman was pale and gravely weak from blood loss. With the angst of a newly minted physician who had not yet seen his fill of death, Blundell lamented that “her fate was decided.” He was right; the woman died two hours later.

Years later, Blundell described his thoughts as he witnessed this “melancholy scene.” He was haunted by a single question: Could he have done something to save the new mother? Blundell reached into the past and decided it was time to reconsider trans
fusion and to give this “neglected operation” the “experimental investigation which it seems to deserve.”
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“After floodings [hemorrhaging],” he wrote explaining his decision, “women sometimes die in a moment, but more frequently in a gradual moment; and over the victim, death shakes his dart, and to you she stretches out her helpful hands for the assistance which you cannot give…. I have seen a woman dying for two or three hours together, convinced in my own mind that no known remedy could save her: the sight of these moving cases led me to transfusion.”
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Like Denis a century earlier, Blundell performed interspecies transfusions to test his theory. Using a syringe, he injected three dogs with human blood. All three died.
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Several experiments later Blundell surmised that the “blood of one class of animals cannot be substituted…for that of another with impunity.”
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Turning his efforts to human-to-human transfusions, he soon recruited husbands as well as male hospital workers to serve as ready blood donors for mothers in need. The results were mixed. Of the ten patients he transfused over eleven years, only five survived.
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Blundell's work set off a rush of blood experimentation in the mid-1800s that culminated in Karl Landsteiner's landmark discovery of the ABO groups in 1901. In the wake of blood typing, blood transfusion quickly entered clinical practice. At New York City's Mount Sinai Hospital, for example, nearly fifty transfusions a year were performed between 1907 and 1914.
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Still, transfusion remained a labor-intensive and dangerous procedure. Patients were required to be in the same room together, and a large staff was needed at the bedside: a surgeon, a surgical nurse, and nurses for each of the patients. Further, the donor risked long-term damage or even amputation of the limb if blood flow to the transfusion site could not be reestablished.

Fresh blood will begin to clot in just five minutes outside the human body. So any possibility of transfusion without the need for a donor at the bedside depended on finding an efficient and safe way to store and transport blood. Over the course of the nineteenth century, researchers experimented with a wide range of substances in the blood to combat clotting. At the turn of the twentieth century, just four years after Landsteiner's landmark discovery, researchers in three different countries, working independently of one another, recognized that the addition of sodium citrate to donor blood kept it from clotting. And unlike other substances tried in the past, it did not appear to have adverse effects for the recipient.
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It was on Europe's battlefields that blood transfusion effectively pushed its way to the forefront of medical practice. When the Spanish civil war broke out in the summer of 1936, bombings of major urban areas left thousands of civilians dead or gravely injured. Led by the physician Frederic Duran-Jordá, the Republican army health service set up a blood distribution network based on voluntary donors, who were called in by rotation at one-month intervals. Over the course of thirty months the Barcelona blood transfusion service recruited thirty thousand donors who provided more than nine thousand liters of blood used in twenty-seven thousand transfusions.
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The blood was stored in five-hundred-milliliter reusable Erlenmeyer flasks that were sterilized by steam. Once the blood was warmed on-site, transfusions could be carried out on the field without further delay.

At about the same time, across the Atlantic, the first blood banks were being created. In 1937 Dr. Bernard Fantus established a central depot at Cook County Hospital in Chicago, which he later called a “blood bank,” as a place where donors could have blood drawn and stored for future use, either by themselves or family members with the same blood type. When World War II broke
out just a few years later, the American Red Cross helped organize a civilian blood service to support war efforts. The Red Cross opened its first center in New York in January 1941, and by the time the war ended in 1945, it had collected well over 13 million units (a unit is just under a pint) of blood.
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The American Red Cross formally established a civilian blood service in the years following the war to help meet what had now become a soaring demand for blood in the States. And in November 1947, directors of more than fifty independent blood banks met in Dallas to draft the charter of the American Association of Blood Banks (AABB), which was established to ensure consistent, research-based standards for transfusion and whose work continues today with more than two thousand member institutions.

Today blood transfusion is one of the most commonly performed medical procedures in the world. In the United States alone, about 15 million pints of whole blood are donated annually by more than 10 million people.
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Transfusion has become a gold standard in treating a broad range of illnesses and injuries, from chronic anemia to blood loss from trauma and surgery—so much so that it is impossible to tally the number of lives that have been saved or improved by the procedure.

I
first stumbled on the Denis case nearly a decade ago while preparing course notes for an undergraduate lecture on harvey's discovery of blood circulation. It was odd and fascinating, but other research projects beckoned. Still, over the years that followed, I could never seem to get Denis and the fate of early transfusion out of my mind. On research trips to France and england for other topics, I found myself stealing a peek at anything that had to do with early blood science. On one corner of my desk I kept a growing stack of research documents—articles, reading notes, illustrations, copies of manuscripts, and scientific correspondence—related to every aspect of early blood work. And nearby on the floor sat an equally overflowing pile of papers about animals, monsters, and interspecies hybrids in early europe. I would not learn about lamy, Martinière, and the basril letter until much later and understand finally how the two were linked, but I became increasingly certain that early animal-to-human transfusions were a case study for larger political strug
gles, religious controversies, and cutthroat ambitions during the late seventeenth century.

Still, it was not until January 31, 2006—after several years of research and while listening to George W. Bush's State of the Union address—that I knew the story of early blood transfusion not only should be told, it
had
to be told. In his address Bush called for “legislation to prohibit the most egregious abuses of medical research [including] creating human-animal hybrids.” Bush's speech echoed a report by the President's Council on Bioethics two years earlier, in 2004, which argued for a congressional ban on animal-human embryonic stem cell research as a way to prevent “some adventurous or renegade researchers” from doing untold damage to the human species.
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History was repeating itself. Jean-Baptiste Denis was also seen by most as a dangerous renegade. Yet he was championing a medical procedure that we know today to be invaluable. Of course there is more than ample evidence to suggest that personal glory and fame were Denis' prime motivators. In fact he actually did precious little original science himself. For men like Boyle, however, scientific research—and particularly transfusion research—meant pursuing questions about the natural and human worlds that were necessarily difficult and unavoidably uncomfortable. In the seventeenth century blood transfusion hit at the heart of what it meant to be human—and what it meant not to be. To imagine early blood transfusion was to imagine a world where hybrid species not only existed but could even be created by science.

In 1666 Boyle asked “whether by frequently transfusing…the blood of some Animal into one of another Species, something further and more tending to some degrees of a change of Species, may be affected.” He speculated that transfusion would provoke no change in the recipient. Still, science had a responsibility to do whatever was necessary to ensure a definitive answer to the question. As
Boyle explained, it was “worthwhile for satisfaction and curiosity to determine that point by Experiments.” Yet as the resounding and nearly immediate bans following the Denis case suggest, there were clear limits to how far the already fluid borders of the animal and the human could be pushed in the late seventeenth century.

In the days and weeks that followed the State of the Union speech, I kept watch on how news outlets and the general public responded to discussions of animal-human chimeras created through stem cell research. It was clear that the president was tapping into deep societal fears surrounding genetic manipulation and, more specifically, scientific research that combined human and nonhuman genes, embryos, and embryonic stem cells. Story upon story appeared on television, on the Internet, and in newspapers about interspecies experiments that scientists had either already performed or were on the cusp of performing. News reports described hybrid creatures born of science, each more stunning than the next: sheep that received human blood-forming stem cells and now sported a liver with more than 40 percent of their cells derived from human cells,
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“humsters” created during human sperm-viability tests using hamster eggs, “geeps” made of fused goat and sheep embryos.
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It was supposedly only a matter of time until the first “humanzee” would make its first laboratory appearance.

Such extraordinary examples aside, interspecies research actually happens daily in scientific laboratories across the world—and in much less sensational ways. Researchers have long injected human cells into mice in order to gauge the effectiveness of a vaccine, and there is a multi-billion-dollar industry centered on creating designer mice (“knockout mice”) that are prone to specific human illnesses like cystic fibrosis or chronic conditions like obesity. Such interspecies research has proven invaluable to developing new drugs and procedures that save human lives or
improve quality of life. Case in point: In 2009, a few months after her son left the White House, Barbara Bush underwent successful open-heart surgery to replace her aortic valve; the replacement valve was from a pig.

Transgenic intersections such as these have given rise to little public outcry. However, cross-species experiments that transplant human neural stem cells into animal embryos or brain tissue are surrounded in controversy. At what point does a mouse brain cease to be mouselike? And at what point would such a chimeric creature take on the moral status, rights, and responsibilities conveyed to humans? The central challenge here is not one of science. In fact science still has very far to go before it could ever catch up with the fictions of Dr. Frankenstein's monster and Dr. Moreau's island.
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Instead the possibility of scientifically created animal-human chimeras, in our own era and in those that have preceded ours, necessarily force society to address issues of species integrity, moral taboo, human and animal dignity, and what is “natural.”
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But most of all we are asked to come up with an answer for the thorniest question of all: What does it mean to be “human”?

The summer following his 2006 State of the Union address, Bush issued his first veto in the five years that he had been in office. The veto stopped Congress's efforts to lift funding restrictions on human embryonic stem cell (hESC) research. In a dramatic and, for many scientists, a welcome turn of events, President Barack Obama signed an executive order in March 2009 that removed preexisting presidential actions on hESC cell research, thereby allowing the National Institutes of Health (NIH) and other agencies to substantially increase funding streams to researchers. This was short-lasting. In August 2010, a federal court issued an injunction calling for an immediate stop to any hESC research activities. As I write, human embryonic
stem cell research is now at a critical crossroads, as policymakers and the public weigh its fate.

I am left to wonder if the seventeenth century would still have halted transfusion experimentation had it known the degree to which future generations would come to depend on it. How many lives would have been saved—or lost—if blood research had been allowed to move forward, instead of being relegated to the footnotes of history for centuries? Every era, particularly one as deep in “Scientific Revolution” as our own, must necessarily confront some of the same time-worn debates about whether the contours of the human body, mind, and soul are as stable as we might like them to be. My greatest hope is that when historians tell our own story decades and centuries from now, they will be able to say that we thought these issues through well and addressed them with fearless curiosity.