Knowing Blood: Medical Observations, Fluid Meanings/Sang sens: observations médicales, interprétations fluides

An exhibition in English and French at the Osler Library of the History of Medicine

By Darren N. Wagner and Nick Whitfield

Knowing Blood is an exhibition that explores the fundamental role of observation in shaping the medical meanings of blood between the late 15th and late 20th centuries. Throughout this period, as today, blood was an evocative signifier of themes ranging from life, identity, community and kinship to sex, lineage, violence and death. For its ability to captivate religious, political and cultural imaginations, blood remains a uniquely special fluid. It is also a powerful and ubiquitous visual symbol.[1]

Medical approaches to its observation have varied widely, and included everything from examination of color with the naked eye to microscopic quantitative analysis, from tasting for sweetness to feeling for a pulse. Each method of observation defines blood differently. As such, modern Western medicine has known not one but many kinds of blood.

In order to reflect this diverse and long history, we have curated an exhibition with objects from the collections at McGill University—the Osler, Redpath and Schulich Libraries, and the Maude Abbott Medical Museum—and also from le Musée des Hospitalières de l’Hôtel-Dieu de Montréal. Five thematic cases highlight different historical approaches to observation, their relation to changing systems of medical practice and to blood’s broader meanings. Here, we describe some of the exhibition’s central themes and objects.

 

Loss and Flow

Fig. 1: Scarificator with twelve blades that cut simultaneously using a spring-loaded trigger and suction cups (likely made in England in the mid-19th century). Musée des Hospitalières de l'Hôtel-Dieu de Montréal Collection.

Fig. 1: Scarificator with twelve blades that cut simultaneously using a spring-loaded trigger and suction cups (likely made in England in the mid-19th century). Musée des Hospitalières de l’Hôtel-Dieu de Montréal Collection.

Our first case, “Lost Blood,” considers the importance of blood’s visuality when let out of the body. Beginning in antiquity and continuing through the early modern period, Hippocratic medicine defined an individual’s health and temperament according to the balance of four humors: black bile, yellow bile, phlegm and blood. Blood loss was important for diagnosing and correcting imbalances, whether through therapeutic interventions, as in leeches and bloodletting, or natural regular secretion, such as menstruation, hemorrhoids and nosebleeds. The items in this case range from a modern facsimile of Johannes de Ketham’s 1491 medical guide to phlebotomy, Fasciculus Medicinae (1729), to John Freind’s Emmenologia—a treatise on menstruation, its quantification and medical remedies promoting its regularity. In an adjacent display plinth, we’ve showcased a 19th-century twelve-blade scarificator and set of suction cups designed for phlebotomy (fig. 1). Medics carefully measured the frequency and quantity of lost blood, and scrutinized such qualities as its color and viscosity. Humoral theory and bloodletting waned in the eighteenth century, but observing lost blood retained significance as a warning of danger in surgery, a symptom of coagulating disorders and a sign of reproductive health.

Fig. 2: Engraving from William Harvey’s Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (Leiden, 1639). Osler Library Collection.

Fig. 2: Engraving from William Harvey’s Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus (Leiden, 1639). Osler Library Collection.

Blood is also observed in vivo, as in the measurement of pressure, the reading of a pulse or the tracing of circulation. Our second case, “Blood Flow,” explores how blood movement within the body came to be known. An important item in the Osler Collection, and a key publication in this history, is William Harvey’s landmark treatise De Motu Cordis (1628). The iconic engraving of De Motu Cordis reveals a series of simple yet profoundly convincing tourniquet experiments that demonstrate the regular systems of arterial and venous flow (fig. 2).[2] Other items include Josephus Struthius’ treatise on interpreting pulse waves, Sphygmicæ Artis (Basel, 1555); a fascimile of Hieronymus Fabricius of Aquapendente’s De Venarum Ostiolis (Padua, 1603), which records observations about venous valves; Michel Boym’s Clavis Medica ad Chinarum Doctrinam de Pulsibus (Nuremberg, 1696) that communicated Chinese knowledge about reading pulses to Europeans; and two associated display plinths that hold injected preparations from the Maude Abbott Collection, which show the vasculature of dog hearts and of a human placenta in stunning colors (fig. 3). This case reveals the close connection between medical knowledge, observational technique and visual representation.

Fig. 4: Corrosion cast placenta (1927). The blue and silver colloidal injections show the umbilical veins and arteries respectively. Preparations similar to these were crucial to the 18th-century observation that blood did not freely flow between maternal and fetal bodies. Maude Abbott Medical Museum Collection.

Fig. 3: Corrosion cast placenta (1927). The blue and silver colloidal injections show the umbilical veins and arteries respectively. Preparations similar to these were crucial to the 18th-century observation that blood did not freely flow between maternal and fetal bodies. Maude Abbott Medical Museum Collection.

 

Life Blood and Bad Blood

Fig. 5: Frontispiece and title page from Georg Abraham Mercklinus’ De Ortu et Occasu Transfusionis Sanguinis (Nuremburg, 1679). Engravings by Corneli Nicola Schurtz showing early experimental blood transfusions. Osler Library Collection.

Fig. 4: Frontispiece and title page from Georg Abraham Mercklinus’ De Ortu et Occasu Transfusionis Sanguinis (Nuremburg, 1679). Engravings by Corneli Nicola Schurtz showing early experimental blood transfusions. Osler Library Collection.

Knowledge of circulation in the 17th century was essential for early experiments with blood transfusion, explored in the exhibition’s third case, “Life Blood.” From the 1660s, experimenters in centers of medical learning like Oxford and Paris attempted transfusions in order to transfer calming temperaments of animals into humans. The uppermost vignette of the frontispiece from Georg Abraham Mercklinus’ De Ortu et Occasu Transfusionis Sanguinis (Nuremburg, 1679) depicts one such procedure between a man and calf (fig. 4). Two centuries later, the British man-midwife James Blundell attempted blood transfusion for the now more familiar motive of restoring fluid lost by uterine hemmorhage. Blundell had no knowledge of blood groups, no sense of how much blood it would be safe to transfuse and no real concern about the air bubbles he observed entering the recipients’ blood stream.[3] It was not until the 20th century that blood transfusion became a common standardized procedure. George Crile of Cleveland was the first American surgeon to perform a direct transfusion of blood between humans, stitching vessels together with small silver cannulas (fig. 5).[4] In 1947, his wife, Grace, recalled witnessing one such operation. She marveled at the restorative effects as the blood flowed, ungrouped and unquantified, directly from donor to recipient:

I stood at the foot of the operating table and witnessed the miracle of resurrection. I saw the livid pallor slowly take on a pinkish tinge. I watched the barely percpetible sighing respiration become established to a normal rhythm, and heard the nurse report that the pulse could be felt at last. Involuntary movements followed, then restlessness, consciousness, and finally, recognition. So suffused with blood did the patient become that his cheeks, his lips, even his ears took on a rosy glow, his eyes resumed a normal expression and he began to talk and jest almost like a man intoxicated.[5]

Fig. 6: George Crile, Hemorrhage and Transfusion: An Experimental and Clinical Research (New York, 1909): End-to-end anastomosis of blood vessels with a silver cannula for the direct transfusion of blood. Humanities and Social Sciences Library Collection.

Fig. 5: George Crile, Hemorrhage and Transfusion: An Experimental and Clinical Research (New York, 1909): End-to-end anastomosis of blood vessels with a silver cannula for the direct transfusion of blood. Humanities and Social Sciences Library Collection.

Observations were not confined to documenting therapeutic miracles, however. They served the important clinical purpose of determining the condition of both donor and recipient, and of determining the therapeutic limitations of blood transfusion. With no method for quantifying the flow of blood between bodies, and no established knowledge on how much blood it was safe to donate, the condition of each party was left to the judgement of surgeons and other witnesses. Turning her attention away from the recipient, Grace recalled how

the donor, a large man of ruddy complexion, seemed to have shrunk to half his size. He was white, hollow-eyed and sighing. Cold perspiration stood on his brow. Constantly he asked for water. There was, of course, no knowledge as to how much blood could be taken from a given donor, nor was there any method of measuring the amount that was being given. Suddenly, with a deep diaphragmatic effort for air, the donor crumpled before my eyes. He was unconscious. He had been bled too low![6]

This is a vivid example of how clinical observations were crucial to early transfusion procedures, which gave fresh affirmation to blood’s life-bearing qualities.

Fig. 7: The first published illustration of sickle cells, from James B. Herrick’s “Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia,” Archives of Internal Medicine (1910). Humanities and Social Sciences Library Collection.

Fig. 6: The first published illustration of sickle cells, from James B. Herrick’s “Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia,” Archives of Internal Medicine (1910). Humanities and Social Sciences Library Collection.

Yet the advent of transfusion therapies served to demonstrate another of blood’s historical associations. As well as being vital, blood can also be pathogenic, even lethal. It can be contaminated, clotted, infected, deficient, or malformed. The case “Bad Blood” interrogates ways of representing these pathological qualities, and therefore of observing deficiencies and defining abnormalities of the blood. Rarely seen unmediated, blood’s pathological conditions are plainly revealed through sufferers’ signs and symptoms the body over. Modern medicine has developed numerous strategies to observe blood disorders: dissections, stains, chemical analyses, antibody tests. On display in this case is the first publication about the observation of the sickle shape of cells related to anemia, James B. Herrick`s article, “Peculiar Elongated and Sickle-Shaped Red Blood Corpuscles in a Case of Severe Anemia” in Archives of Internal Medicine (1910) (fig. 6). Hematological atlases of the 19th and 20th century, such as Edward E. Osgood and Clarice Ashworth’s Atlas of Hematology (1937), showcase illustrations of other such microscopic phenomena. These atlases allowed physicians to present observations of pathologies that profoundly mark blood as abnormal and people as sick.

 

Seeing Blood

The collections of the Osler Library include many books that bear witness to the challenges of blood’s microscopic interpretation. A final case of the exhibition, “In Blood,” explores the historical importance—and difficulties—of learning to observe human blood scientifically, with instruments such as the microscope and hemocytometer. Some of the earliest such examinations were by the Dutch draper and microscopist Antonie van Leeuwenhoek. His claim that the red blood cells were globular was not corrected until the 19th century when the English surgeon William Hewson’s microscopically observed their discoid shape. Hewson’s posthumously published Experimental Enquiries (1775–77) includes a fold-out table of “flat vesicles,” in which he draws comparisons between blood constituents of various species (fig. 7). In France during the same period, Hewson’s contemporaries began correlating the constituents of blood with particular pathological conditions. The hemocytometer, a device used for counting blood’s constituents, soon permitted the rapid quantification of this knowledge. The early 20th-century example we have on display was part of a physician’s medical case—an inclusion that indicates the entrenchment of hematological observation as part of routine medical practice.

Fig. 8: Illustrations of blood cells from different animals, from William Hewson’s Experimental Enquiries: Containing a Description of the Red Particles of the Blood in the Human Subject and in Other Animals (London, 1775–77). Osler Library Collection.

Fig. 7: Illustrations of blood cells from different animals, from William Hewson’s Experimental Enquiries: Containing a Description of the Red Particles of the Blood in the Human Subject and in Other Animals (London, 1775–77). Osler Library Collection.

Despite their ascendancy through the 19th century, instruments such as the hemocytometer did not wholly displace older traditions of observation. Forensic science of the early 20th century was one specialty in which the primacy of the naked eye persisted. Major W. D. Sutherland’s manual Blood Stains, published in England in 1907, begins with the following remark: “Every one knows what freshly shed blood looks like, but it is not easy to determine that a stain on cloth, wood, iron, glass, stone, etc., is really due to blood.”[7] Sutherland intended to clarify the ambiguous manifestations of bloody traces—dried, faded, smeared, concealed—and put forth a catalogue of grisly incidents in which the identification of blood was crucial to the detection of criminal foul play. His book appeared at a time when the emergent science of blood grouping was opening another dimension to the visual history of blood. The historian Jenny Bangham has noted that early in the 20th century blood groups were only known “when samples were mixed – when red cells clumped together, or agglutinated, samples were ascribed to different groups.”[8] As seen in the film Blood Groups and Transfusions (1965), which was one of the several multimedia items included on our exhibition’s touchtable display, the earliest knowledge of blood groups depended on mixing techniques, unassisted visual examinations and the trained ability of nurses and surgeons to recognize agglutination. Texts on blood transfusion published in the first half of the 20th century, such as Robert Kilduffe and Michael DeBakey’s The Blood Bank and the Technique and Therapeutics of Transfusion (1942), typically included illustrations of blood typing reactions as guides to medical observation.

Fig. 9: Illustration from Arthur Mourant’s The Distribution of the Human Blood Groups (Oxford, 1954). A hematologist and director of the Blood Group Reference Laboratory in Britain from the 1940s to 1960s, Mourant constructed ethnic and racial maps of the global distribution of human blood groups. Humanities and Social Sciences Library Collection.

Fig. 8: Illustration from Arthur Mourant’s The Distribution of the Human Blood Groups (Oxford, 1954). A hematologist and director of the Blood Group Reference Laboratory in Britain from the 1940s to 1960s, Mourant constructed ethnic and racial maps of the global distribution of human blood groups. Humanities and Social Sciences Library Collection.

Shifting scales from individual samples to global demographics, blood groups became foundational for making other types of observations about taxonomy and biological essentialism. The British hematologist Arthur Mourant, for instance, believed resolutely that the properties of blood offered scientists and anthropologists an objective lens for studying human racial groups. In 1954, Mourant published The Distribution of Human Blood Groups, an elaborate compendium of blood group and genetic data; it included detail maps that correlated race with blood types (fig. 8).[9] His views about the links between blood and race are now scientifically discredited and ethically insupportable. Yet medicine continues to create knowledge through observation that builds on blood’s ancient status as bearer of identity, lineage, togetherness and difference. As curators, we hope to have shown the many shades of this dynamic history, and to have prompted our viewers and readers to critically explore from where our knowledge of blood flows.

 

Knowing Blood: Medical Observations, Fluid Meanings / Sang sens : observations médicales, interprétations fluides is on at the Osler Library of the History of Medicine from January to August 2016. Funding was generously granted by the McGill Medical Faculty. Admission is free.

Darren N. Wagner is Postdoctoral Fellow of the Canada Research Chair of the Social History of Medicine at McGill University. He co-edited the scholarly collection The Secrets of Generation: Reproduction in the Long Eighteenth Century (University of Toronto Press,  2015). He is now writing a book about sex, nerves and sensibility in 18th-century culture and medicine.

Nick Whitfield is a postdoctoral fellow at the Department of Social Studies of Medicine at McGill University. His research interests are in the history of medicine in Britain and North America during the twentieth century, focusing on topics in surgery and blood transfusion. He is presently completing a four-year project on the history of minimally invasive surgery between 1980 and 2000.

 

[1] Jacalyn Duffin, History of Medicine: A Scandalously Short Introduction (University of Toronto Press, 2010).

[2] For a concise account of Harvey’s discovery, including the various experiments he used in its defence and exposition: Andrew Gregory, Harvey’s Heart: The Discovery of Blood Circulation (Cambridge: Icon Books, 2001).

[3] Kim Pelis, “Transfusion, with Teeth”, in James M. Bradburne (ed.) Blood: Art, Power, Politics and Pathology (New York: Prestel, 2001), 175–92.

[4] Susan E. Lederer, Flesh and blood: Organ transplantation and blood transfusion in 20th century America (Oxford University Press, 2008).

[5] George Crile, An Autobiography, edited, with sidelights, by Grace Crile, volume 1 (New York: J.B. Lippincott Company, 1947), 166.

[6] Ibid.

[7] Major W. D. Sutherland, Blood Stains: Their Detection, and the Determination of their Source (London: Baillière, Tindall and Cox, 1907), 1.

[8] Jenny Bangham, “Writing, printing, speaking: Rhesus blood-group genetics and nomeclatures in the mid-twentieth century”, The British Journal for the History of Science, 47, 2 (2014), 335–61: 338.

[9] Jenny Bangham, “Blood groups and human groups: Collecting and calibrating genetic data after World War Two”, Studies in History and Philosophy of Science, 47 (2014): 74–86.

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One comment

  1. Pingback: Knowing Blood: Medical Observations, Fluid Meanings/Sang sens: observations médicales, interprétations fluides | Amigos de la Historia Veterinaria

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