by Rose George
From 1915, Major Lawrence Bruce Robertson, a Canadian surgeon, began using a technique of indirect blood transfusion that he had learned in civilian life at a Toronto hospital. This involved withdrawing blood, transporting it in a syringe, and then transfusing. This method freed him to use transfusion more than otherwise: there was no need to find a soldier, cut open his arm, keep him close. He saw how dramatic a change blood could bring in a soldier in shock. “The change from a pallid, sometimes semi-conscious patient with a rapid flickering pulse to a comparatively healthy looking conscious and comfortable patient with a slower and fuller pulse is dramatic evidence of the value of transfused blood.” Another doctor wrote more lyrically that men who seemed lifeless were given blood and “it was like putting a half dead flower in water on a hot day.”47 Another young surgeon, an American captain named Oswald Robertson, used recent developments in blood storage and pioneered the use of blood mixed with sodium citrate, then stored in glass bottles on ice. Robertson called this process “a blood dump,”48 but it was also the first disembodied blood transplant and the world’s first blood bank.
By 1918, base hospitals and casualty stations on the Western Front were transfusing 50 to 100 pints of blood to an average of fifty wounded personnel daily. In the context of millions of wounded men, that’s not much blood. By the next war, blood transfusion had been fully accepted by the British military, which planned in prewar years to set up an efficient blood supply to its forces and operated it extremely effectively. Field Transfusion Unit trucks carried refrigerators containing 1,100 pints of fresh whole blood, and other units carried plasma, “slung underside in containers which in the ordinary way hold trench mortar shells; four bottles and two transfusion sets took the place of three shells.”49 Transfusion was so routine that the Ministry of Information’s official account of wartime blood use, Life Blood, had a chapter called “The Tenth Man’s Chance.” At the battle of El Alamein, one in ten men received blood, three bottles each.50
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In the Wellcome Library in London, I find a propaganda film released by the Ministry of Information in 1941, a time when neither “propaganda” nor “Ministry of Information” sounded sinister. The film is called Blood Transfusion and is narrated by accents that now sound cut-glass and royal but then were normal on-screen and on the wireless.51 The film tells us with appropriate images that blood transfusion was widely used in the First World War on the Western Front, then the setting changes to the living room of a house on Talfourd Road in the southern London borough of Camberwell. A scene from 1921 is reenacted: a telephone rings. It is black and Bakelite, and answered by Percy Lane Oliver, a middle-ranking civil servant of middle age who is playing himself and who was about to become historic. Oliver, son of a Cornwall lighthouse keeper but a Londoner since childhood, worked for Camberwell council. He was an ardent volunteer and had been awarded an OBE (Order of the British Empire) in 1918 for running four refugee hostels. In 1921, he was forty-three years old, married to Ethel Grace, and honorary secretary to the Camberwell Division of the British Red Cross. He wore glasses, was balding in a way that seemed that he had always been like that, and had a face that fitted the name Percy.
The call came from King’s College Hospital, a mile and a half away, and the caller wanted blood. As the film showed, and as the story goes, Oliver immediately found three other volunteers from among his Red Cross colleagues in case his blood group wasn’t the one required, and all four set off for the hospital. Nurse Linstead, one of the Red Cross employees, was chosen to give “a pint of the best” and so became the country’s first voluntary blood donor.52 Within a few weeks, the Olivers had organized twenty-two volunteers ready to give blood if needed, and so began a system of voluntary blood donation that continues today.53
That is the official history. The reality is less cinematic. The Camberwell Division had supplied blood donors several times before that historic call, according to medical historian Kim Pelis.54 Nurse Linstead was not the first voluntary blood donor: even when transfusion was not routine, during the nineteenth century, husbands gave blood for their wives in childbirth. The First World War had popularized blood transfusion, but it wasn’t a revolution. By the end of the war, even the best field hospitals were transfusing only fifty patients a day: hardly anything, among the appalling numbers of wounded. The blood to treat bleeding soldiers came from bleeding soldiers. There was no difficulty in procuring donors, wrote Major General W. G. MacPherson in his medical history of the Great War: “The spirit of comradeship among the troops gave a plentiful supply.” This consisted of “lightly wounded men, dental patients, and men suffering from sprains, flat feet and minor injuries.”55 Soldier donors weren’t paid but they were soon offered three weeks’ leave in England, a powerful incentive.56 Harvey Cushing reported that when volunteers were sought for transfusion experiments, and “Blighty leave” given as inducement, they came “like trout to a fly.”57
But the wartime spirit of comradeship did not survive the transition to peace, and the notion of an organized system of blood donation faltered. The medical profession applied its Semmelweis reflex, a refusal to accept change, named after Ignaz Semmelweis, who realized that doctors delivering babies after performing autopsies were lethally unhygienic but was scorned for decades. When it came to storing blood, “the feeling in England,” wrote Victor Horsley Riddell, “is that this is carrying change too far.”58 Surgeons and doctors stuck to what they knew: blood should be used fresh if it was used at all. Fresh blood meant having the donor come to the patient, slice open a vein—the term was “cutting down”—and then convey the blood either by connecting the two veins (direct transfusion) or by using a syringe or pump to transfer the blood (indirect transfusion). Most donors expected money for their blood. There was a register of paid blood donors kept in Liverpool that was made available to all local hospitals. In Bradford, hospitals paid £10 ($36) a donation to donors who cleared the Wassermann test, the standard screening method for syphilis.
Volunteers were an option, but they were less available or reliable. Medical staff often had relied on an informal circle of potential donors. Patients used the blood of friends and relatives. You used whoever you could, or whoever was nearest. A hospital doctor in Edinburgh, wrote Dr. Alastair Masson, used junior doctors or medical students. “My House Surgeon, Dr. Carmichael,” or “Mr. Handyman, a healthy and powerful young student.”59 Another resorted to relatives, though this didn’t always work. Once, when no relative could be found, the doctor asked a student to give of his blood. “However, he was about to sit his finals a couple of days later so it was thought advisable to take only a little. In the end, the patient was given 600 ml blood taken from one nurse, two residents, three students and the writer.” Many disapproved of this practice: a letter writer to the Lancet deplored the exploitation of the medical student, already “a hard-worked person, little able to give a pint and a half of his blood.” What was to be done? Doctors were sometimes seen walking the streets looking for donors, offering cash. People in public service such as the police and firemen were considered good targets for giving blood for nothing, although one eminent surgeon thought this a bad idea. “The policeman’s lot is said not to be a happy one, and it would be putting rather a severe strain on his already superhuman benevolence to expect him to give his blood to all who need it.” In Evanston, Illinois, firemen were asked to donate blood because the local police chief complained that his men—avid blood donors—were looking anemic.60
The donor pool was also reduced because doctors wouldn’t consider half the population. Women, the same surgeon believed, would present the “disability of nervousness.” Also, our veins are smaller. In the United States, male donors were preferred because doctors couldn’t bear to cut into a woman’s arm.61 Women were no good.62
Overseas, payment was also usual. At the Second International Blood Transfusion Congress in Paris, it was reported that Parisians were paid on a sliding scale: 100 francs for the first 200 grams and
50 francs for each 100 grams thereafter.63 A correspondent wrote to the British Medical Journal about a Frenchman who had given 257 liters of blood that year and was still selling.64 By the 1920s, hospitals in New York were paying $100 a pint.65 American newspapers reported young women who funded college with blood donations. Blood transfusions were now being used to treat more than thirty maladies, and selling blood was one of the few sustainable industries in the Depression. Hospitals allegedly tried to ensure that their sellers were healthy. But “since the profit is considerable,” wrote the New York Times, “there is a temptation to make sales as frequent as possible.” Despite some interesting measures to protect donors’ health—a Massachusetts law dictated that donors get a pint of whiskey as well as $25—doctors complained that the donor was often in greater need than the recipient.66 The money created a blood sale infrastructure, with middlemen, professional sellers, and fierce competition. In a magazine account of his time as a professional blood seller in 1929 New York, Charles Nemo (Nobody) described his life living in a blood sellers’ boardinghouse, watched over by a middleman. A fellow blood seller traveled around the United States looking for the best markets for his blood. Baltimore was no good as hospitals limited sellers to a quart of blood a year. Philadelphia was more promising: there was a shortage of blood donors “after the police force became tired of being heroes for a day by volunteering blood.”67 Now and then the press published objections to the notion of selling blood. At New York’s Flower Hospital in the early 1920s, women medical students—but not the men—gave their blood for nothing when the price of blood became exorbitant.68 Blood altruism was praised in the press, but the sellers were dominant: even in the 1930s they were powerful enough to form a union.
The Olivers wanted something different. This mixture of paid and co-opted donors—known as “on-the-hoof”—was inefficient. They believed strongly in the voluntary ideal, and Percy Oliver didn’t see why this couldn’t apply to blood. Countries that paid donors attracted drug takers and promiscuous people. Paying for blood attracted “a very different class of person.” The conviction that unpaid blood was better was shared by Geoffrey Langdon Keynes, who had been converted to the power of blood transfusion during the Great War, and who later wrote a textbook on it that made him almost as famous as his economist brother John Maynard. “It was not difficult to find paid donors,” he wrote. “But it was not so simple to obtain in this way individuals whose Wassermann reaction was likely to remain permanently negative.” After Nurse Linstead gave her pint of blood to King’s College Hospital, the Olivers decided to do something radical. They would set up a register of reliable blood donors who would never ask for payment. Percy Oliver noted their names on a database, which in 1921 meant index cards, and each card would list contact details, plus the donor’s blood group and health history. Donors would be screened ahead of donating and their blood group noted. A telephone would be manned day and night. Hospitals would call for blood; the Olivers would have it brought to them, in the shape of a person. In return, doctors had to follow their rules. “The needle method of extraction alone is to be used. Opening the vein, cutting down upon it, or levering it up, is forbidden.”69 It made more sense: a less invasive needle meant a donor could be reused, and a less painful procedure meant they would more readily volunteer in the first place.
They began to set their scheme in motion, using their home as an office. (Percy Oliver continued to work for the council.) It was named the London Blood Transfusion Service, and “The Service” by its volunteers. It may have consisted of some index cards and a phone, but the Olivers’ operation was the world’s first voluntary blood panel and the beginning of a shift to a model of altruistic blood donation in Britain that has endured one hundred years. In the first year, only four donors were signed up and they were called upon only once.70 The next year, the donors numbered thirteen.71 In August 1922, a woman whose husband was dying at Guy’s Hospital was “reduced to stopping strangers in the street to ask them to give their blood.” One of those strangers belonged to the Camberwell Division of the Red Cross; the woman in trouble contacted Mr. Oliver for a donor, and her husband lived. “From that time on,” Mrs. Oliver recollected, “the word seemed to go round in hospital circles that there was a band of lunatics somewhere down Camberwell way willing to give their blood to any necessitous patient in hospital.”72
Free blood? From prescreened donors who were healthy and who would come when asked? Hospitals should have loved the idea. Yet overturning the habit of paying for blood caused problems. Some donors were treated with puzzling disdain. Sometimes, “having hurried from their business or private affairs, [they] were told curtly that they were not required and sent back with no explanation that they could give their employers.”73 Oliver had to exercise constant vigilance to protect his volunteers. This entailed “a watch against possible injury to donors through faulty technique at the hands of inexpert operators, as well as insistence upon observation of the ordinary courtesies.”74 Donors were largely a polite lot. “Fuss is the thing donors like least of all,” wrote one newspaper. “There have even been protests from at least one prominent member that they were treated too gently at the hospitals and that they dislike being ‘wrapped in cotton wool’ and stroked by a lot of pretty nurses. But possibly this last protest would not be supported by a majority of the association.”75 Even disgruntled donors rarely snitched on the hospitals, simply marking politely on their donor cards that they were unwilling to serve at the hospital again. Eventually, it was discovered that hospital staff assumed that donors were paid and so felt entitled to treat them carelessly.
Logistics was another concern. Finding a donor on an index card was one thing; finding a donor who had a private telephone in 1920s London was much harder. (Even ten years into the service, when there were 2,050 registered donors, only 400 had a phone.76) The Olivers dealt with this with gusto. “When hospitals called,” wrote Kim Pelis, “they contacted donors by telegraph, constable, taxi-driver, and sometimes by bicycle.”77 Another option was the police force. “Station Officers showed themselves ready to help,” wrote Frederick Walter Mills in a 1949 history of the London Service. “But donors generally did not like being called upon by a policeman, since they found neighbors were disinclined to take a charitable view of the cause of the visit. One donor accepting the kind offices of the police on such an occasion, had his family’s embarrassment increased by being returned to his home in the early hours of the morning by a Black Maria.”78
Other matters were worked out over the years. The ideal donation amount was judged to be 400 cubic centimeters for men and 300 for women, and the interval between donations should be not less than three months for men.79 Women could donate only every four months: their hemoglobin took longer to regenerate, and they were naturally lower in iron than men, a gender difference seen only in humans and only in menstruating women (after menopause, levels align). With these measures, the voluntary donor was sure to be in better health, spiritually and physically. Also, they were a bargain for everybody. When Oliver learned that in one Midland city, donors were being paid 4 guineas ($20) per donation/sale and an annual retainer, he did some sums. That would cost London £25,000 ($121,000) a year to run the service, when actually it cost a tenth of that.80 By 1930, sixty-eight hospitals were using the voluntary system—now renamed the British Red Cross Transfusion Service—and were charged £1 and 1 shilling ($5) a call for operating expenses.81 Other funds came from a partnership with the Ancient Order of Druids, which had—obviously—gained a reputation for collecting and recycling tinfoil. All this cash was put toward finding more donors. Percy Oliver had strong feelings about how to do this. In 1932, he wrote a letter to the Derby Daily Telegraph to complain about the reporting of a case in which a young Derby lad had given blood for his father. “Mr. Oliver, without belittling the action, suggests that ‘undue prominence to an everyday occurrence is likely to give an utterly erroneous idea of this simple operation.’”82 Blood donation should not
be seen as heroic because most people don’t think they are heroes and would be intimidated. It must be seen as a simple medical procedure that did no harm. Already, the service was having trouble with frightened family members. A daughter called to give blood readily consented. It would have been her first donation, but “her mother accompanied her to the hospital and absolutely forbade the surgeon to take the blood.” Oliver later pointed out that some two hundred donors had agreed to serve only by keeping it a secret from their parents or wives.83
Instead, recruitment should remain personal. A lecture in a drafty village hall, where Oliver could show some slides and answer questions, was more effective than press reports of selfless saintly donors whom no one could relate to. This was ironic. Blood transfusion, previously reliant on the donor and the recipient being in physical proximity, was becoming anonymous and impersonal with the storage of blood allowing a distance between donor and receiver. Donors were also forbidden from finding out about where their blood was going. When one man gave blood, then made his way to the ward to see the patient, the Transfusion Service managers were scandalized. “When after fruitless attempts to get an explanation of his conduct, he phoned to say he was leaving for Australia, that saved us the job of getting rid of him.”84
