by Rose George
Oliver traveled all over the country to give talks, despite poor health. In 1934, he gave 104 lectures, mostly funded out of his own pocket. He thought it should be made clear, wrote Frederick Walter Mills, “that the blood given serves a real need and is not just used for experimental purposes.” Stories of real people were more powerful than statistics, and prejudice and myth should be battled with science and fact. “The speaker should be prepared to meet suggestions that, in the blood banks particularly, blood has been wasted, and questioners may insist, without being able to give proof, that they have heard of instances where blood has been used to fertilize the tomatoes.”85
This outreach worked. People across the country learned about blood donation and knew that in London they should call Mr. or Mrs. Oliver at 5 Colyton Road, where the Olivers had moved after their landlord, annoyed at the Druids’ tinfoil that was being stored in the house, had raised the rent. The press wrote positive and glowing stories of ordinary donors such as Mr. Brown, summoned by the “tinkle-tinkle” of a telephone bell in his busy city office, on a cheerful, sunny day, to attend to a man with jaw cancer who needed blood. Mr. Brown went, though he had given blood only two weeks before, but hadn’t liked to say, in case they couldn’t find another donor. The names were pseudonyms. “The men I have written of are free lance,” wrote W. Addison in the Saturday Review, “and do not wish to be known. The curious fact applying to these odd fellows is that they all come from odd walks in life. Down with the pick, pen, or drill, off to the hospital, and back to work.” They were also all registered with the British Red Cross Transfusion Service, belonging “to the organization which has been formed in recent years to supply donors as and when required.”86
The success of London was noticed and soon imitated. In Edinburgh, a surgeon named Jack Copland, shocked by the death of a relative who died for lack of blood, set up a donor panel in 1930. Six years later, by the time Copland’s donors were activated and plentiful, there were 560 transfusions carried out in Edinburgh.87 Other provinces and regions had organized donors, more or less successfully. Even so, the model of paid blood continued to persist. One man visiting London from Budapest signed up to the Transfusion Service and was scandalized at not being paid. He complained that he charged £20 ($96) a quart for his blood at home, “dirt cheap for the world’s most valuable liquid,” and sued the recipient of his blood for £10 ($48). (He did not win.)88 In 1934, the people of Sheffield were paid £1.10 ($5) a donation. At the Second International Blood Transfusion Congress in Paris in 1937, the London system, and the concept of a network of voluntary donor panels, was accused of being “hopelessly Utopian.”89 Only the Netherlands and Denmark had followed the all-volunteer model of blood donation. Oliver’s confirmation that operating costs per case were only 8 shillings (about $5) did not deter the skepticism, even as his service was now receiving seven thousand calls a year.90
By the final years of interwar peace, there were all-voluntary systems around the country. The British Red Cross Transfusion Service had created a model that was successful and impressive. It worked. But in a war, in a great city, it would not do.
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London, 1938. Preparations. Across Britain, thirty-eight million gas masks were given to children and adults.91 Children’s masks were first nicknamed Mickey Mouses to make them less terrifying, then shaped like Mickey.92 (My mother, a war toddler, thought hers creepy.) People were told to start digging garden plots and to grow vegetables, and they were not told that the production of millions of cardboard coffins was under way.93 The first air-raid shelters were distributed, named for Home Secretary John Anderson, and sold for an affordable £7 ($28) each. Life looked different: red postboxes were painted with special yellow detector paint, supposed to change color if poison gas was in the air. The sky was filled with what New Yorker correspondent Mollie Panter-Downes called “the silvery dermatitis” of antiaircraft barrage balloons.94
Coffins, children, cabbages: London’s authorities had spent years readying for calamity on all fronts. But they had not thought it necessary to prepare any blood. In 1937, the secretary of state for war had been asked what the nation proposed to do about a mass blood supply. He said, “It is more satisfactory to keep our stores of blood on the hoof.”95 He meant that the best way to store blood was how nature intended: inside a human body. By the beginning of 1939, a single emergency blood depot had been set up in a bombproof building in the outer London suburb of Cheam. It was a depot in name only, with a capacity to store 1,000 pints, but empty. Planners expected it could be stocked within seven days of hostilities. Until then, the actual emergency blood supply for a city of several million people consisted of the stock kept by four London county hospitals for urgent maternity use: eight pints.96
Janet Vaughan knew the planners were wrong. Her interest in the Spanish Civil War had introduced her to the astonishing work of Frederic Durán-Jordà, a Catalan physician. In wartime Barcelona, he had successfully pioneered the mass collection, storage, and delivery of blood. He made blood mobile, transporting it to the front line in glass bottles in a converted fish van. Durán-Jordà was visionary but precise and practical. The Barcelona donor center had its own glassblower to make ampoules exactly as he needed.97 He experimented with sodium citrate, now unquestioned as the standard additive to stop stored blood clotting, and found that mixing in glucose made for healthier red cells. When it was Durán-Jordà’s turn to drive the van, he did so while singing the theme tunes “I’m Popeye the Sailor Man” or “Who’s Afraid of the Big Bad Wolf?”98
He is also featured in the Ministry of Information’s 1941 film on blood transfusion. The narrator, supposedly a colleague of Durán-Jordà’s, says that “we bled some four thousand five hundred civilians into a citrate solution,” and I picture thousands of Spaniards collectively dripping blood into swimming pools of lemony liquid. When Sidney Vogel, an American surgeon volunteering with the Republicans, visited the Barcelona operation in 1937, he was astonished to see workers lining up along the stairways ready to give blood. And then, a bare room where men and women lay prone, all being bled by specially trained assistants. “Bottled blood for transfusions in wartime!,” he wrote. “I had used it but I had never seen it bottled.” He was more surprised to find a young man, an artist in civilian life, whose only job was to apply iodine to the donor’s vein in preparation for a needle, and who was summoned with the call of “Pintor! Pintor!” (“Painter!”). (Barcelona donors must have been hardier than London’s: iodine burns made for the most compensation claims in the London Service.) It was a streamlined production line of blood that had never been seen before, and it worked. Withdrawn, mixed with citrate solution, then bottled, Barcelona’s blood was good for eighteen days.99
The Barcelona service fascinated Janet. It uprooted the on-the-hoof model for a new, efficient method of collection and delivery. Durán-Jordà had also shown that blood need not be collected by surgeons and doctors, who would have more pressing matters to deal with in wartime. The bleeders could be nurses but also “women with BSc degrees and some laboratory training.”100 Blood could be separated from its donor and transported more efficiently. This insight, she understood, would be essential in the war to come. When medical staff would be dealing with the injured, when communications might be bombed into uselessness, calling donors to overburdened hospitals would no longer work. With Durán-Jordà’s model, she could turn London’s blood supply from mom-and-pop to hypermarket. She had also read of the Russians, who had been taking blood from road accident fatalities and suicides and storing it at low temperatures.101 Janet didn’t think cadaveric blood was a good idea, and nor since then has science (it is difficult to maintain the quality of dying blood and the concept is unpalatable to the public). But she took the Russians’ storage method, mixed it with the fish vans and glassblowers and ingenuity, and began to plan.
In late 1938, she approached the medical school dean again and asked him to let her explore how best to store blood, for what was coming.
She got assent and £100 ($400) and sent off two assistants in a taxi to buy “immense quantities” of rubber tubing, corks, and clips. They made up transfusion sets Vaughan called “crude,” found donors, and set about bleeding. But war didn’t come: at a conference in Munich, Neville Chamberlain and other leaders dismembered Czechoslovakia to appease Adolf Hitler, and the war footing sat down. “Everyone said,” she wrote, “that the only blood shed at Munich was the blood Janet shed at Hammersmith.” It was diverted to hospital use, and for Janet to use on patients. For the next few months of prewar, Vaughan and her team researched the health and usefulness of stored blood and found it good. But even now, in a year that felt like war was coming, there were no government plans to store blood. She thought this dangerous. She would not be exaggerating, she said later, to say that blood transfusion in war was as important as bandages.102
In early April 1939, she gathered some fellows—doctors and pathologists—in her Bloomsbury flat and began to plot and plan. The minutes of the meetings of the Emergency Blood Transfusion Service exist in the archives of the Wellcome Library, and they are as rich as blood. The meetings were always in the evening, after the day’s work was done, and they lasted hours. Here I let my imagination go for a stroll. Janet Vaughan would be wearing a tweed suit. She would be kind but brisk. Later, someone described her as “down to earth but like air on a mountain.”103 The others might have bow ties. They would smoke pipes. They would drink tea or gin or whiskey and eat crumpets. They would do this while deciding on the size of bottles, or what kind of armrests to put on the “bleeding chairs,” and they would change modern medicine.
The revolution would begin with logistics. During the Spanish Civil War, 10 percent of air-raid casualties had required blood transfusions.104 If this applied to London, it meant sixty-five thousand casualties a day. The practical thing to do would be to set up blood depots throughout the city. They would be located in areas of London outside areas most vulnerable to bombing, but near enough to easily deliver blood to major hospitals. The depots would control the bleeding of donors in-house and in the community, they would store blood and deliver it to where it was needed, and they would also undertake medical research. There would be four depots: two north of the river and two south.
First, the science. At the inaugural meeting, the minutes record a suggestion that 50cc of 3.8 percent citrate containing 0.1 percent glucose should be added to every 450cc of blood. This was fiercely debated. And there were other issues to resolve. Logistics and equipment, obviously: they planned for eight bleeding couches per depot, at £21 ($84) each. Twelve Cheatle forceps; six sphygmomanometers; one gross of rubber teats; three thousand yards of Elastoplast. And the donors: how to deal with those?
At this stage, the Bloomsbury group—this other Bloomsbury group—took care to consult with Percy Oliver. He was present at the first meeting but not at many thereafter, and I wonder at these medical women and men, and whether they shut him out. In 1936, when Oliver wrote a piece in the British Medical Journal, an accompanying editorial seemed defensive about the decision to publish the work of someone who was not a scientist or medical man, while acknowledging Oliver’s “unique position as an authority on the problems connected with blood transfusion.” There was no call, it wrote, “for a lifting of the eyebrows when a layman like Mr. Oliver refers to the controversial matter contained in headings such as ‘cross-grouping’ and ‘universal donors.’”105 Oliver wrote with both confidence and apology in his article, pleading for a national blood transfusion conference “with all diffidence as a layman.”106 Early on, his expertise was welcome in the Bloomsbury meetings, because the depots would need blood, so they would need donors, and Oliver had those. As for syphilis, Oliver pointed out that promiscuity increases in wartime. But the committee felt it was a risk that must be taken. They should be screened, because syphilis was definitely a worry. In the end, whether to inform a donor of a positive syphilis test was left to each depot director to decide. Vaughan later tried telling donors, but after they became “extremely indignant,” she left well alone, afraid to prejudice donor recruitment. A different view might prevail in a peacetime organization. Oliver’s advice on donor cards was more accepted and his specimen cards adopted. These asked for contact details, blood group, whether the donor had any national service obligations, and “the character of the arm vein.”
There were many calculations to be made. A population of eight million Londoners, therefore a catchment area of two million per depot. In the event of bombing raids, each depot should plan to minister to ten thousand casualties. For this, each would need a panel of twenty thousand donors, enough to be able to supply five hundred bottles a day of group O in an emergency, and to hold five hundred more bottles in cold store. The plan at first was to use only donors with group O blood, which could be transfused into most people without harm. (By 1940, improvements in cross matching allowed the use of all four blood groups.) Trained assistants would do the grouping. “I can always remember,” wrote Janet, “George Taylor of the Salton Laboratory, the English authority on blood groups, saying with great solemnity, you must also enroll girls to determine these blood groups and this should be done at once; it is not easy to procure young girls.”
It was not easy to procure the right bottle, either. Without the proper storage vessel, all the sodium citrate in the world wouldn’t keep blood safe or make it portable. The choices were few but they were tricky. A Beattie waisted type? A whiskey cap on a United Dairies bottle? A McCartney screw cap? Or a modified McCartney bottle of the L.C.C. type? Vaughan’s children grumbled that their home was littered with old bottles, and throughout the summer the deliberations continued. By the second week of June, the Bloomsbury set had decided on a modified milk bottle because they were easy to obtain and also easy to deliver in milk crates. For transport, they would convert Wall’s ice-cream vans. Sturdy, refrigerated, and they wouldn’t smell of fish.
The committee was informal and unsanctioned—“no authority!” remembered Janet, with glee—but then Vaughan sent a memorandum about their plans to Professor William Topley of the London School of Hygiene, who was known to be organizing emergency services. Professor Dibble—Vaughan’s superior—heard of the memo and called her “a very naughty little girl.”107 As if that would stop her. After a good while, someone working with Topley responded positively and asked for a budget. Her friend the dean advised her to triple all the costings. She did, and this was accepted. The organization of the blood supply was handed to the Medical Research Council, which in a postwar report wrote that “from the time of the Munich crisis in 1938, the question of blood during wartime had been much in the minds of medical men.”108 And of one particular woman.
At the same time, the British army was setting up an equally pioneering system of blood supply, under the command of Colonel Lionel Whitby. The Army Blood Transfusion Service would set up a depot at Bristol, ask for blood from the surrounding populations of the southwest, and fly it to the front. No other military facing war had such a plan, and no other military in the war had anything as successful as the Army Blood Transfusion Service. For a logo, the army chose a vampire bat.
Janet was to run the northwestern depot, in the town of Slough. She set off alone to find premises. “How fortunate I was,” she wrote in her memoir, “to go to Slough where everyone—mad as they thought me at the time—was more than willing to help me.” There was an unshackled energy about Slough that appealed to her. She called it “a frontier town,” grown up after the First World War around a vast trading estate, full of migrant workers “with no settled traditions and customs to be disturbed.” She was directed to Noel Mobbs, chairman of the Slough Trading Estate, which housed dozens of factories including the chocolate maker Mars and a social center. Mr. Mobbs did not believe a war was coming, but he said the depot could move into the social center, that there was space for cold storage rooms to be built there. There was also a bar.
Premises were found for the Luton, Sutton, and M
aidstone depots in a disused part of a hospital, in an adult education center, and in two converted houses. Teams of people were sent out to appeal for donors, advised by publicity experts from companies such as Dunlop and Horlicks who volunteered their time. From July, the press began to publish regular appeals for donors. They should find the nearest “empaneling center,” which could be found by phoning a switchboard (Central 8691). Volunteers would be pricked in the ear or finger, their blood group tested and then registered. Transfusions would take place only in the event of war. In the first three days, five thousand people signed up. Three days later, there were eleven thousand volunteers. Keep coming, said the men of the press and from Dunlop and Horlicks. “The empaneling centers are prepared to welcome 30,000 a day.” By the end of the summer, when war seemed near, the Slough depot alone had fifteen thousand donors on its books.
On September 1, 1939, Janet Vaughan received a telegram from the Medical Research Council that she described as “laconic.” It read, “Start bleeding.” The ice-cream vans were driven to Slough, the donors were called, and at eleven fifteen two days later the staff of the northwestern depot stood in the social center bar in white coats and listened to the prime minister, Neville Chamberlain, announce on the wireless that the country was now at war with Germany. “And then,” wrote Janet, “we went back to our bleeding.”
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Slough depot. Wartime. The place bustled with nurses, secretaries, telephonists, medical technicians, drivers, scientists. There were one hundred staff. Diverting from Durán-Jordà’s model, the bleeding here was done by medical staff supplied by the Medical Research Council. The drivers were anyone willing to drive Wall’s ice-cream vans full of blood through bombs and blacked-out streets. Most were women. These drivers: I picture them as forthright young women in heavy coats, full of pluck. But there was also “Mrs. E. O. Franklin’s chauffeur Brady, a mad Irishman,” who kept the vans ticking over. When Liverpool was bombed and its transfusion service destroyed, Janet went to the bar to recruit volunteers to drive up supplies to the damaged city. She loved this bar for what it meant to her staff and understood that the depot depended not only on equipment and science. “My young drivers, girls, coming in late at night having driven through terrible weather and blackout, to be able to get some whisky in the war was very important.” In many interviews, she said the same: “Someone once said, ‘Janet was the only person who had the sense to set up an Emergency Service in a bar.’”
