by Rose George
One regular driver was Lady Dunstan, “who must have been at least 70. She always wore a string of pearls and a toque [a small hat] rather like Queen Mary, but she was never daunted.” Do not underestimate Lady Dunstan: the conditions were usually hard and often terrifying. “Intimate knowledge of the roads under black-out conditions was essential,” wrote the Medical Research Council, “but had to be coupled with a willingness to drive while a raid was in actual progress.” Yet the drivers were so adept, sometimes they reached the hospital with their blood before the casualties that had lost theirs.
One day, her ladyship returned in great pride from a Canadian military hospital that had requested blood, and announced with wonderful grandeur: “Yes, the surgeon insisted on me coming into the theatre and seeing exactly what he was doing and why the blood was needed. I think I was able to help him.” Another volunteer, wrote Janet, was “a remarkable old lady whose only interest in life before the war had been her string of ponies and her bridge. She came and said she wanted a job and we set her down amongst the young technicians to fix a singular nasty wire filter that was being used at that time for stored plasma.” During her frequent episodes of illness, she dispatched her chauffeur in her Rolls-Royce to fetch her filters that she could fix at home while abed. “One of her friends said she had never been so happy in her life before. She knew we depended on her work, as we did, and through us casualties all over the country.”
It was a time of stepping up, making do, and derring-do. Katie Walker, a nurse employed at the depot for a couple of years, started work having taken only her British Red Cross exams. “I learnt to drive—you didn’t have to do a test or anything then—and I drove the ambulances, took blood around London to where it was needed. We also set up stations for taking blood, all over the place.”109
And who was giving them this blood? Plenty of people. Much of the recruitment had taken place in the months before the war. At Slough, it helped that the depot was housed on the huge trading estate. Factory workers were approached on-site. Bleeding teams went into the countryside to recruit, with success. Around the country, regional depots were doing similar work. And there was also by now social contagion. Giving blood was an accepted social good. In 1939, when the first evacuees were sent from the city to the countryside, Londoners used to the idea of donation spread the notion. “In a Hampshire village,” reported the Times, “a London woman who has moved there was asked if she could obtain some more donors for the blood transfusion service. There was, first, herself, she realized, and then, having registered herself, she went out, met a willing response, and in an hour or two 21 more people had registered because of her approach to them.”
Bleeding of donors was done both at the depot and by mobile teams sent out into the surrounding small towns and villages where they set up temporary bleeding centers in a town hall, factory break room, church hall, or village pub. Janet was very proud of the quality and sterility of “the bleed.” The housewife in the country village or small town, she wrote, “was often a most faithful and regular donor.” There was no question, now, of heeding the distaste of the medical establishment for women’s blood. Many women gave every three months throughout the war, “feeling it the one personal contribution they could make to the war effort.”110 Iron tablets were often handed out to combat the inadequacies of rationed diets.
The South London depot at Sutton—telephone number Vigilant 0068—was bleeding six hundred to seven hundred donors per week by 1941 when the Blitz began. Forty percent came to the depot to be bled, having been called up by postcard; the rest were bled at “outlying bleeding centers.” In an emergency, donors were fetched from nearby factories. The depot didn’t need to call upon donors more than once every six months, wrote Sutton’s director, because so many donors were available.111 There were quiet periods, even then. During a major offensive or disaster, hordes of donors came once and then not again. To counter the helplessness of mass disaster, we donate a pint of usefulness: this instinct persists today. After 9/11, 570,000 additional units of blood were donated, but 208,000 were discarded and only 260 units were needed to treat 9/11 victims.112
The bleeding teams learned that a loudspeaker van transmitting a special appeal was helpful. If the loudspeaker transmitted a message that the blood needed to be flown at once “to some particular fighting front or blitzed city,” donors flocked to give. After the Nazis invaded Denmark and Norway in 1940, one depot raised its weekly donor panel from eight hundred to three thousand almost immediately. Vaughan, the scientist, liked to think that this was not the only thing that drew donors to give blood. “Of course the man or woman in the village on the Chilterns likes to feel he is making a vital contribution to the war. [But] donors are really interested to know what happens to the blood they give and in the scientific advances made in blood transfusion. They respond to facts and figures as well as sentiment.”113
The press thought differently, preferring to present probably fictitious but vivid accounts of a link between donor and recipient. A bloodline. During the First World War, this desire for connection had been noted. Donors and recipients expressed a wish to know who was on the other end of the bloodline in either direction. “On the 13th June,” wrote A. C. Tayler in 1914 to a surgeon, “you took my leg off above the knee, and until I received blood from someone else you considered the betting about 3 to 1 on my pegging out. […] Can you find time to let me know the name and address of the man who gave me blood? I should much like to write to him.” A donor in 1917, a gunner named Birditt, asked to know if the patient who now had his blood “is recovering alright.”114
The North East Regional Blood Transfusion Service, via the Driffield Times, presented several colorful though improbable instances of blood brotherhood. On Sunday, November 19, 1945, a Miss M. Lee of Ingle Nook, Stork Hill, Beverley, gave her blood. It was flown overseas three days later, and, on November 30, transferred to Sergeant Howells, wounded by a mine, one amputated leg, who then made favorable progress. Mrs. Backhouse of Beverley assisted Private Cook of Meanwood Road, Leeds, who was almost eviscerated by a mortar bomb launched at him near Venlo. Several feet of bowel emerged from his abdominal wound, but he was transfused with blood from Beverley and he lived.115
The official account of the transfusion service, Life Blood, used a similar device, presenting personal stories of “a large, middle-aged woman, a soldier, a workman, a young red-haired girl of about twenty, an elderly man with an A.R.P. badge and a limp, and a railway goods guard who has brought his lamp along with him, as he proposes to go on duty directly his visit is over.” The middle-aged woman, Mrs. Alice Edwards, is a widow with one son in the army and a daughter in the ATS (Auxiliary Territorial Service). She started to give blood to do her bit, then found “a little blood-letting seemed to do her good, to overcome a feeling of heaviness, and she comes now every three months—‘for her own health,’ so she says.”116 In the UK, personal contact was restricted to this type of propaganda, but Russians allowed for a more real intimacy. And why not, when people were sharing something as intimate as body fluid? Each bottle of donated Russian blood was labeled with the donor’s name and contact details. As most Russian donors were women, and the blood went to serving soldiers, this had a predictable outcome. In 1943, the Dundee Courier reported that this friendly transfusion “has led to a number of romances between the soldier patient and the blood giver.” In some cases, soldiers wounded for the second time asked for blood from the same girl.117
The war embedded the idea of blood donation in popular consciousness like nothing else had done. There was nothing more powerful than the message that blood was going, almost directly, into the veins of a wounded soldier, even if it wasn’t. Then again, people gave for all sorts of reasons. The Army Blood Transfusion Service encountered one old gentleman with high blood pressure. Before the war, wrote the Gloucestershire Echo, “he used to pay ten guineas to his surgeon to be bled. Now he follows the mobile collecting teams of the Army Blood Supply Depot, and s
urrounded by pretty V.A.D.s [women from the Voluntary Aid Detachment] and ATS, has it done for nothing.” The brigadier in charge of the depot saluted “the faithful crowds of high blood pressure victims who follow our teams around, giving their blood not only for the benefit of our wounded men, but also for their own benefit.”118
By 1942, the donation of blood had become many things to many people. It could be a weapon of moral superiority. That year, Miss Ivy Standing and Miss Grace Standing were posted some white feathers and accused of cowardice “while young girls who used to be your playmates are doing your bit.” The accompanying poison pen letter finished with what was meant to be a powerful flourish. “P.S. We doubt whether you have even given blood to help a wounded soldier.” The reporter’s flourish was better. “Curiously enough, both girls have given blood transfusions.”119 The same year, James Eric Oldham of South Sale near Manchester, who was on trial for stealing carpets, offered the fact of his blood donations as mitigation. He had given six or eight pints of blood, milord, and it had weakened his will. The mitigation failed.120
Another man offered, in his memory of war, perhaps my favorite explanation for donating that I’ve ever encountered. “1941. War. Blood needed. I had some. Why not?”121
* * *
Slough, Luton, Maidstone, Sutton, and the Army Blood Transfusion Service: they all gathered blood, they all supplied it, and after a few months their staff also began to transfuse it. Among the civilian blood depots, Janet was convinced that Slough was special. Everyone knew to ask Slough for blood, and they would get it. At first, they would call for it by telephone. But “they soon learnt that Slough could hear and see the bombs falling and would arrive.” After a year of waiting, during the period known as “the bore war” or the “Sitzkrieg,” the bombing began in the autumn of 1940. The ice-cream vans would get near the bomb sites and deliver their blood to the hospital where the casualties were being taken, or they would perform transfusions on casualties in the street.
On the home front, the depot staff learned to wear electric lamps on their foreheads like miners so that if electricity failed “or the lights were off because the windows were broken and blackout curtains were blowing in the wind,” they could see where to stick in their needles and hang their bottles. They changed the needle design because of a house fire on the Great West Road. Vaughan arrived at a hospital filled with casualties and found a little girl, horrifically burned. She left the girl to die, because she had to see who could be saved with a transfusion, but after saving who she could, Vaughan returned to the girl and found her alive. Her legs and arms were so burned she had no veins there. And Janet again remembered something she had read, that you could give blood into bones. “That was the great thing about medicine in the war, you could take risks because people died so they were no worse off if they died because of what you did.” She took the biggest needle she could find, stuck it in the girl’s breastbone, and told a nurse to pump in blood. (When depot staff couldn’t find a vein, they called it “Digging for Victory.”) Two hours later, Janet came back to the girl to find that the nurse had got two pints in. After that night, they devised needles to transfuse into the bone marrow. They had special flanges to hold them in place, so they could be used on boats and landing craft “when it might be easier to get into a large bone than an invisible vein.” The flanges were used at Dunkirk; the girl lived.
Years later, Harriet Higgens, that burned little girl, applied to Oxford. She remembered Vaughan, who had visited her later in the hospital and sucked blood out of her ears with a glass tube (Harriet doesn’t explain why). And all the while, wrote Harriet, “she explained what she was doing and spoke to me as if I was as interested and intelligent as she was.” She was allowed to select three colleges on her application, but the only college she put on her form was Somerville, where Vaughan was then principal.122 “So,” said Janet Vaughan of this, “nice things happen.”123
The depots treated thousands of casualties, but the staff also did scientific research. They learned that a trauma victim needed on average two and a half milk bottles’ of fluid, with two bottles of blood used for one bottle of plasma.124 There was flexibility: overseas, war surgeons learned that “the only criterion was the need of the man.” The quantity to be given was the quantity lost. “In cases of necessity,” wrote Major General W. H. Ogilvie, a noted surgeon, “blood has been given at the rate of half a pint a minute by using two veins simultaneously, and as much as 18 pints has been given in the course of a two-hour operation.”125
The war created ongoing innovation, in science and practice. Plasma was now routinely separated from blood, dried, and used. It was much easier to transport than perishable blood, and judged useful at treating blood loss. Also, because plasma has no cells, it didn’t need to be cross matched. The army’s plasma-drying facility had been built with donations from the Silver Thimble Fund of the women of India.126 Sometimes, dried serum—plasma without its clotting factors—was adequate treatment. This was essential for the mass evacuation of Dunkirk in the spring of 1940, when the depot sent all the blood it had to the coast. But the casualties kept coming, and the system could not cope, even after the Americans began sending over blood and plasma on ships under a program called Plasma for Britain.127 Vaughan and her staff had also been working on using plasma, but the plasma looked cloudy and full of clots, so they hadn’t dared risk it until Dunkirk. “We knew men must die if we didn’t transfuse them, so we took a risk on our very odd-looking plasma.” It was another risk justified by war, and the plasma worked “like magic.”128
By the spring of 1941, when the air raids stopped, they expected the demand for blood to drop but it didn’t. Transfusion worked and surgeons and doctors kept doing it. “In many cases,” wrote Janet, “no doubt the pendulum swung too far and unnecessary transfusions were given, but on the whole the educative value of the war time transfusion service was great.” So was its organization. “It was gratifying,” wrote the Medical Research Council after the war, “to see how easily the organization, planned without any practical experience of a large scale transfusion service, swung into action, reflecting great credit on all those who had given so much time and thought to the preparation of the scheme.”129
Vaughan learned to say yes to any request, because “what men and women need in a desperate emergency is reassurance. They can hold on if help is coming, and—given the lead—other men and women will always be prepared to give that help.” Just before D-day, Janet received a phone call from the head of Emergency Medical Services. “Janet, we have made no arrangements for the Ports, will you look after them?” She said yes, having no idea what looking after the ports would entail. “As so often we heard no more, but I can only hope that the Ports received reassuring messages that Slough would come if needed.”130
At the end of the war, a memorandum on the South West London Blood Supply Depot, the only one of the four to maintain comprehensive records, showed that in 1940 it had distributed 9,410 bottles of blood, and in 1945, 22,397.131 Some was used for bomb casualties, but it was notable, wrote Janet, that “even when no bombs were falling, even for long periods, the steady increase in the demand for blood was maintained. So remarkable was the progress made by blood banks and the transfusion services during the war years that there has been a universal demand for their retention in perpetuo.” Regional depots were working well around the country. The Army Blood Transfusion Service’s work had been equally impressive. At the outbreak of war, it was collecting 100 pints a day. By war’s end, when the army had set up 850 satellite centers from Reading to Penzance, it collected 1,300 donations a day. The record amount bled in one day was 1,657 pints.
For Major General W. H. Ogilvie, “the greatest surgical advance of this war, more important even than penicillin, is the development of the transfusion service. A transfusion service, with blood banks sufficient to meet any needs, must be available for the resuscitation of the injured and the restoration of the sick in civilian life.” And so it ca
me to pass.
* * *
In 1945, Janet Vaughan left the depot. She had had five years of death and burns and bombs, like countless others, but when she was asked to go to the Nazi death camp Belsen to research how best to feed starving people, she said yes. The prevailing medical dogma was that the most effective treatment of starvation was protein hydrolysates, strong proteins in liquid form. She was driven over the Rhine on wooden pontoon bridges, and she waved to troops returning from the front. She saw hundreds of forced laborers in striped pajamas, spat out from their camps and wandering over the countryside. When she got home, she burned all of her husband’s striped pajamas.
Before they reached it, they could smell Belsen: a stench of shit and dead bodies. The senior officer at the camp expected that these new visitors had come to help. No, they said. They had come to do research. That sounds brutal now, but Vaughan believed in science, and they would soon need to save all the prisoners of war who would emerge from Japanese camps. The science had to be done, even if she found herself having to inject hydrolysates into skeletal men who saw her medical apparatus and screamed “Nicht crematorium!” because the Nazis had sometimes injected the condemned with paraffin before sending them to the gas chamber.132 Vaughan writes that this was so that they burned better. This was horror, but Vaughan kept on: when she had to pick the living from the dying in piles of bodies; when she was attacked by naked, desperate men screaming for bread in five languages. She did enough research to show that small amounts of food were a more efficient treatment of starvation than hydrolysates. She wrote to George Minot, her hematologist hero, of seven-year-old children who looked twenty and girls of eighteen who looked fifty, of the constant stench of feces and filth, of men weeping at the sight of her “unable to expect kindness or friendliness.”133 She wrote a letter home that said, “I am here—trying to do science in hell.”134
