Not all blood is the same

In 1900, the Austrian chemist, botanist and medical researcher Karl Landsteiner realized that not all human blood is alike, that some people's blood contains substances that are toxic to other people's blood.

That began to solve the mystery of why some people who received blood transfusions were fine, while others became ill and often died.

Karl Landsteiner
Karl Landsteiner

Landsteiner subsequently discovered three of the four genetically determined blood groups or types, O, A and B. A couple of years later, Alfred von Decastello and Adriano Sturli, Landsteiner's colleagues in Vienna, identified a fourth blood group, AB. While about 30 blood types have been discovered, the original four essentially cover everyone.

In 1910, at the Heidelberg Institute for Experimental Cancer Research in Germany, Ludwig Hirszfeld and Emil von Dungern demonstrated that blood type is an inherited trait.

In the speech he made when he accepted the Nobel Prize in 1930 for his work, Landsteiner described the mystery blood presented, and how he and his fellow researchers unraveled its secrets.

In 1922, Landsteiner moved to the Rockefeller Institute of Medical Research in New York, where he discovered an extremely powerful blood antigen he called "the Rh factor."

Today, hospital personnel make sure they know a mother's blood type in case she needs a transfusion. She will also be tested for her Rh factor because it can pose a danger to her baby's well being.

Blood draw

The science writer Douglas Starr has made something of a specialty of blood.

His book, Blood: The Epic History of Medicine and Commerce, and the PBS documentary series it inspired, Red Gold, cover the waterfront on this vital component of life, and our relationship to it.

The PBS website has a great discussion guide that sums up the topic impressively, and includes a timeline of important developments in our evolving relationship with blood.

Red Gold

Even before we understood its function, humans invested blood with value and meaning. As Starr writes in an essay in the guide:

Blood: It’s strange that this most familiar of substances has always been so laden with feeling, so heavily freighted with mystery and symbolism. Consider the vocabulary: blood of our fathers; blood of Christ; the nation’s blood; lifeblood; blood brothers, blood sacrament, blood libel.…The history of blood involves not only medicine, but also culture and religion. It is a story of change — how a mysterious liquid became a global commodity and reflected the soul of each society that used it.

A dangerous remedy

One physician's exploration of possible remedies for deadly hemorrhages that occurred during and after birth led to a renewed interest in blood transfusion in the 19th century, and to the first human-to-human transfusion.

James Blundell, who like many physicians and researchers of the time also delivered babies, studied the short, disastrous history of transfusions and came to two far-reaching decisions — that only human blood should be used, and that it should be used for one purpose only, to replace blood. No curing mental illness, no altering personalities.

Blundell performed the first human-to-human transfusion in 1818, and went on to transfuse 10 patients over the next several years, half of whom died. Even with that dubious track record, transfusion took on new life, because Blundell's results weren't that bad, given the mortality picture of the time, according to Douglas Starr, author of Blood: An Epic History of Medicine and Commerce.

In 1873, Franz Gesellius, a Polish doctor, studied the records of all the transfusions he could find and determined that 56 percent  of the subjects had died. Critics began to attack transfusion as an attention-grabbing gimmick, and an dangerous one at that.

At the end of the 19th century, transfusion appeared to be headed the way of bloodletting and other quackery.

Investigations in blood

William Harvey's monumental achievement in discovering the circulatory system inspired two of his friends to dabble in the study of blood — Christopher Wren, the architect who designed St. Paul's Cathedral and other remarkable London buildings (Wren was an astronomer before he turned to architecture), and Robert Boyle, a pioneer in modern chemistry.

The men were all members of the Experimental Philosophy Club in Oxford, England, and admirers of the work of Francis Bacon, who advocated first-hand investigations into the natural world, rather than accepting long-held orthodoxies.

At the time, it was thought that the blood was impervious to anything that came from the outside world. Using a prototypical syringe made of a quill and a bladder, Wren and Boyle injected dogs with opium and other drugs, and showed that the dogs were affected — that they reacted to the opium, for example, by falling asleep.

These experiments inflamed the scientific community, and no end of creatures were injected with every kind of fluid, from urine to milk, sometimes with fatal results.

Richard Lower, an Oxford-trained doctor and protege of Wren and Boyle's, in 1665 decided to see what happened when he injected a dog with blood from another dog, connecting the two vein-to-vein. The experiment failed. The blood just pooled up in the connecting tube, Douglas Starr relates in his book, Blood: An Epic History of Medicine and Commerce.

Then, Lower tried tapping an artery in the donor dog, and this time the experiment worked. The stronger pressure from the arterial blood made for a successful transfusion, leading Lower to reason that "one Animal may live with the blood of another," Starr writes. Lower's experiments set off a frenzy for transfusions in England and, soon, in France.

Jean-Baptiste Denis, one of the French King Louis XIV's doctors, thought he might cure violent people of their rages by transfusing them with the blood of gentle animals like calves and sheep. At the time, people believed that blood contained a sterotypical set of characteristics of the creature that possessed it. For a while, it looked like Denis had had a stroke of genius, as one violent character in particular seemed for awhile utterly transformed.

Lower was furious, accusing Denis of stealing his work. Meanwhile, some human transfusion subjects began to die (blood being much more complicated than these men understood), including some high-profile patients of Denis. The French Parliament banned transfusions in 1670, followed by the British Parliament and eventually the pope.

That was the end of transfusions in Europe until the early 19th century.

Still, Starr writes, these early researchers "cracked the wall of humoral medicine, showing that the body was ruled not by vague humors but by chemicals, vessels and pumps."

Our inner sea

Aeons ago, life on earth consisted of single cells suspended in the primordial sea. They took their nourishment directly from the surrounding waters, and excreted their waste products to be carried away, automatically, by the currents.

As more complicated animals evolved, the sea became private and internal in the form of blood, but it retained the original salts and the chemically useful pH, or acid-alkaline balance, of roughly neutral. When the first creatures slithered onto land, they took that inner sea with them.

The balances have changed slightly in the millions of years since then, but the individual cells of the human body are as dependent on the blood’s constancy as the first cells were on the never-changing sea.

From Shock-Trauma (1980), by Jon  Franklin and Alan Doelp