Medieval Medicine: A History of the Study of Blood

2024 Author: Seth Attwood | [email protected]. Last modified: 2023-12-16 15:55

Why did our ancestors bleed each other with liters and how were they treated for anemia? What does a realistic portrayal of Christ's wounds have to do with Jewish pogroms? How did the first blood transfusion experiments end? And what did the author of the novel "Dracula" rely on? We will talk about how people's ideas and knowledge about blood were formed.

It would seem that for a modern person belonging to European culture, blood is just a biological fluid with a set of certain properties and characteristics. In fact, such a utilitarian view tends to be held by those with a medical or science education.

For most people, no amount of school anatomy lessons can abolish or neutralize the powerful symbolic meanings that blood is endowed with in culture. Some myths associated with blood have already gone out of use, and we only see their traces in religious prohibitions and kinship terms, in linguistic metaphors and poetic formulas, in proverbs and folklore. Other myths have emerged quite recently - and continue to emerge before our eyes.

Blood like humor

Ancient medicine - and after it Arab and European - considered blood to be one of the four cardinal fluids, or humors, along with yellow and black bile and phlegm. Blood seemed to be the most balanced bodily fluid, hot and humid at the same time, and was responsible for the most balanced sanguine temperament.

The 13th century theologian Vincent of Beauvais used poetic arguments and quoted Isidore of Seville to prove the sweetness of blood and its superiority over other humors: “In Latin, blood (sanguis) is called so because it is sweet (suavis) … those in whom it prevails, kind and charming."

Until a certain time, diseases were considered a consequence of a violation of the harmony of fluids in the body. Blood was more dangerous in its excess than in deficiency, and the documents that have come down to us with the histories of patients are much more likely to speak of plethora than anemia. Some historians associate "diseases of excess" with the economic and social status of patients, because only wealthy people could go to doctors, while the common people were treated by other specialists and for other diseases. In turn, the excessive plethora of such patients was explained by their lifestyle and too abundant food.

Bloodletting scheme from Konrad Megenberg's "Book of Nature". 1442-1448 years

The doctor prepares to bleed. A copy of the painting by Richard Brackenburg. 17th century

Bloodletting instruments. XVIII century

The main therapeutic manipulations of humoral medicine were aimed at removing excess fluids outside. Doctors prescribed choleretic and diaphoretic decoctions, abscess plasters and bloodletting to their wards. Arab and European medical treatises have preserved diagrams of the human body with detailed instructions from where to bleed for various diseases.

With the help of a lancet, leeches and cans, surgeons and barbers (it was they who occupied a lower place in the hierarchy of medical professions who directly followed medical recommendations) removed blood from the hands, feet and the back of the head with cups and plates. Since the middle of the 17th century, venous cutting has periodically raised doubts and criticism, but it did not completely disappear even after the spread of biomedicine and its official recognition.

Other practices related to humoral ideas about blood are still in use today - from “warming up” mustard plasters or goose fat for colds to cans, which were widely used in Soviet medicine and Soviet self-medication practices. In modern biomedicine, cupping is considered to be either a placebo or an alternative technique, but in China and Finland they still maintain a reputation for strengthening, relaxing and pain relieving.

Other means were used to make up for the lack of blood. Galen's physiology placed the center of hematopoiesis in the liver, where food was processed into bodily fluids and muscles - such views were held by European doctors until about the 17th century. In addition, there was a concept of the so-called "insensitive evaporation", which can be conditionally identified with skin respiration.

This doctrine, which dates back to Greek writings, was formulated in the early 17th century by a Padua physician and Galileo's correspondent Santorio Santorio. From his point of view, internal moisture extracted by the body from food and drinks evaporated through the skin, imperceptibly for a person. In the opposite direction, it also worked: opening up, the skin and internal pores ("wells") absorbed the external particles of water and air.

Therefore, it was proposed to fill the lack of blood by drinking fresh blood of animals and people and bathing from it. For example, in 1492 Vatican doctors tried in vain to cure Pope Innocent VIII by giving him a drink from the venous blood of three healthy youths.

The blood of christ

Jacopo di Chone. Crucifixion. Fragment. 1369-1370 years- National Gallery / Wikimedia Commons

Alongside the pragmatic concepts of blood as humor, there was a branched blood symbolism that combined pagan and Christian views. Medievalists note that execution by crucifixion led to death from suffocation and dehydration, but not from loss of blood, and this was well known in the early Middle Ages.

Nevertheless, starting from the 13th century, the scourging, the way to Golgotha and the crucifixion, which appeared as "bloody passions", became the central images for meditation on the soul and devout worship. The scene of the crucifixion was depicted with streams of blood, which the grieving angels collected in bowls for communion, and one of the most important iconographic types was "Vir dolorum" ("Man of Sorrows"): the wounded Christ surrounded by instruments of torture - a crown of thorns, nails and a hammer, sponges with vinegar and spears that pierced his heart.

Stigma. Miniature from the life of Catherine of Siena. XV century - Bibliothèque nationale de France

The stigmatization of St. Francis. Around 1420-1440 - Wallraf-Richartz-Museum / Wikimedia Commons

By the High Middle Ages, visual representations and religious visions of the suffering of Christ became increasingly bloody and naturalistic, especially in northern art. In the same era, the first cases of stigmatization occurred - by Francis of Assisi and Catherine of Siena, and self-flagellation became a popular practice of humility of the spirit and mortification of the flesh.

Since the end of the 14th century, theologians have been discussing the state of Christ's blood during the triduum mortis, the three-day interval between crucifixion and resurrection. In the visions of the mystics, Christ was crucified or tortured, and the taste of the wafer - a symbolic analogue of the Body of Christ during the sacrament - in some lives begins to be described as the taste of blood. In different corners of the Christian world, miracles took place with statues crying bloody tears, and bleeding wafers, which turned into objects of worship and pilgrimage.

At the same time, blood libels spread throughout Europe - stories about Jews who, in one way or another, try to desecrate the sacred host or use the blood of Christians for witchcraft and sacrifices; in time these stories coincide with the first major pogroms and expulsions.

Paolo Uccello. The miracle of the desecrated host. Fragment. 1465-1469 - Alinari Archives / Corbis via Getty Images

Craftsman from Valbona de les Monges. Altar of the Body of Christ. Fragment. Around 1335-1345 - Museu Nacional d'Art de Catalunya / Wikimedia Commons

This obsession with the blood and body of Christ reaches its peak by the 15th century: during this period, theology and medicine on the one hand, and believers on the other, ask questions about the status of the body and its fluids, about the status of Christ's Body, about the presence and appearance of the Savior. Most likely, the blood of Christ and the saints caused sorrow to the same extent as joy: it testified to human nature, purer than the body of an ordinary person, to the hope of salvation and victory over death.

Blood as a resource

For centuries, humoral medicine believed that blood is formed in the liver from food and then through the heart through the veins to the internal organs and limbs, where it can evaporate, stagnate and thicken. Accordingly, the bloodletting eliminated the stagnation of venous blood and did not cause harm to the patient, because the blood was immediately formed again. In this sense, blood was a rapidly renewable resource.

William Harvey demonstrates to King Charles I the beating heart of a fawn. Engraving by Henry Lemon. 1851 year - Wellcome collection

In 1628, the English naturalist William Harvey published a treatise "Anatomical study of the movement of the heart and blood in animals", which summarized his ten years of experiments and observations on the movement of blood.

In the introduction, Harvey referred to the treatise "On Breathing" by his teacher, University of Padua professor Girolamo Fabrizia d'Aquapendente, who discovered and described the venous valves, although he was mistaken with their function. Fabrice believed that the valves slow down the movement of blood so that it does not accumulate in the extremities too quickly (such an explanation still fit into the humoral physiology of ancient physicians - first of all, into the teachings of Galen).

However, as is often the case in the history of science, Fabrice was not the first: before him, the Ferrara doctor Giambattista Cannano, his student, the Portuguese doctor Amato Lusitano, the Flemish anatomist Andrea Vesalio and the Wittenberg professor Salomon Alberti wrote about the valves, or "doors" inside … Harvey returned to earlier hypotheses and realized that the function of the valves is different - their shape and number do not allow venous blood to flow back, which means that blood flows through the veins in only one direction. Then Harvey examined the pulsation of the arteries and calculated the rate of passage of blood through the heart.

Blood could not form in the liver and slowly flow to the extremities: on the contrary, it rapidly circulated inside the body in a closed cycle, simultaneously leaking through the internal "wells" and being sucked in by the veins. Opening the capillaries connecting arteries and veins required both a better microscope and the skill of gazing: a generation later they were discovered by the Italian physician Marcello Malpighi, the father of microscopic anatomy.

An experiment demonstrating the movement of blood in a vein. From the book Exercitatio anatomica de motu cordis et sanguinis animalibus by William Harvey. 1628 year - Wikimedia Commons

Heart. Illustration from the book De motu cordis et aneurysmatibus by Giovanni Lanchisi. 1728 - Wellcome Collection

Harvey's work meant both a revision of Galen's physiological concepts and a new approach to blood. The closed circle of blood circulation increased the value of blood and called into question the rationality of bloodletting: if blood is a finite resource, is it worth wasting or wasting?

Physicians were also interested in another question: if blood moves in a vicious circle from veins and arteries, is it possible to compensate for its loss in case of severe bleeding? The first experiments with intravenous injections and blood transfusions began in the 1660s, although veins were injected with liquid medicine, wine and beer (for example, the English mathematician and architect Sir Christopher Wren, out of curiosity, injected the dog with wine, and she instantly became drunk).

In Great Britain, court physician Timothy Clarke infused drugs into exsanguinated animals and birds; the Oxford anatomist Richard Lower studied blood transfusion in dogs and sheep; in France, the philosopher and physician Louis XIV Jean-Baptiste Denis experimented with people. In Germany, the treatise "The New Art of Infusion" by the German alchemist and naturalist Johann Elsholz was published with detailed schemes of blood transfusion from animals to humans; it also provided advice on how to achieve harmony in marriage with the help of blood transfusions from a "choleric" wife to a "melancholic" husband.

The first person to whom Lower transfused the blood of an animal was a certain Arthur Koga, a 22-year-old theological student from Oxford, who suffered from dementia and fits of rage, which the doctors had hoped to subdue with the blood of the meek lamb. After a 9-ounce infusion of blood, the patient survived but was not cured of dementia.

Denis's French experimental subjects were less fortunate: out of four transfusion cases, only one was relatively successful, and the last patient who was wanted to be cured of rampage and a tendency to brawl with a calf blood transfusion died after the third injection. Denis was put on trial for murder, and the need for a blood transfusion was questioned. A monument to this episode in the history of medicine was the frontispiece of "Anatomical Tables" by Gaetano Petrioli, who placed in the lower left corner an allegorical figure of a blood transfusion (transfusio) - a half-naked man embracing a sheep.

Sheep blood transfusion to man. 17th century - Wellcome collection

Report by Richard Lower and Edmund King on Sheep Blood Transfusion to Man. 1667 Wellcome Collection

New attempts at blood transfusions began in the Empire era, after the discovery of oxygen and its presence in arterial blood. In 1818, British obstetrician James Blundell, who by this time had published several experiments on blood transfusions, injected a woman in labor who was dying of postpartum hemorrhage with her husband's blood, and the woman survived.

During his professional career, Blundell undertook intravenous blood injections as a last resort in ten more cases, and in half of them patients recovered: blood became the resource that could save the life of another person and which could be shared.

Blood transfusion. 1925 year - Bettmann

Nevertheless, two problems - blood clotting during injection and complications (from a sharp deterioration in well-being to death) - remained unresolved until the discovery of blood groups in the early 20th century and the use of anticoagulants (sodium citrate) in the 1910s.

After that, the number of successful transfusions rose sharply, and doctors working in field hospitals found a way to extend the life of the blood taken: to save a person, it was no longer necessary to have a direct blood transfusion - it could be stored and stored.

The world's first blood bank was established in London in 1921 on the basis of the Red Cross; it was followed by blood banks in Sheffield, Manchester and Norwich; following the Great Britain, storage facilities began to open in continental Europe: volunteers were attracted by the opportunity to find out the blood type.

Blood types

Typically, people are aware of eight types of blood: blood can belong to type 0, A, B, or AB and be Rh + and Rh- negative, giving eight choices. Four groups, discovered by Karl Landsteiner and his students in the 1900s, form the so-called AB0 system. Independently of Landsteiner's team, four blood groups were identified in 1907 by Czech psychiatrist Jan Jansky, who was looking for a connection between blood and mental illness - but did not find and honestly published an article about it. The Rh factor is another system discovered by Landsteiner and Alexander Wiener in 1937 and empirically confirmed by physicians Philip Levin and Rufus Stetson two years later; it got its name because of the similarity between the antigens of humans and rhesus monkeys. Since then, however, it turned out that the antigens are not identical, but they did not change the established name. Blood systems are not limited to the Rh factor and ABo: 36 of them were opened in 2018.

However, the old notions that blood and other bodily fluids taken from young people are able to heal and restore youth have not gone away. On the contrary, it was their vitality and translation into a new language of progress that made medical research on the properties of blood and clinical experiments available to the public. And if Bram Stoker's novel Dracula (1897) was still based on archaic ideas about the rejuvenating effect of drinking blood, other works appealed to the future and placed blood renewal in the current scientific context.

Alexander Bogdanov. A red star. Edition 1918- Publishing House of the Petrograd Soviet of Workers' and Red Army Deputies

In 1908, the Russian physician, revolutionary and writer Alexander Bogdanov published the novel Krasnaya Zvezda, one of the first Russian utopias. Bogdanov discovered the ideal socialist society of the future on Mars, whose inhabitants share blood with each other. “We go further and arrange an exchange of blood between two human beings … … the blood of one person continues to live in the body of another, mixing there with his blood and bringing a deep renewal to all his tissues,” the Martian tells the hero-hitman.

Thus, the Martian society literally turned into a single organism, rejuvenated by common blood. This physiological collectivism existed not only on paper: as a doctor, Bogdanov tried to implement it, having achieved the creation of the Moscow Institute of Blood Transfusion in 1926 (the first blood transfusion station opened in Leningrad five years later). True, like other utopian projects of the early Soviet era, anti-aging "exchange transfusions" were rejected in the early 1930s.

Unwilling to follow Bogdanov's mystical program, his colleagues adhered to a narrower and more economical view of blood. In particular, Soviet transfusiologists Vladimir Shamov and Sergei Yudin investigated the possibility of cadaveric blood transfusion: if blood is a resource, then it must be used entirely and it should not be lost with the death of a person.

Blood and Race

In the second half of the 19th century, thanks to the dialogue between many different scientific disciplines, new social and natural science theories arose. In particular, physical anthropology borrowed the concept of race from natural history; a variety of scientists have proposed classifications of human communities and the corresponding typology of races based on characteristics such as the shape and volume of the skull, the proportions of the skeleton, the color and shape of the eyes, skin color and hair type. After the First World War, anthropometrics (measuring skulls) were supplemented by new methods - a variety of tests for cognitive abilities, including the famous IQ test, and serological studies.

Interest in the properties of blood was sparked by the discoveries of the Austrian chemist and immunologist Karl Landsteiner and his students Alfred von Decastello and Adriano Sturli: in 1900, Landsteiner discovered that blood samples from two people stick together, in 1901 he divided the samples into three groups (A, B and C - later renamed to group 0, aka "universal donor"), and the students found the fourth group AB, now known as "universal recipient".

On the other hand, the demand for such research was driven by the needs of military medicine, faced with the urgent need for blood transfusions in the multinational massacre of the First World War. In the period between the two world wars, doctors examined and typed the blood of 1,354,806 people; during the same time, more than 1200 medical and anthropological publications devoted to blood were published in the USA, Great Britain, France and Germany.

Racial map of Europe. Germany, 1925 - American Geographical Society Library Digital Map Collection

In 1919, Polish infectious disease doctors Hannah and Ludwik Hirschfeld, relying on the typing of the blood of soldiers of the Serbian army, published a paper on the alleged connection between blood groups and race. This work inspired a whole area - Aryan seroanthropology, which was a bizarre mixture of eugenics, racial anthropology, applied medicine and folkish ideology.

Seroanthropology was looking for connections between blood, race and soil - and tried to substantiate the biological superiority of the Germans over their eastern neighbors. The whole German Society for the Study of Blood Groups, founded in 1926 by the anthropologist Otto Rehe and the military doctor Paul Steffan, worked on this issue.

The first came to seroanthropology from pure science, the second from practice: Steffan did blood tests, checking soldiers and sailors for syphilis; both sought to reconstruct the racial history of Germany and discover the Nordic race - the "true Germans" - through serological analysis. So the blood group turned into another parameter that defines the border between races and connects German blood and German soil.

The statistics at the time suggested that the carriers of group A predominate in Western Europe, and group B in Eastern Europe. In the next step, the blood was combined with the race: dolichocephals, Nordic slender blondes with high cheekbones, were opposed to brachycephals, short owners of round skulls.

Paul Steffan's map. 1926 year - Mitteilungen der anthropologischen Gesellschaft in Wien

For a visual demonstration, Steffan drew up maps of the world with two isobars - the Atlantic race A, which originated in the Harz mountains, in northern Germany, and the Godvanic race B, which originated in the vicinity of Beijing. Isobars collided on the eastern border of Germany.

And since the underlying assumption was a hierarchy of races, blood groups could also be assigned different physiological and social values. There have been attempts to prove that the owners of group B are more prone to violent crimes, alcoholism, nervous diseases, mental retardation; that they are less proactive and more vicious; that they are more guided by the opinions of others and spend many times more time in the toilet.

Such constructions cannot be called innovation: they only transferred hypotheses from the field of eugenics and social psychology into the field of serological research. For example, as early as the late 19th century, the French philosopher Alfred Foulier reflected on the customs of town and country in racial terms:

“Since cities are theaters of the struggle for existence, on average, victory is won in them by individuals gifted with certain racial properties. … dolichocephalics prevail in cities compared to villages, as well as in the upper grades of gymnasiums compared to the lower ones and in Protestant educational institutions compared to Catholic … brachycephalic.

The concept of group B as a "Jewish marker" was explained by the same mechanisms: for old anti-Semitic views, they tried to use scientific evidence, even if they were not supported by empirical data (for example, according to studies conducted in 1924 in Berlin, the proportion of groups A and B among the Jewish population was 41 and 12, for non-Jewish - 39 and 16). During the era of National Socialism, seroanthropology helped to substantiate the Nuremberg racial laws designed to protect the blood of the Aryans from mixing with the Asiatic race and endowing blood with political meaning.

Although in practice birth and baptismal certificates were used to determine race, Nazi German documents had a specific line for blood type, and the precedents of incest were widely discussed. In addition to issues of marriage and childbirth, purely medical problems of transfusiology also fell into the sphere of attention of the Nazis: for example, in 1934, the doctor Hans Zerelman, who transfused his own blood to a patient, was sent to a camp for seven months.

In this aspect, the Nazis were also not original: the inadmissibility of transfusing Aryan blood into Jewish veins was preached at the end of the 19th century by the Lutheran pastor Adolf Stoecker, and in the anti-Semitic pamphlet "The Operated Jew" by Oscar Panizza (1893), the transformation of a Jew into a German was to be completed by Black Forest blood transfusions …

A poster against blood segregation for transfusion. USA, 1945- YWCA of the U. S. A. Records / Sophia Smith Collection, Smith College Libraries

Quite similar ideas existed on the other side of the ocean, only they concerned blacks. The first American blood bank, created in 1937 in Chicago, instructed donors to indicate race when questioning - African Americans were identified by the letter N (negro), and their blood was used only for transfusions to blacks.

Some donation points did not take blood at all, and the American branch of the Red Cross began accepting African American donors since 1942, strictly ensuring that blood from different races did not mix. At the same time, the US Army began to indicate the blood type on soldier tokens in addition to the name, unit number and religion. Segregation of blood continued until the 1950s (in some southern states, until the 1970s).

Blood as a gift

If the First World War fostered research interest in blood groups, then the Second World War and its aftermath - primarily the creation of atomic energy and the nuclear strike on Hiroshima and Nagasaki - spurred the study of bone marrow transplantation. A prerequisite was the understanding of the function of the bone marrow as an organ of hematopoiesis: if the patient's body needs not just temporary support, but constant support - for example, in case of blood diseases, then it is logical to try to transplant an organ directly responsible for blood production.

Knowledge about blood systems and numerous cases of complications led to the assumption that only bone marrow from a close relative, best of all genetically identical to the recipient, can be transplanted. All previous attempts at bone marrow transplantation ended in the death of patients from infections or immune reactions, later called GVHD - a "graft versus host" reaction, when the recipient's cells come into immune conflict with the donor's cells and begin to fight each other. In 1956, New York physician Edward Donnall Thomas performed a bone marrow transplant to a patient dying of leukemia: the patient was fortunate enough to have a healthy twin.

Georges Mate - Wikimedia Commons

Two years later, another doctor, French immunologist Georges Mate, proposed a bone marrow transplant from an unrelated donor. Experiments on animals have helped to understand that for a successful transplant, the recipient must be irradiated in order to neutralize his immune system.

Therefore, from an ethical standpoint, the only chance was for patients already suffering from radiation exposure, and such a chance appeared: in November 1958, four physicists were sent to the Parisian Curie hospital after an accident at the Serbian Institute of Nuclear Physics in Vinca with an irradiation of 600 rem. Deciding on an unrelated transplant, Mate placed the patients in sterile boxes to protect them from infections.

Subsequent studies of bone marrow cells made it possible not only to understand the nature of the immune conflict, but also to separate transplantation and consanguinity in a narrow medical sense. Today's national and international registries of bone marrow donors total more than 28 million people. They work across family ties, boundaries and territories - and create a new type of kinship, when a donor from one end of the world and a recipient from the other end up united not only by a set of proteins on the cell surface, but also by a gift relationship.