Book review: Blood

I just finished reading Blood: An Epic History of Medicine and Commerce by Douglas Starr. I began reading this for work. I work at a blood bank as the Training Manager and Technical Writer. My intent is to develop curriculum for a class simply called Blood 101 that would be a nice orientation and introduction for new employees to attend. This would be especially beneficial for employees like me who entered the blood industry for the first time and knew little to nothing about the history of blood within our country or the world for that matter. What began as a piece of research for work, became a riveting study of one the most critical pieces of humanity: human blood. Starr’s book is a stunning look at superstitions, medicine, war, invention, illness, politics, money, greed, defeat, humility and change. The gripping tale had me hooked from chapter one and took me through a long and twisted history of the human race.

Starr breaks the book into three main areas: Blood Magic, Blood Wars and Blood Money. In each area he focuses on not just the uses of blood, but the overall perception of the product or gift, the underlying implications for its presence in our bodies and in medicine, our understanding and misunderstanding of its properties and how it helped shape the particular period of history being discussed.

Blood Magic goes back to the beginning of when we first see or hear of blood being used, primarily through the use of blood letting to relieve a variety of illnesses.

Doctors bled patients for every ailment imaginable. They bled for pneumonia, fevers, and back pain; for diseases of the liver and spleen; for rheumatism; for a nonspecific ailment known as ‘going into a decline’; for headaches and melancholia, hypertension and apoplexy. They bled to heal bone fractures, to stop other wounds from bleeding and simply to maintain a bodily tone.

(pg. 17)

Starr tells us how George Washington, suffering from what doctors now consider strep throat, instructed his doctors to bleed him to relive the pain and constriction. As part of his treatment, over the course of 13 hours, 7.5 pints of blood was let from his body (consider that most adults have 10-12 pints total in the body). This led to preterminal anemia, hypovolemia and hypotension. Washington (68) died the same day. Starr further discusses the transition of viewing blood as one of the four “humors” in our body carrying mystical powers, to a key component running throughout our body and being highly involved in our coronary, systemic, pulmonary and renal circulation systems. The concept and practice of transfusion became more common though blood typing had not yet taken place, which led to numerous deaths and complications.

Blood Wars talks about how blood was a key component in WWI and WWII and theorizes (very successfully) how the availability of blood and plasma helped the Allies win WWII. Starr discusses the rapid growth and understanding of blood during this period of time including the discovery of blood types (A, B, O), the discovery of the process of fractionation and being able to use the different components of blood (red blood cells, white blood cells, platelets and plasma) in a variety of applications and the discovery and use of citrate and other anticoagulants to store blood longer.

Lastly, Blood Money talks about the evolution of the Red Cross, independent non-profit blood banks affiliated with the American Association of Blood Banks (AABB), of which my current employer is associated, and for-profit blood banks and plasma centers. Starr talks about the evolution of illnesses like Hepatitis and eventually AIDS and the failings of the industry and countless governments to protect the blood and plasma supply and how we senselessly infected thousands of hemophiliacs and ordinary citizens through unsafe supply and transfusion procedures. He talks in detail about many of the profit plasma centers created in impoverished sections of cities where the poor and unhealthy are exploited for a few dollars a pint, while the plasma center turns a profit of many times over what they paid the donor. Only since the late 90s has sufficient, consistent testing been run on this product to ensure its safety for the general population.

The book was eye-opening, educational and often times heart rending. I’ve been so ignorant regarding much of our history related to blood and the tragic epidemic of AIDS that is stampeding mercilessly throughout our world. This book helped give me a microscopic, scientific, but human glance into the larger picture and to understand different angles of this multi-dimensional topic. I highly recommend this book to anyone who wants to read a fascinating tale of our history. I hope to one day make this required reading for my kids (*a few curse words are used in the stories told of a couple of the AIDS victims who were unwittingly transfused with the virus either through blood transfusion or through the injection of Factor VIII for treatment of hemophilia). I’ll leave you with a couple of the critics’ comments of this book.

“Starr’s lively history…courses with greed, altruism, and woozily vivid details.” Entertainment Weekly

“Meticulously researched, elegantly told.” Newsday

“Starr writes like a wildly enthusiastic high school biology teacher who arrives each day bristling with excitement, leaping about before the chalkboard, cracking jokes, and zealously banging his fist on his desk. Even the most indifferent brats pay attention, and so too will readers. …Starr has created what amounts to a history of the human race perceived through the filter of blood as a medical product.” Village Voice Literary Supplement

“A vivid account.” The Economist

“Blood should be included in all first- and second-year medical curricula.” Scientific American

“This is first-class science writing, with a striking message.” Publishers Weekly