British Red Cross
INTRODUCTION
The history of blood transfusion is a subject of interest to historians of medicine and scholars of Africa, as well as those who work in and follow developments in global health. Like today, the introduction of new medical practices in Africa at the beginning of colonial rule held great promise for generally improving health. In the case of transfusion, as this study shows, there were advances to be sure, but also some setbacks. Most important, blood transfusion could not be put in place quickly or exactly as it was practiced in the countries of Europe or in other developed countries. The procedure required some important modifications in order to be widely practiced in Africa; hence, its history offers many lessons for those currently interested in economic development and global health.
Blood Transfusion and the Origin of AIDS
This book grew out of the response to a question from colleagues studying the origin of AIDS. As is often the case with unexpected epidemics, the most immediate concern was about the cause of the disease after it was identified in 1981. Once that cause was discovered a few years later, an extensive search began for the origin of the virus. Despite speculation about such things as conspiracies, fallout from germ warfare research, and divine retribution, by the late 1980s virologists identified simian immunodeficiency viruses of chimpanzees and monkeys in Central and West Africa as the antecedents of the human immunodeficiency viruses that caused AIDS.1
One important feature of simian viruses, however, complicated the question of the origin of AIDS. According to scientists, the simian viruses from which the human immunodeficiency viruses (HIV-1 and HIV-2) were adapted have existed in African chimpanzees and monkeys for thousands of years. Moreover, humans have long had contact with these animals as sources of food and pets, but a person can tolerate relatively well a simian virus infection from cuts or bites.2 So the question was, why did the adapted human immunodeficiency viruses become pandemic only in the last thirty years?3
Blood transfusion was not the first explanation suggested; rather it was that a chance, random mutation produced the particularly deadly HIV virus. This theory was reinforced by early evidence that suggested the human virus was new. An extensive search for human tissue and serum found that the earliest sample infected with HIV antibodies was from 1959.4 Using this sample and multiple other later ones, researchers have taken advantage of the fact that HIVs mutate at a predictable rate so that they can compare the changes in DNA sequences of the HIV samples and estimate approximate dates of their common ancestor virus. Accordingly, they have estimated that the oldest human immunodeficiency virus dates from the period between 1921 and 1933.5
Even if this human virus is of relatively recent origin, the problem with the random-mutation explanation is that a dozen other human immunodeficiency viruses have been discovered that have also adapted from simian ones and from regions as far away as a thousand miles.6 This has led many researchers to seek another explanation of what changed to make it possible for the simian viruses to begin adapting into human ones at different locations in Africa in the first half of the twentieth century.
The most obvious source of change in much of sub-Saharan Africa at the end of the nineteenth and beginning of the twentieth century was the establishment of European colonial rule. Some provocative hypotheses have been offered to explain the specific developments that could have increased the opportunities for adaptation of viruses as well as their epidemic spread. For example, demographic and social change, or altered patterns of environmental exploitation could have increased passage of viruses from simians to humans or between humans.7 These suggestions have usually been found in concluding sections of articles on the scientific basis of dating the emergence of viruses, although two recent book-length treatments of the origin of AIDS have summarized, and in one case attempted to analyze, them.8 These are broad generalizations requiring detailed research to be verified. In addition, these explanations have usually been suggested by scientists, only a few of whom have actually ventured into archives, but none with historical training in the critical evaluation of sources.9 Therefore more serious scholarship by historians is essential before drawing any conclusions.
My colleagues’ theory was that the multiple adaptations were facilitated by new, albeit unintentional means of transmitting disease between humans in Africa in the last century. Their research focused initially on the use of insufficiently sterilized needles in mass campaigns against disease that began during colonial rule, in order to show that this might have been a new way for someone infected with a simian virus to transmit it to another person. They maintained that this so-called serial passage increased the chance for the adaptation of new human immunodeficiency viruses.10 These results raised the question of whether another otherwise lifesaving procedure, blood transfusion, began early and frequently enough in Africa also to have facilitated adaptation of SIVs to new HIVs and their epidemic spread. In this case even less frequent use of transfusion might have had a greater impact because of its unparalleled efficiency of transmitting disease, nearly 100 percent. To their credit, they recognized their limitations as historians, and they sought additional expertise.
Africa and the History of Transfusion
My colleagues’ ignorance of the history of blood transfusion in Africa was not just the result of their lack of historical training. In fact, there has been very little written on Africa even though the history of blood transfusion has been told many times in many ways. Its role as a reanimating force—still the term used by French transfusion services—is perhaps the earliest characterization, dating back to the sixteenth century, and it continued into the nineteenth century, for example in an 1804 English caricature of Napoleon receiving injections of courage from the blood of a tiger.11 At the beginning of the twentieth century, transfusion was described as a “miracle of resurrection” by George Crile’s wife, who assisted at one of his first successful transfusions.12
Most histories of transfusion have emphasized technical discoveries. A classic case is the first chapter of Geoffrey Keynes’s Blood Transfusion (1922),13 which describes the attempts beginning with Richard Lower in England and Jean-Baptiste Denys in France in the 1660s, following William Harvey’s discovery of blood circulation. Keynes also mentions the efforts of James Blundell in the first part of the nineteenth century, but the main purpose of the book is to demonstrate the much more successful techniques discovered after 1900, which were first used on a large scale during the Great War (1914–18), in which Keynes (whose older brother, John Maynard Keynes, was the famous economist) had recently served. Subsequent histories, usually in the form of articles or introductory chapters of transfusion texts, have also focused on new techniques developed during the rest of the twentieth century.14 Those histories freely skipped around time periods and locations to document the discoveries and innovations of those who built on their predecessors around the world to perfect the increasingly important medical procedure.
This book differs from most of those histories in its focus on one geographical area. Only recently have there been such histories—for example Susan Lederer’s Flesh and Blood (2008), which examines the