Man Up: Give Blood Like a Victorian

Fair Warning: As a medical historian I forget sometimes that people don’t necessarily deal with blood and gore, even a hundred or so years removed, on a daily basis. Though this article doesn’t contain anything too gratuitous, and I certainly don’t want to dissuade you from reading it, it does describe medical procedures that some readers may find uncomfortable.  

In America and Australia blood is essential. Blood and blood products are used to help people suffering with cancer, who have undergone surgery, been involved in traumatic accidents, or have conditions like hemophilia, which prevents blood from clotting.

In order to meet this demand Australia needs more than 27,000 blood donations per week, while America, presumably because of the considerable population difference, requires over 44,000 donations daily. In fact, every 2 seconds an American will be in need of blood.

This blood can only be procured from donors. I’m going to hazard a guess that the inevitable questions about synthetic blood have only been fuelled by True Blood (the show and its fictional product) as the American Red Cross blood service states explicitly that blood cannot be manufactured.

Despite this, however, only 1 in 30 people in Australia give blood (that’s approximately 3% of our population) even though 1 in 3 people will need blood or blood products in their life time. Moreover, it is estimated that the demand for blood will increase by 100% in the next 10 years. 100%.

Across both of these countries, then, the Red Cross is understandably keen to encourage donations. How they do this, and how effective these campaigns are considered to be, varies.

Around this time last year, it was reported both in Australia and in the US that blood levels were dropping radically. Towards the end of June, Australia was on notice that the Red Cross had less than 3 days’ worth of blood remaining. A month later, blood supplies across the Pacific, in the United States, hit fifteen year lows with far fewer donations than anticipated, or indeed needed to keep supply steady.

So what do we do? How do we convince people of the need to donate blood? It can be scary and uncomfortable, and I’ll be the first to admit, as someone who does not regularly donate, that it all seems like a lot of work. The answer, according to one comedian writing in a Sydney commuter magazine recently (which has unfortunately been lost to me and, to the best of my knowledge, is not reproduced online), at least in part, was to provoke people (especially men) into volunteering to roll up their sleeves. Rather than the softly-softly approach, the tugging on heart strings or outright begging, it suggested that we should try a more competitive approach: tell these people to drink their cup of concrete.

Now of course, while this presents an array of complicated issues for anyone with an interest in gender (for what kinds of expectations would this be reinforcing or encouraging amongst and about boys and men) my medical-history brain buzzed with examples of behaviours which might just instill a healthy dose of competition while illustrating a (not unproblematic) solidarity of days gone by.

The Victorians are a great source for this sort of thing; endless male bravado and a willingness to put it into print. I figure if a selfless tale of Victorian male camaraderie can’t move men to donate then, frankly, I’m not sure what can.

Cast your mind back to 1891 (if you’re in the 20-30 age bracket, like me, then we’re talking about the time of your great, great grandparents, in all likelihood). We’re in Chicago, a relatively new city and one of the fastest growing in America having emerged from next to nothing just over half a century prior.

Mr. John Dickerson, a Chicagoan and member of the Knights Templar, is in need of a skin-graft. Dickerson had previously suffered from a form of cancer which had “spread [across] his right hip and thigh”; the tumors so extensive that it was determined that they should be surgically removed.

Dickerson went under the knife and, although the surgery was considered a success, had been left with “a sore about a foot square and so large that the skin was unable to grow over it.” The same man who had removed the tumors, a Dr. Fenger, decided that he would attempt a skin-graft in order to further aid Mr Dickerson’s recovery.

Fenger secured some goats, at first; not an entirely unreasonable prospect, not least because we still use animal parts in certain surgeries today. He did, however, keep “them for some time in the hospital yard” (much ‘to the annoyance of some of his other patients,’ apparently) which is not quite standard practice in most of the US currently.

When he deemed Dickerson’s wound ready for the transplant, Fenger “killed one of the kids,” skinned it and attempted the graft. Unfortunately, however, the operation wasn’t successful and the goat skin needed to be removed.

Not deterred, Fenger decided that he should try human skin; if only he could get his hands on some he seemed very sure that the operation would be a success. But how would one procure up to a square foot of human skin? Not quite on the same scale as the 44,000 pint-sized blood donations needed in America every day, but no small feat either.

The St. Bernard Commandery, of which Dickerson was a member, came to the rescue when 300 Knights “stepped forward and offered to submit themselves to the surgeon’s knife for the sake of their stricken brother.” With this rush of volunteers, January 18, the very next day, was decided upon as the proper time “for their partial self-immolation.”

Accommodating this horde of men all volunteering their skin was a challenge. Fenger decided to reduce the number of volunteers to 175, in part because he simply didn’t need skin from 300 people. He also split the remaining individuals into groups to be seen separately, but successively, so as to avoid overwhelming the hospital.

Once the men had been sorted, they were to head, individually, to be prepared for the surgeries. Not everyone was fit to donate, but those who were would be taken to a room next to the operating theatre. There they “exposed [their] left arm” so as to allow the area where the skin was to be removed to be cleaned. The skin was “first thoroughly rubbed, then washed with a preparation, the main ingredients of which were soap and water, after which the part was bathed with alcohol.” It also seems that the man in the chair, now prepped, would be given the razor to take into the operating room to give to Fenger and his staff to carry out the procedure itself.

Dr. Bernauer, one of Fenger’s aforementioned staff, “deftly seized the razor” and would “cut four lines on the arm to mark the size and boundaries” of the piece of skin that they wanted to take. “Before the Knight of the Cross knew what was the matter the piece of skin was shaved off, seized with a pair of pincers by Dr. Mahler and handed to Dr. Fenger.” Like a Band-Aid; straight off.

The skin was then placed on the “raw and palpitating flesh” (their words, not mine) of Dickerson.

The man who had given the skin for the operation wasn’t forgotten, however. “No sooner than the skin had been removed” was there a bevy of staff available to him to disinfect and dress the fresh wound.

146 men later, and approximately 146 inches of skin was removed: “About one inch to each man.” Many of the men were described not only as “willing” but as “smiling victim[s of] skinning’ and none had ‘flinched nor asked for an anesthetic,” Should it have been necessary, it was confidently reported that “every man who was operated upon was ready and willing to give up half a dozen inches if needed or called upon.”

Some of these donors were so keen that they had travelled significant distances. “One man had come all the way from Rockford [in Chicago]… and another traveled over 100 miles to do a like sacrifice.”

Others just oozed confidence and determination. One young whipper-snapper waltzed into the operating theater having been prepped for his skinning. He handed over the razor telling Bernauer to “Help yourself.” And upon seeing “how small a piece of the flesh had been taken” made a face which said plainly: “Is that all you want? I was ready for an amputation.”’

The procedures that these men underwent would not have been painless, particularly without any anesthesia, and yet without hesitation they marched forth to help their brother out.

Compare this to a blood donation. The whole ordeal can be over in under 15 minutes; there’s no need for anesthesia (because you’re not having a chunk of your flesh removed!), though of course there is still that pinching sensation; and as a bonus you’re not required to carry your own needles to the nurses. You might not be paid in cash (though let’s remember that neither were the Knights) but compensation in the form of cookies or juice to pep you up post-injection shouldn’t be sneezed at. If you’re lucky enough to find this lovely Greek lady you might even get a milkshake!

These dudes were not getting milkshakes in exchange for their inches of skin – although whether they would have wanted a milkshake anyway is an entirely different issue; milk supplies were notoriously unsavory in the nineteenth century. And the likelihood of scarring was (and still would be, I imagine) much higher than when being discreetly relieved of 470mL of liquid (that’s a pint, give or take 3 millilitres).

Now, certainly, there are an innumerable number of conditions at play which can and should change our understanding of the Knights’ willingness to give – more than it’s possible to enter into here. Even I, however, still find it hard not to respect the willingness of these men to donate almost 150 square inches of skin for a member of their fraternity.

If indeed we need to find some inspiration to spur us to donate – men, women, or otherwise – perhaps there is something for us in the past? I’m not sure we’d necessarily want to replicate the exact conditions and qualities that made the mass-donation of skin possible but maybe we can still use this knowledge to encourage greater participation in important, potentially life-saving, social (and medical) institutions.

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Just in case you were interested: If you are looking to donate blood you should check out the American and Australian Red Cross websites for more information:

America: http://www.redcrossblood.org/

Australia: http://www.donateblood.com.au/

A caveat: I was asked by my editors to include a small note here about who can and cannot donate blood, with particular reference to men who have sex with men in both Australia and America. In the US currently, this group of men are banned for life from donating. In Australia, these men, and any women they may have had sex with, are banned from donating for 12 months.

Understandably, this is an incredibly relevant political issue, however, its complicated nature and my limited knowledge of the inquiries and investigations which surround it mean that I can’t in good conscience give you an indication of direction in which we should head from here. This is not me offering my tacit support or agreement, but nor is it an expression of my unmitigated condemnation of the practice. Rather, it is an acknowledgment that this is something I do not have the proper authority or expertise as of yet to weigh in on, and it seems unproductive to provide you with an opinion still very much in its formative phase. I think it might also, however, be a call for all you inquisitive readers, many of whom will be better informed than I, to continue to research, discover, and perhaps tentatively weigh in on the debate in the comments below.

Image Attribution:                    Images sourced from morguefile.com

References:                                 The story itself and all relevant quotes in the article have been taken from a newspaper article from 1891: ‘Skinned for a Brother: Knights Templar Save the Life of John O. Dickerson,’ Chicago Daily Tribune, 19 January 1891, p. 1.