American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

2019 Excelsior Surgical Society/Edward D. Churchill Lecture

Blood and the Moving Wheels of History—Revisited

Steven D. Schwaitzberg, MD, FACS

Often enough a surgeon looks up and sees a bag of blood hanging from the IV pole. Focused on the patient she or he turns back down to the wound.  Stepping back, we live in a world of blood. It flows from the body from the misadventures of our work or the traumatic forces of the external world. Yet how much do we really know about blood beyond replacement algorithms or anticoagulation protocols? Blood has a long and extraordinarily rich history. These are multifaceted stories full of myth, darkness and well as light.  Perhaps we should ponder just how that red bag arrived on the pole in its current form and where the narrative of blood-based resuscitation might be going.

"Blood and the Moving Wheels of History" explores three facets surrounding our life's blood: the blind side, the dark side, and the bright side.  The "blind side" delves into myths and mysteries associated with blood. The mythology of blood is engrained in every culture from the beginning of time. As a result, the ideas of blood permeate throughout our languages, our cultures, our media, and our religions—even today. Still, in some parts of the world the myths of the power of blood still manifest. As strange as the blind side is, the dark side is more bizarre.  The "dark side" of this lecture reveals the belligerent and blatant disregard for frailty of human life in the pursuit of financial gain. The victims—hemophiliacs—guilty of nothing but the unfortunate genetics that made them dependent on blood products to reverse the inadequacy of their own coagulations system, were knowingly preyed upon by organizations that were either too lazy or too greedy to prevent the ravages of the human immunodeficiency virus they forced upon these victims, which was clearly fatal in the 1980s. The "bright side" of this story begins a few hundred years ago, a bit misguidedly at first, with animal-to-human transfusion. Since Karl Landsteiner unlocked the secrets of blood typing, the role of surgery in developing the art and science of transfusion has been profound. These advances have often been catapulted in the horror of war where soldiers and civilians rallied together to save lives. Ironically, some of the most important advances of today are lessons we have had to learn repeatedly until they finally stuck.

When you have a moment, really look at the red bag hanging from the IV pole and marvel at the blind, dark, and bright stories hiding inside.