Book Review

Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America

N Engl J Med 2008; 359:1079-1080September 4, 2008

Article

Flesh and Blood: Organ Transplantation and Blood Transfusion in Twentieth-Century America
By Susan E. Lederer. 224 pp., illustrated. New York, Oxford University Press, 2008. $35. ISBN: 978-0-19-516150-2

The transfer of blood components, solid tissues, or organs from one person to another is basic to the practice of modern medicine and surgery. Because the only source of blood and organs is the human body, transfusion and transplantation imply giving away and receiving parts of one's “self.” Transfusion and transplantation therefore challenge the perception of self for both the donor and the recipient. Furthermore, some physicians may see in these measures opportunities to bring therapy to its most remote borders and convert surgical imagination into surgical reality.

Lederer sets out to explore “how the body and its parts — organs, tissues, cells, and fluids — possess not just medical and surgical significance, but complex political and cultural meanings as well.” She begins by describing early attempts at transfusion and skin transplantation in America, attempts that were made without a knowledge of blood and tissue types and under primitive surgical conditions. She documents the way in which the popular press hailed these pioneering attempts and the way in which public interest prompted further attempts despite many failures and a lack of systematic studies. Lederer also shows that similar attitudes persisted throughout the 20th century. The documentation she includes in the book illustrates that therapy often precedes science, the latter lagging even generations behind. The “therapeutic imperative,” which lies at the heart of surgery, seems to have served as a stronger force of development than has science, and public interest may have made that force even stronger.

Lederer documents the fear some people have had of receiving blood or organs from persons of another race. She also discusses the ways in which lawmakers in several U.S. states have dealt extensively with the role of race in this field of medicine. Racial identity has probably been one of the main obstacles to the rational development of transfusion and transplantation in the United States.

Transfusion and transplantation deal with fluids, tissues, and organs that may be offered, banked, demanded, sold, and bought. Transfusion and transplantation therefore have strong economic implications. Economic factors and profit-seeking may serve both as driving forces and as obstacles to development. Lederer describes the ways in which U.S. society has attempted to cope with these developmental forces and obstacles, with varying degrees of success.

The focus of the book is entirely American, and therefore it may leave the reader with a desire to know whether the development of transfusion and transplantation in other parts of the world has followed similar paths. Information from other highly developed countries that could serve as “control material” might have increased the value of this work, especially information from countries with fewer racial problems and with a weaker belief in the free-enterprise system. Such countries do exist. On the other hand, the narrow focus allows the author to go into great detail. The book contains an impressively large number of references, which may be of benefit to authors of future works on this subject.

Because Lederer's style is mainly that of story-telling, readers may note the lack of a discussion of sociological theories related to the development of transfusion and transplantation and of an attempt to generalize the findings into hypotheses. The drawing of conclusions is left to the reader. The book may be heavy reading, and several chapters might have benefited from a briefer presentation. However, the large number of single episodes described in detail increases the value of the book as a work of reference.

I would recommend Lederer's book to those interested in the history of medicine in general, and especially to those interested in the history of transfusion and transplantation in the United States and worldwide.

Hans Erik Heier, M.D., Ph.D., M.H.A.
Ullevaal University Hospital, N-0407 Oslo, Norway
h.e.heier@medisin.uio.no