“Blood tells the story of men”, writes Gérard Tobelem in blood stories (Perrin). While 20 minutes seeks to understand why blood is at the center of many conspiracy theories, it seemed natural to us to go to the source first with this eminent professor of hematology.
Former President of the French Society of Hematology and of the French Blood Establishment, Gérard Tobelem analyzes for us the “mystical and profane” reasons for our attraction to blood.
Why did you specialize, at the beginning of your medical career, in the study of blood?
During my studies I wanted to have a clinical activity – to take care of patients, to provide help to the sick – but I also had a curiosity for research and understanding of biological mechanisms. However, there was not much choice, the only discipline where one could have these two activities at the same time was hematology, which had been a pioneer since the end of the 19th century in this field. Because it’s easier. With a drop of blood and a microscope, and chemical tests, studies can be carried out. It’s less easy with a lung or a heart…
French hematology is internationally recognized. Would you say that French doctors have a particular appetite for blood?
I do not think so, no. French hematology in general and I in particular owe a lot to Doctor Jean Bernard. I was lucky enough to be able to work as an intern at the French school of hematology, the most prestigious in the world, alongside him. I was his last assistant. Jean Bernard was an enlightened mandarin. Thanks to him, France experienced a golden age of hematology. At that time, from the 1950s to 1970s, the golden age, at the Saint-Louis hospital in Paris, we received trainees from all over the world. We received a large part of the leukemias from France, the research laboratories were next to the patients. Jean Bernard entrusted responsibilities to very young assistants, and he also had an ability to communicate and therefore to raise a lot of funds, he was one of the first doctors to appear regularly on television.
When was medicine really interested in the study of blood?
It took time, because blood has had both an extraordinary secular and mystical side throughout history. Blood carries a form of ambiguity, it is both a vector of poisons and benefits. For centuries, bloodletting was the only therapeutic act. The medicine of Antiquity was a medicine of “humors”, the blood was one of them, with all the unknowns that we had about blood circulation.
Has the scientific study of blood been slowed down by blood-related beliefs?
Absolutely, and it still is today sometimes. According to a dogma of ancient medicine, blood is ambivalent and therefore dangerous. In Greek mythology, the blood of the Gorgon is a violent poison or a prodigious medicine that can bring the dead back to life, depending on whether it comes out of the right or left vein of his neck… Then the monotheistic religions raised blood to a very important rank. For the Jews, the soul was in the blood. Christians first hated blood and then elevated it to the rank of the eucharist, an incarnation of god. In Islam, animals are bled so as not to eat their blood, because even animals have a soul. The consequence of these beliefs was that for many centuries those who first took an interest in transfusion had great difficulty, the transfusionists were banished from society.
Yet blood also fascinates. Wasn’t there a curiosity for his role?
There is both fascination and fear, taboo. It’s all extremely mixed up. There are many expressions in which the word “blood” comes up: flesh and blood, having blood on your hands, being of mixed blood, blue blood… This place in everyday language is not insignificant. Moreover, with the expression “good blood cannot lie”, there is an intuition about the role of blood: genetics is in the blood. If blood fed beliefs and fears – with, for example, in many religions, ritual animal sacrifices where blood was allowed to flow – it is because before the arrival of the microscope, around the 18th century, there was no way of knowing what was inside. We knew there was salt, because of its taste, but we didn’t know anything about red and white blood cells, platelets… The mystery could easily be maintained.
From your point of view, does blood still exert this power of fascination today?
Yes I believe it is a constant. Blood has been the red thread of life since the first cave paintings in prehistory, with these drops of ocher to represent the flowing blood. And today, in films, as soon as you have a death in a film, you see a trickle of blood at the level of the mouth. Blood is profane and mystical, it is synonymous with life and death.
When did the first transfusions date?
In the course of the 15th century, the principle of blood circulation was discovered, and that changed everything. Until then it was thought that blood was made and destroyed in the body. Thus, the more blood we removed, the more good we did for an organism, like a well whose water we would like to clear. With the discovery of blood circulation, we understood that if we remove blood, we sometimes have to put it back. The first transfusions, with animal blood, were disasters but it remains the first therapeutic gesture in the history of medicine – apart from a few medicinal infusions. For the first time, there was a will to heal. It’s a revolution.
Have you sensed a change in perception, among the general public and doctors, vis-à-vis the study of blood? I am thinking in particular of the impact of the contaminated blood affair or the AIDS health crisis…
The most serious blood-related diseases. Receiving blood from someone else is not trivial. I get a part of him in me, it’s an intrusion. In very sick or anemic people, questions arise less, of course, because the transfusion will do immense good. But when one is in good health, the question arises. The tainted blood affair marked an entire generation and marked the world. People could legitimately ask questions about this practice. At the end of the 1990s, we were able to completely secure transfusions, confidence gradually returned.
You may be biased, but would you say there is anything more interesting in medicine than the study of blood?
If I’m being honest, I’ll say there may be heart. It is an organ that also has a whole imagery, like the seat of passion. Someone who has a myocardial infarction will remember it all their life, the pain and the trauma are such… After that, there will be a self-discipline of the patient, we will not see the need to monitor him. But – because there is a “but” – the heart is only striking from the moment it has manifested itself. Before we put love, not death. While the blood alone carries all these symbols.