Five Quarts_ A Personal and Natural History of Blood - Bill Hayes [72]
Next, Stoker makes a little stumble. He has Van Helsing happily point out that Arthur is “of blood so pure that we need not defibrinate it.” Only in a work of fiction would this be considered an advantage. Blood that does not produce fibrin is blood that doesn’t clot. A real-life Arthur would’ve been suffering from a disorder analogous to hemophilia and clearly would not have been a doctor’s first choice when selecting whose vein to slice open. In the story, however, the physicians are glad to avoid the sticky problem of coagulation, which I can certainly appreciate. Upon exposure to air, blood at the site of an injury immediately begins to clot, or congeal. The body is trying to self-seal. Platelets (so named for looking like tiny plates) converge on the site, clumping together and simultaneously secreting chemicals that turn the blood-borne protein fibrinogen into long, sticky threads. Red and white cells get caught in the webbing, and the clump becomes a clot. At a wound site, clots are lifesaving. But within the circulatory system, a clot may lodge in a blood vessel (this is called an embolism) and cause stroke or death. While anticoagulants prevent clots from forming during transfusions today, such agents did not exist during the era portrayed in Dracula—hence the need to defibrinate.
Defibrination was a crude but clever process developed in the 1820s and used up through the introduction of anticoagulants in the 1920s. Wildly varying methods arose, but each took time, so I can see why Bram Stoker, if only to keep the scene moving, had Dr. Van Helsing skip this step. One method involved collecting the donor’s blood in a bowl, whipping it with a wire eggbeater, then filtering out the clots through a stretch of gauze. Even simpler was allowing the collected blood to settle for several minutes and then scooping out what congealed. Sometimes, too, the blood was twirled in a flask containing glass beads around which clots would form. These methods were not foolproof—bacteria entered the process, and clots slipped through—but transfusions had become safer, if only just. (To be fair, they did represent a vast improvement over the previous treatment for blood loss, bloodletting. Up until the 1820s, for example, a woman with uterine hemorrhaging following childbirth was commonly bled. Now, there’s a horror story.)
Once Lucy is drugged up, Van Helsing proceeds. Arthur lies next to his fiancée while the doctor removes from his bag the necessary instruments—what he calls the “ghastly paraphernalia of our beneficial trade.” Although Stoker doesn’t linger long on the procedure, details suggest that his fictional doctor may be performing an actual type of transfusion that, at the time Dracula was written, would have been highly experimental, a direct artery-to-vein transfer. This method, considered promising in animals, made a short-lived leap into human use in the late 1890s. You’ll soon see why it so quickly came and went. Typically, the blood donor’s radial artery (one of the two main arteries in the forearm) was exposed, distended, tied off or clamped, sliced open, and then either sewn directly to the recipient’s similarly exposed vein or connected to it via a small