Blood Work (8 page)

Medical training in France, as throughout Europe, was steeped in traditions that had endured since the thirteenth century, when the first major teaching faculties had been founded. After completing their bachelor studies, students from well-placed families requested admission into the medical schools, where they attended lectures and suffered through oral exams before serving an apprenticeship. Like the courses at the university, the apprenticeship rarely focused on hands-on patient care. Lowly surgeons were the ones who worked directly with patients—and often in painful and unpleasant ways.

The physicians took a more philosophical approach to health. Their knowledge was squarely rooted in the texts of Galen, Hippocrates, Aristotle, and Avicenna, among others. The students learned about the structures and functions of the human body primarily through the droning words of their instructors, who recited, often verbatim, the works of these old masters.
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And the students scribbled word for word their teachers' magisterial lectures with cramped and ink-stained hands. They did not have the luxury of thinking independently, much less forming their own thoughts, during the lessons.

As a Montpellier-trained physician, Denis underestimated how hard it would be to navigate the strict hierarchies and brutal politics of the Parisian medical world. Since at least the late sixteenth century, rivalries and tensions between the doctors of the craggy hills in the South of France and those who trained and practiced in cosmopolitan Paris had been intense. Montpellier produced nearly 40 percent of all physicians in France, but the university had a troubled reputation as a party school where medical students were just as likely to drink and cavort with prostitutes as they were to learn the intricacies of the Hippocratic corpus. As the philosopher Julien Offray de La Mettrie wrote in the following century: “In Montpellier, those who are destined for medical careers are for the most part young good-for-nothings who give themselves over to dissipation and indulgence for the first two years of their studies. It is only in the third that they even begin to study, in order that they may reply to frivolous questions such as:
Quid est vita?
[What is life?]”
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Disdain for Montpellier's medical school and its long-standing reputation for unruliness was linked, no doubt, to the fact that the school had long accepted Protestants among its students. The faculty had also shown itself open to pursuing new ideas, especially those of William Harvey—who was himself a Protestant.
Since as early as the 1650s, Harvey had supporters among the University of Montpellier's faculty members. And within the ten years that followed, circulation had established itself not only in the teaching curriculum there but also among the less-trained Montpellerian surgeons.
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This was not at all the case farther north at the University of Paris medical school, where Harvey's theories were still most unwelcome. Medical education and practice in France's capital had long been steeped in the traditions of the Paris Faculty of Medicine. The medical school prided itself in being among the last and most prominent strongholds against blood circulation. Nearly forty years after Harvey's
De motu cordis,
the “anticirculator” argument continued to lay a claim on the hearts and minds of students in the French medical school. In the early years following Harvey's claims, a student at the University of Paris named Simon Boullot defended a thesis that denounced circulation. Using a traditional Galenist argument, Boullot held firm that circular movement was too straightforward and was suitable only for the simplest of creatures. In humans blood crossed the chambers of the heart through invisible pores to be transformed “into a pure spirit and juice, which keeps warm the native heat of all of the members.” Boullot argued strongly that there was nothing in the structure of veins and arteries—seen or unseen—to indicate that blood was pumped throughout the body by the heart.
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He passed his thesis defense with flying colors and with the great praise of his examiners.

In 1645, however, it looked as if circulation might have a chance of success at the University of Paris. A student named Jean Maurin presented an ambitious thesis titled “Whether, because of the circulatory motion of the blood in the heart, Galen's method of healing is to be changed.”
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Maurin gave credence to the idea that blood vessels formed a branching and interconnected network
(anastomosis) that could account for the circulatory path of the blood. The thesis was approved by his committee, largely because it was chaired by Jean Riolan, one of the few members of the faculty who had shown a quiet interest in circulation. In 1648 Riolan himself finally spoke out publicly in favor of circulation. Yet even he remained attached to basic Galenic notions that blood was produced by the liver. Riolan also argued that blood took a full two or three days to circulate completely through the body.

This and other “circulator” arguments were patiently tolerated by the rest of the Parisian medical faculty, but it soon became clear that tolerance would be the best, if not the only, thing that circulation's proponents could hope for. In later years the dean of the Paris medical school would sign off on two student theses that condemned circulation theory:
An sanguis per omnes corporis cenas et arterias jugiter circumferatur? Neg.
(Is the Blood Conveyed Continuously Through All of the Body's Veins and Arteries? Negative), and another with a circular title of its own,
Est-ne sanguinis motus circularis impossibilis? Aff.
(Is Not the Circular Motion of Blood Impossible? Affirmative).
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Filled with naive hubris, Denis came to Paris from Montpellier ready to make a name for himself in a city where he was clearly at a disadvantage, both by birth and by training. Denis began his efforts to make connections with the Paris medical community by offering anatomy tutorials, for a fee, to medical students and other curiosity seekers. When human dissections were first performed the late Middle Ages, physicians sat in elevated chairs above both the corpse and the barber-surgeon. Book in hand, a physician-professor explained basic anatomy and gave orders to a surgeon to reveal the specific body part under discussion. Space was too tight in the small rooms of Denis' home for such a magisterial design. A small platform alongside the dining room table
on which the cadaver was displayed was likely all that was possible. Yet this did not keep Denis from projecting the overconfident demeanor of a newly minted physician. Following the more hands-on approach of the Renaissance anatomist Vesalius, Denis performed portions of the dissections himself. With a large leather-bound anatomy sitting alongside the corpse, Denis took apart the cadaver—layer by layer, piece by piece—while young medical students leaned in as closely as they could, even at the risk of being overcome by its rotting stink. (We have no record of what the newly married Mrs. Denis thought of her husband's craft in their home. It is probably safe to say she was not pleased.)

Denis continued to wait eagerly for more detailed news of the English successes in transfusion. After nearly two months' anticipation, the French
Journal des sçavans
(
Journal of the Erudite
) finally printed a translation of Oldenburg's announcement regarding Boyle's presentation of Lower's experiments to the Royal Society. On the last day of January customers spilled onto the cobblestone street in front of Jacques Cusson's printshop on the rue Saint-Jacques. Denis was no doubt among the greedy crowd who clamored for copies of the paper. A few flips of the pamphlet pages, and there it finally was—a faithful rendering in French of England's claims on canine blood transfusion.
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The young doctor devoured the details and set to work to try his own hand at the procedure. His first order of business was to review, in the presence of his paying students, the anatomy of the cardiovascular system. Assisting Denis, the surgeon Emmerez rolled his sleeves up above the elbow and fastened a rust-stained apron around his waist. The cadaver had been gutted nearly as soon it had been brought into Denis' home, the entrails tossed into the nearby river; the softest organs were always the first to rot. Emmerez reached into the open cavity, pushing and probing
body parts as Denis narrated the path of blood that had once flowed through the man's dead body. Denis recited Harvey's main propositions regarding circulation. First, the production of blood began in the digestive system. Second, it flowed to the heart from the inferior vena cava with the help of an elaborate system of valves that ensured the one-way direction of its flow. To demonstrate the point Denis sliced open a large vein; he pushed the tip of his knife through the valve in one direction with relative ease. Then coming at it in the opposite direction, he showed how the closed venous valve blocked his tool. The men then turned their attention to the heart, which they removed from the body and placed on a nearby table, and explored the chambers.

Denis' demonstration was little more than a recitation, with visual aids, of what had become conventional wisdom over the three decades following William Harvey's groundbreaking work. However, the French doctor could not contain his excitement about what he had been hearing regarding transfusions by the English. During one of his dissection demonstrations, he shared his conviction that transfusion was “new and completely convincing proof” of the truth of circulation. But instead of respectful nods, he received chortles and chuckles from his audience, which was populated largely by students from the conservative University of Paris medical school. Blood transfusion, they retorted, was too “chimeric and ridiculous” to be believed.
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Furious, Denis ordered the incredulous audience out of his home. He believed, like every highly trained physician in the early modern era, that his words demanded respect. He was seething.

Not one to take humiliation lightly, Denis would do everything possible to prove them all wrong. A few weeks later he once again enlisted the help of the surgeon Emmerez to experiment firsthand with blood transfusion. They arranged to have two small dogs brought to them. One was a tall, fat female span
iel, and the other a small, skinny, short-haired male that looked something like a fox. The dogs, Denis later explained, “had never been fed together and their appearance was so different that they seemed almost as if they were animals of different species.” Denis resolved not only to replicate the English experiments but also to go a step further. He would transfuse blood into one without killing the other.

In front of a group of carefully selected supporters, Denis and Emmerez embarked on their trial. They began by muzzling the dogs to “keep them from crying”
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and then positioned the animals head to foot, so that the thigh of the recipient almost touched the neck of the donor. This was a two-man job. Scalpel in hand, the doctor and his assistant followed Lower's well-choreographed procedure to the letter. They marveled as arterial blood pulsed through the system of small tubes that connected the two animals. Another tube emptied the recipient's own blood into a shallow bowl. Though it seemed to Denis that the amount of blood flowing into the recipient equaled the blood coming in, there was no way to know for sure without checking. From time to time Denis and Emmerez gingerly disconnected the two tubes and confirmed that blood was indeed moving through them. And they noted with pleasure that it was gushing too fast and remained too hot to clot. They delighted as well at the regular pulsations they could feel in the throbbing vein of the recipient. The platter continued to fill. Nine ounces had been let from the recipient and, presumably, were replaced by another nine ounces from the donor.

Then, suddenly, the experiment took an unwelcome turn. The spaniel weakened measurably and looked very close to death. Without hesitating Denis ordered Emmerez to stop the experiment and begin stitching up the dogs. The spaniel who had unwillingly donated blood remained weak. It had only enough
energy to crumple into a corner of the room. The other dog was “vigorous” and attempted to scratch off its muzzle. It jumped down from the table, shook itself, and stumbled over to its owner for treats and pats when called. Denis admitted, however, that the dog was obviously not quite as “awake and gay” as before the trial. It had been a painful and exhausting procedure for both animals. To be sure that the animal's sluggishness was a matter of the discomfort of the incision rather than an effect of the transfusion itself, Denis performed a control experiment. He brought in a third dog of similar size and made an identical incision in the jugular vein. Once stitched back up, this dog appeared even more “beaten” than the one that had been transfused. And though the transfused dogs ate heartily in the two hours following the experiment, the third subject refused to eat.

Denis kept all three dogs in his small apartment during the week that followed. He noted their every movement, every morsel they ate, and compared their weights. Denis may not have mentioned the disarray that the animals must have caused in his home—or his wife's displeasure of having unruly canine houseguests—but he did gloat with pride that all three dogs returned to perfect, and playful, health in short time. He also noticed an odd side effect of the procedure. It turned out that the donor spaniel had been pregnant. The dog miscarried a few days later and, curiously, Denis reported, “only three or four drops of blood could be found” in the offspring.
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One week later a new experiment was in the works. There was no need to confirm the utility of blood transfusion; Denis took that now as a given. Instead, this next experiment would test orders of magnitude. If one dog's blood could be transfused into another, would it be possible to exchange blood among three different ones? On March 8, 1667, Emmerez set out his surgical
tools once again on a makeshift operating table in Denis' dining room. It had not been easy to herd three rambunctious dogs up onto the table, especially when they already knew what was in store. But with the help of tight ropes and muzzles, they had been restrained.