Drawing Blood: Technology and Disease Identity in Twentieth-Century America

As a marker of destiny, a carrier of familial traits—indeed, as the very “river of life”—human blood has long been invested with profound cultural significance. Yet today, as we near the end of the twentieth century, physicians often claim to make medical decisions based on precise, objective, scientific measurements of the blood. Does history matter? Is our reading of blood still grounded in cultural understandings? In this excellent book, Keith Wailoo suggests that the answer to both questions is “Yes.” His analysis uses ideas about the blood as windows onto a changing century to illuminate relationships among different types of physicians, among different medical institutions, and, perhaps most important, between people who have come to be labeled (or not labeled) as having a disease of the blood.

As Wailoo shows throughout the book, there has always been a complex relationship between diseases and technology (and by this term he means far more than simply the physical artifacts). On the one hand, a disease such as anemia came to be constructed as something to be best explained by the use of technology. On the other hand, the use of that technology gave legitimacy to the people who could (and would use) those tools. Technology was used to help create identities for both patient and physician in ways that were flexible enough to serve the needs of many different constituents, often at the same time. Wailoo’s astute reading is relevant to the use of diagnostic technologies in general, not only those used to study blood. A particular strength of the book vis-à-vis the history of technology is the attention paid to technologies that were thought applicable at the time, whether or not we now hold them to be useful.

Wailoo takes a number of diseases as emblematic. Countless nineteenth-century family physicians employed “moral management” for their female patients diagnosed with chlorosis. At one time a central disease concept, chlorosis disappeared from center stage by the 1920s, which reflected both a change in the structure of medical practice and a shift in attitudes toward diseases of women—the latter shift reflecting what Wailoo terms “medicine’s enduring desire to define, through technology, a legitimate female identity” (p. 45). Splenic anemia localized anemia to a particular organ, an abdominal organ that had been of relatively little interest until early twentieth century surgeons (the dominant medical specialists of the age) found it to be within easy grasp, and used it to label a new anemia as one susceptible to surgical intervention.

Aplastic anemia led medical professionals to look more closely at the industrial world that was increasingly their patients’ workplace. They were forced to grapple with “medical” issues that included legal and social values—if industrial practices caused aplastic anemia, should the workplace be made safer, or should “susceptible workers” be removed? In other words, did the illness indicate a problem with the patient, or with the environment? The development of a cure for pernicious anemia highlighted newly formed relationships between universities and pharmaceutical industries. Sickle-cell anemia forced those who studied it to deal with issues of race and racial identity. Earlier in the century, Emmel’s blood test was used to label people as members of a specific race; a change to hemoglobin electrophoresis may have led to different formulations for the disease, but the meaning of the technology was no less embedded in a specific social context.

In the final chapter, Wailoo considers how federal support of medical research has changed the world of blood and blood diseases. He examines leukemia and the formation of the specialty of hematology-oncology, as well as how the technology that enabled easier diagnosis of the sickle-cell trait forced patients and caregivers to confront new social dilemmas. He weaves each of these stories into a world that was changing not only outside medicine but also within, as physicians (and technicians...