A review of A Genealogy of the Gift: Blood Donation in London, 1921-1946, by Nicholas Whitfield.
Nicholas Whitfield opens his dissertation with the juxtaposition of two images. A 1909 diagram shows the layout of individual positions for blood transfusion in an operating room centered on two adjacent tables for donor and recipient, while a 2006 organizational chart for the ‘Preparation of Blood Components’ includes the act of donation as only one aspect of a complex system connecting donor with the eventual recipient (pp.30-31). Whitfield locates the critical phase of this organizational transformation in the middle of the century, an important period too often neglected by historians of science and medicine. Moving beyond technical accounts of transfusion history, Whitfield’s study of the moral and organizational debates associated with the transformation of blood donation in London presents a compelling reinterpretation of the face-to-face ‘gift’ relationship inferred from arrangements such as the 1909 diagram in the context of the transformation of British society during the Second World War (pp.13-14).
Following postwar commentators such as Richard Titmuss, anthropological and sociological theorists of contemporary donation have assumed that the connection of donor and recipient made the act an exemplar of an altruistic ‘gift’. To these commentators, the rationalization of the donation process in the late twentieth century undermines these relationships and with it the foundation for a system of altruistic anatomical donation. Whitfield offers a historical correction to these narratives of decline (pp.15-17). In the spirit of Angus Calder’s work on the important role the tension of myth and experience in The Myth of the Blitz (1991), Whitfield’s study of the rise of blood donation in London demonstrates that the ideal of altruistic donation emerged during wartime emergency as an ‘enabling myth’ for a system of anonymous, bureaucratic donation (p.25, p.275).
The situation and progression of Whitfield’s argument support his central contention elegantly. In Chapter One, Whitfield establishes a ‘baseline’ for donation practices through the history of London’s Red Cross Blood Transfusion Service (RCBTS) in the 1920s and 1930s. Operating before effective blood preservation, the RCBTS sought donors assumed to have the ‘correct’ psychological traits to respond when summoned to bleed. Studying the correspondence of its founder, Sir Percy Oliver, Whitfield traces how the RCBTS sought to recruit a select few rather than the largest possible number of donors, relying heavily on voluntary organizations such as the Rover Scouts for recruits. Contrary to the assumption of face-to-face donation, the anonymity of the recipient anchored a donation scheme based on the Edwardian ideal of disinterested service. This ideal proved to be enduring (pp.44-67).
Mobilization for the War promoted the adoption of new technologies, such as the preservation of frozen blood in banks, and new moral frameworks for the act of donation. In Chapters Two and Three Whitfield presents his account of the Emergency Blood Transfusion Service (EBTS). Unlike the Edwardian ethos of voluntarism, the EBTS embodied the collectivist ethos of British socialists, who had previewed this alternate system during their involvement with the Republican medical corps during the Spanish Civil War (pp.103-104, 107). Anticipating war with Germany, these socialists threw their efforts into the planning of the EBTS, as part of a general civil defense effort. Following its establishment in 1938-39 the EBTS successfully recruited 100,000 blood group O, or ‘universal’, donors whose blood could be collected and held ready in national depots (p.109, p.114).
In its national media campaign, the EBTS redefined donation as an activity of national service rather than the province of a virtuous elite (pp.119-121). Along with other measures such as the deferral of syphilis screening for donations these changes reflected a reconfiguration of the acceptable donor population based on speed and imagined emergency (pp.124-126, p.130).With the outbreak of hostilities, blood depots, envisioned as sites of storage by early planners, became hybrid institutions devoted to both blood extraction and storage but also sites for the cultivation a sense of local citizenship. Many donors felt that their act was the most tangible form of wartime service they could offer (p.143). Acknowledging the power of a local donor community, the EBTS reorganized its donation procedures to cultivate a sense solidarity, allowing donors to mingle in waiting rooms or over tea after donation (pp.170-172, pp.175-178, p.181).
Wartime mobilization redefined the gift as well as the giver. By virtue of anonymity and blood product recombination, blood depots imposed greater separation between donor and recipient. In Chapter Four Whitfield describes how the propaganda generated on behalf of blood transfusion worked to establish the imagined ideal of face-to-face donation as a motivational tactic to draw donors to blood depots — posters often carried representations of individual children and servicemen (p.210). Publications such as the magazine Lifeblood drew on the new visual techniques of mass market realist publications such as the Picture Post to ‘make real’ the imagined beneficiaries of an individual donation. Educating readers about the new technologies of preservation and transport became a central part of the rhetorical link between donor and individual recipient (pp.210-215, p.222).
In Chapter Five, Whitfield examines how these new expectations and rherotics shaped the formation of postwar blood transfusion plans. In reading the plans for the National Blood Transfusion Service in 1943, Whitfield returns to the central irony of his argument: planners of rational, standardized systems were keenly aware that their scheme depended on co-opting, or even creating, networks of face-to-face social relations (p.234). Amidst debates over the organization of the National Health Service in 1946-1948, these interests facilitated the emergence of a hybrid system combining elements of on-call donors with the techniques and information management of wartime regional depots (pp.245-252).
Consequently, postwar commentaries on donation mistook publicity for posterity. The ‘golden age’ of personal contact and the ‘depersonalization’ of modern medical bureaucracy were not opposed phenomena but products of the same historical moment (p.282). It is the great merit of Whitfield’s history that he presents this conclusion not as an endpoint but as an opening for using the act of donation as an opportunity to weave together work in the history of medicine, ethics, anthropology, and British history in order to deepen our appreciation of the role that the idea of the gift has played in our conceptualization of donation. His success in this effort makes his dissertation (and subsequent book one hopes) worthy of a wide readership in all these fields.
Robin Wolfe Scheffler
Program in the History of Science and Medicine
Mass Observation Archives
British National Archives, Records of the Red Cross Blood Transfusion Committee
Wellcome Library for the History and Understanding of Medicine: Publicity materials
Red Cross Archive, Records of the Red Cross London Blood Transfusion Service and Minutes of the Voluntary Blood Donor’s Association.
University of Cambridge. 2011. 309pp. Primary advisor: Nick Hopwood.