and have even become part of regular practice.” Admitting that this was not the case “at interior posts where conditions are not always favorable,” Kok nonetheless gave as the principal reason for the wide use of transfusion “the efficacy of the procedure, the simplicity of instrumentation, and the lack of specialized and expensive medicines during the war.”51
The thesis provided few details about location, except for one reference to Katanga. It concentrated instead on practical techniques such as obtaining donors, in which case Kok went first to the immediate family or friends of the patient, with a preference for young females “who agree more voluntarily than the men,” and if unavailable then made a request to infirmary personnel. Compatibility testing was done by the simple mixing of blood drawn from donor and patient. Wasserman tests were done if time permitted, and 250 cc of blood was typically drawn into a mixture with sodium citrate. Blood was given to the patient in the sickbed, and the author stated, “in over a hundred blood transfusion done in ten years I never encountered serious shock.” He described the risk of transmitting various diseases, with some (e.g., tuberculosis, sleeping sickness) being more serious than others. By taking precautions such as examining potential donors, he concluded that “the danger of transmitting illness by blood transfusion is not very serious.” As to the illnesses most frequently and effectively treated by transfusion, the first was anemia, the most common cause of which was hemorrhage during a difficult childbirth; next was toxic anemia from worms; and, behind that, anemia from advanced cases of malaria. The author’s ultimate conclusion: “Blood transfusion, despite the difficulties inherent in the native setting, . . . can be used more with very satisfactory results.”52
Early Transfusion in the British Colonies
There was far more variety in the number of British colonial holdings in sub-Saharan Africa, but like the Belgian Congo there was a similar pattern in how new health facilities were developed. This development included initial investments before the First World War that followed colonial interests at ports, capitals, and business enterprises. Medical missionaries were also active, but unlike the Congo, there were significant settlers in Kenya and southern Africa.53 Beginning in the 1920s the expansion of hospitals and European-trained doctors followed a policy to move health facilities out of the capitals to rural areas where missionaries had mostly been providing Western medical care. “A government hospital is a tangible sign of Government activities which is understood by every native,” argued J. L. Gilks, principal medical officer for Kenya in his 1921 annual medical report.54 “It is a fact which cannot be gainsaid, that the provision of medical attendance, even of the crudest and most primitive description, is the best form of advertisement for any form of activity among natives.” In 1925 there were twenty-three colonial medical service doctors in Kenya and twenty-five in Uganda. Ann Crozier’s study found that a total of 424 colonial service doctors had served in Kenya, Uganda, and Tanganyika by 1939.55
A very rich source of evidence about transfusions in British African colonies before 1939 comes from the British Red Cross, which created branches in the colonies. In the settler colonies of Kenya and Southern Rhodesia, for example, blood donor panels, or lists of donors, were established in the 1930s as a way of obtaining more reliable sources of blood for transfusion both for Africans and Europeans. This method of donor recruitment was developed between the wars in the large cities of Britain, France, and the United States,56 where hospitals compiled lists of volunteers who were pretested for blood type and screened for illness. They were to be called, even on short notice, to have blood drawn when a transfusion was needed. Not only was this system inspired by the need for a more reliable source of blood for transfusions, but volunteering on these panels was seen as an activity to draw volunteers to help start Red Cross branches in the British colonies. The most obvious significance of establishing blood donor panels was to stimulate interest in transfusions by Western doctors already in place and with knowledge of the procedure. In effect, this was a case of supply stimulating demand.
The pioneer of this model of blood donor service was Percy Oliver, who was invited to give a talk at the 1930 British Empire Red Cross Conference, held in London, relating his experience of over a decade in that city. Shortly after the First World War, Oliver, his wife, and other members of a local Red Cross division in the London neighborhood of Camberwell answered a chance call from a local hospital to give blood for a transfusion. Until then, hospitals had relied on nurses, orderlies, or other hospital staff to serve as donors when no family member was available who matched the blood type of a patient in need of a transfusion. Oliver contacted other members of his neighborhood division, and over the years hospitals in London came to rely on this ready source of blood for transfusion. Oliver and his wife were called when the need arose, and the volunteer was sent to the hospital, where blood was drawn and given to the patient. Oliver reported that the organized service, which began in 1921, provided over 1,360 donations in 1929.57
The London conference was an opportunity for representatives from dozens of branches of the British Red Cross in colonies and dominions around the world to meet as well as to hear speeches and reports of activities. Oliver was one of the first plenary speakers, because his London Blood Transfusion Service was a very successful and highly visible program of the British Red Cross. At the 1930 conference he recommended work with blood donors “to all delegates as a very fine form of service for Red Cross members,” but he warned them not to serve simply as a channel to recruit donors to be placed in the hands of the hospitals. His “bitter” experience was that the chapter needed to act “as a buffer between the institutions and the donors, to protect their interests.”58
It did not take long for members in both Kenya and Southern Rhodesia, where Red Cross branches had been established only a few years earlier, to start blood transfusion services. The 1932 annual report for Kenya stated, “A blood transfusion service has been organized and has a panel of 24 donors, including 10 members of Toc H [a service club started by WWI veterans], for whom lectures on the subject were arranged.” The same year the Southern Rhodesia branch reported, “a Blood transfusion service has been organized and a number of VAD [Voluntary Aid Detachment] members have enrolled as donors.”59 Indirect evidence of blood transfusions in Northern Rhodesia is contained in a March 1931 administrative report from the commissioner of Northern Province about banyama, or vampire men, the rumors about which were being fueled by appeals for blood donors and transfusion in the province.60
As the numbers indicate, this was a small start, and in subsequent years the numbers did not grow very quickly. The Kenya Medical Research Laboratory, in Nairobi, reported annual blood group tests in the 1930s of between ten and thirty individuals each year. The Rhodesian Red Cross branch stated in 1939 that the number of volunteers had risen to 903, with 650 of them grouped. “No life will be lost for lack of a willing donor,” the 1939 annual report proudly boasted.61 In fact, that same year Southern Rhodesia proclaimed with much fanfare the establishment of a “National Blood Transfusion Service,” including a new building. This was, of course, a premature and hollow boast, partly because of the limited numbers, but also because it ignored the problem of saving the lives of all Africans. In any event, the war quickly put an end to such plans, yet this is at least an indication of the technical feasibility of a blood transfusion service in Africa.
These examples are telling of the practice of transfusion that can be found in the published literature and unpublished colonial reports before the Second World War. Yet they are not complete. For example, they do not discuss transfusion in French colonies, which will be covered in the next chapter, nor do they include unpublished or otherwise unrecorded individual cases, like Lejeune’s patient whose desperate conditions also prompted transfusions to save lives. In the end it is impossible to know the full extent of transfusion during this period because it simply was not always judged worthy of reporting. In fact, regular inclusion of transfusion in French colonial medical reports did not begin until 1955. Only rarely did a hospital or colonial report mention the establishment of a transfusion service, as in 1949, when the two big hospitals
