Blood by Lawrence Hill

wards. When he prevailed upon physicians to wash their hands in a chlorinated lime solution between their autopsies and their maternity ward work, the maternal mortality rate from blood poisoning dropped dramatically. The resolution of this problem became an obsession for Semmelweis. He was convinced of the importance of his discovery but failed to convince his peers of the necessity of assiduous hand-washing to prevent rampant blood poisoning in maternity wards.
    Contemporaries derided the work of Semmelweis, who lost his job at the Vienna hospital. Doctors would continue to spread disease from cadavers to patients, or from patients to patients, causing new mothers and others to die of blood poisoning for many more years, until the germ theory was accepted and hand-washing became the norm. Semmelweis suffered from various professional setbacks and personal problems. He was tricked into visiting an asylum, which he was not permitted to leave. Instead, he was straitjacketed and beaten.
    Within two weeks of being detained, it appears, Semmelweis cut his finger during an altercation with asylum employees. The wound became gangrenous. Semmelweis developed blood poisoning — the very problem he had been trying to avert in maternity wards. Within two weeks of being “admitted” into the institution, Semmelweis died. The year was 1865. It was not until the following century that his passionate efforts to help women avoid blood poisoning in maternity wards led Semmelweis to be dubbed the “saviour of mothers.”
    Likewise, Bruce Chown of Winnipeg could be considered the modern-day “saviour of babies.” Over the course of time, countless fetuses and newborns have died because — as we finally came to understand near the middle of the past century — their blood types were incompatible with that of their mothers. This is because an antigen, or molecule on the surface of the red blood cell, is present in most, but not all people. A person with this antigen is considered Rh-positive and will have a positive blood type. Someone without it is Rh-negative and will have a negative blood type. With regard to pregnancy and childbirth, this factor becomes critically important — and potentially fatal for the fetus or infant — when the mother is Rh-negative and the baby is Rh-positive. This can occur if the father is Rh-positive. If some of the baby’s red blood cells leak into the mother’s bloodstream — and this can happen during childbirth or in the case of miscarriage, abortion, or other in-uterine trauma — the mother will develop antibodies against the Rhesus factor in the baby’s blood cells. As a result, if the mother becomes pregnant again with an Rh-positive baby, the mother’s antibodies may attack the baby’s blood. This can result in jaundice, brain damage, and the death of the fetus or newborn child. Indeed, as recently as the early twentieth century, mortality from erythroblastosis fetalis — also known as hemolytic or Rh disease — was 50 percent. It accounted for 10 percent of fetal and neonatal deaths in Canada, and claimed the lives of some 10,000 babies annually in the United States.
    There are now almost no such deaths in Canada, partly as a result of the pioneering work of Bruce Chown. In 1944, Chown — head of pediatrics at Winnipeg Children’s Hospital — founded a lab in the basement of the hospital to study the cause of Rh disease. Chown, who is described by the Canadian Medical Hall of Fame as one of the greatest Canadian physicians of all time, developed the first Rh exchange transfusion in Winnipeg in 1945, and went on to develop a facility with Connaught Laboratories to manufacture an Rh immune serum. By coating the fetus’s red blood cells and thus disguising their foreign nature, the serum tricks the mother’s bloodstream into thinking it’s compatible with that of the baby. Rh immunoglobulin was licensed for use in 1968, and soon helped prevent many more fetal neonatal fatalities in