Does it matter when the first blood transfusion occurred in Africa? If we are to believe the Serial Passage Theory of HIV emergence, then sometime in the early twentieth century, not one, but as many as a dozen strains of simian immunodeficiency virus (SIV) passed from West African apes and monkeys to people, although only a handful became epidemic, and only one – HIV-1M – became a global pandemic. Because SIVs have likely infected Africans for hundreds, even thousands of years without become epidemic, the mystery is why in a relatively short time span during early European colonial rule multiple epidemic HIVs emerged in fairly close geographical proximity. Some medical historians and biomedical researchers believe that mass colonial injections campaigns that administered vaccines to tens of thousands of African villagers in rapid succession during and immediately after World War I allowed blood tainted with SIVs to mutate into lethal HIVs. A related theory is that the introduction of blood transfusion therapy in Africa by the end of World War I was the culprit. Blood transfusions allowed large quantities of potentially tainted blood to be passed from one patient to another, facilitating HIV mutation into lethal strains in the ensuing decades. Labor migration, urbanization, and sex work contributed to turn HIV-1M into a continental disease that was later carried to other parts of the world.
New evidence suggests that blood transfusion therapy in Africa might be decades older than previously thought. In 1892 a German military staff doctor in coastal East Africa performed the first known blood transfusion in Africa on a German official on the verge of dying from a disease called blackwater fever, characterized in part by severe anemia. The doctor believed that injecting large quantities of blood would restore lost red blood cells and revive the patient, which it apparently did. What makes the case especially interesting is that the doctor unhesitatingly enlisted an African employee as the donor, and the patient readily agreed – despite the presence of other Europeans who could have supplied blood. The case thus seems to belie expectations of early colonial fears of racial blood mixing. Perhaps this is because this first known blood transfusion in Africa coincided with European breakthroughs in blood serum therapy, which held that people or even animals indigenous to a region were resistant, if not immune, to local diseases. Their blood, and the blood of people who had recovered from a disease, offered possible immunizing agents to vulnerable people, such as Europeans traveling in Africa for the first time. The German doctor may very well have chosen an African to supply blood in the hope that it contained therapeutic properties for blackwater fever, which was believed at the time to be a deadly form of malaria.
Although the first case of blood transfusion in Africa is not likely to have spawned epidemic strains of HIV, it was symptomatic of a medical culture willing to experiment with blood transfusions and injections – not just of human blood, but also of animal blood – for a variety of maladies in the search for life-giving therapies, immunizing agents, or just to determine how mysterious diseases like malaria, dengue fever, sleeping sickness, and yellow fever were transmitted. Diverse people and animals were believed to have had different blood attributes, and this diversity was a strong impetus to medical experimentation. Although modern medical ethicists would shudder at intentionally injecting infected blood into healthy individuals, this is exactly what took place at the turn of the twentieth century in places as far apart as American-occupied Cuba and the Philippines for yellow fever, in Italy, Oklahoma, and Baltimore for malaria, and in Vietnam for typhoid. And in German-controlled Cameroon, where epidemic forms of HIV are likely to have originated, a German doctor after the turn of the century was willing to inject infectious blood from a European suffering from malaria into a healthy person – his own wife – to test malaria transmissibility. She contracted the disease eight days later. Other European and colonial doctors were willing to inject themselves with infectious human and animal blood, and did so as well to colonial subjects who had no say in the matter.
In the past twenty years the timeline for epidemic HIV emergence has been continuously pushed back, from the 1950s to the interwar years. A renewed focus on early blood experiments in Africa and elsewhere, which aimed to uncover modes of transmission and possible immunizing principles of tropical diseases, might help biomedical researchers better understand the origins of epidemic HIV and other diseases.
Image Credit: “Commemorative Red Ribbon White House 2014 World AIDS Day 50174” by Ted Eytan. CC BY SA 2.0 via Flickr.