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A meandering history of blood tackles transfusions, taboos, and trauma

Nine Pints: A Journey Through the Money, Medicine, and Mysteries of Blood

Rose George
Metropolitan Books
368 pp.
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Blood is a vital fluid. Essential to life, it is often taken for granted, especially when it stays where it belongs, safely contained in our bodies. Rose George, freelance journalist and author of books that render legible the overlooked (1) and the distasteful (2), here turns her attention to blood in its myriad biological, cultural, historical, and international dimensions.

In nine chapters, corresponding to the roughly nine pints of blood each adult person is circulating at any given time through a complex network of arteries and veins, she explores blood donation and transfusion; leeches; the organization of transfusion services in England; HIV and other bloodborne diseases; plasma as fluid and as a major industry; menstruation, menstruation technologies, and menstrual taboos; trauma surgery and the physiology of hemorrhage; and the future of blood, including the ongoing search for artificial blood.

No armchair explorer, George makes the journey to the heart of blood a personal one. The book begins as she watches her own blood—female, type A positive—moving from her arm into the plastic bag in a British donor center. Here, she introduces the workings of the circulatory system, the discovery of the blood types, blood products, and the merits of paying for blood versus voluntary blood donation.

In a chapter entitled “That most singular and valuable reptile,” George explores the history of medicinal leeches and the rediscovery of their value in modern plastic and reconstructive surgery. These creatures—which she clarifies are not, as George Horn indicated in his 1798 treatise, reptiles—can remove excess blood without damage to the microvasculature. She visits Biopharm, a large leech breeding facility in Wales that ships leeches to surgeons around the world, where she permits Carl Peters-Bond to apply one to her hand. “I have blanked out what it felt like,” she writes, noting that a photograph taken during the experience shows her “face screwed up in a classic expression of disgust.” She marvels at how well modern patients tolerate the application of leeches in all their living, slimy glory.

Perhaps not surprisingly given her previous book on human biotrash, George devotes two chapters to menstrual blood and its management over time and space. Traveling to rural Nepal and India, George meets women whose menstrual periods render them exiled to the outdoors, where they are vulnerable to the elements, snakes, and sexual assault.

Outraged by the treatment of these women—the girls who cannot attend school and the conspiracy of silence about the biology of the menstrual process—George reminds readers that menstrual stigma is not confined to Asia. She considers at length the apparently enduring belief in the United States that bears and other creatures of the wild are attracted by menstrual odor. She quotes, for example, from a 1981 pamphlet from the National Park System (“Grizzly! Grizzly! Grizzly! Grizzly!”), which warns visitors to stay clean and avoid perfumes and that “women should stay out of bear country during their menstrual period.”

Later, George describes her own menstruation, calculating the amount of menstrual blood she has discharged over 35 years and bemoaning the lack of biomedical data on menstruation and women’s reproductive health. Here she notes that until 1992, the National Institutes of Health had no programs for vaginal research.

In the 21st century, surgery for traumatic injuries has exploded. Where once amputation was the only hope, surgeons have been able to transform injury into livable disability and productivity. George chronicles the prodigious blood requirements for such surgeries and the outcomes as she relates an experience in which she witnessed incredible, if ultimately futile, efforts to save a young female bicyclist after a traffic calamity in London.

As George notes, one of the holy grails of 20th-century medicine was the search for a blood substitute—one made ready at a moment’s notice and not burdened by the extraordinary immunological complexity of blood itself. Someday, perhaps, the necessity of blood-type congruency for transfusion may seem as quaint as the practice of blood-letting, but we surely will never cease to wonder at the exquisite differences in blood itself.

Each chapter of Nine Pints reflects George’s experience, personal investment, and broad attention to the historical, political, social, biological, and moral aspects of blood. If the organizational thread is not always easy to follow, the book nevertheless overflows with telling examples—some fantastic, some uncanny, all informative about the sanguinary fluid.


  1. R. George, Ninety Percent of Everything: Inside Shipping, the Invisible Industry That Puts Clothes on Your Back, Gas in Your Car, and Food on Your Plate (Metropolitan Books, 2013).

  2. R. George, The Big Necessity: The Unmentionable World of Human Waste and Why It Matters (Metropolitan Books, 2009).

About the author

The reviewer is at the Department of Medical History and Bioethics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53706, USA.