The word "bank" typically refers to financial institutions, large and small, from the storefront where you go to cash your checks to the big investment firms of Wall Street. Yet there is a class of banks that deals not with money but with bodily fluids—blood, sperm, and breast milk. These "banks" aren't part of our financial system, but banks they are, nevertheless.
To Kara W. Swanson, author of the new book Banking on the Body, that word is more than "mere metaphor"; it carries with it ideas and consequences for how we perceive the body and its byproducts. "This term, borrowed from financial banking and redolent with implications of markets and cash flows, created the context in which Americans learned to think about body products and in which we developed our contemporary laws governing property in the human body," she writes.
I spoke with Swanson, a professor of law at Northeastern University, to learn more about these banks and the market for our body products. A lightly edited transcript of our conversation follows.
Perhaps you can just start by sketching out a bit of the historical background. Where does the term “banks” first get used to talk about storage of the body's fluids and organs? How has that metaphor evolved over time?
This question was my starting question for the book. Like most of us, I was very familiar with the body “bank,” especially the blood bank, but I had never stopped to think about why we called it a “bank”—and the more I thought about that, the odder it seemed to me. What sort of bank goes around begging for donations?
Finding out where that metaphor came from was the easy part. It originated in a very particular historical moment, 1937, in Depression-era Chicago. One doctor, Bernard Fantus, was charged with managing the supply of blood for Cook County Hospital, which was the public hospital in Chicago—it treated those who could not afford to go to public hospitals, and it relied on public funds. In 1937, money was very tight, and the hospital was operating on a shoestring budget.
Blood transfusions in the 1930s had become pretty common and safe (30 years earlier they were neither), but the problem was that they were expensive. Since doctors had begun working in earnest to incorporate them into medical care around the turn of the 20th century, they had relied on paid blood sellers as the most common source of supply. Sometimes they could access volunteers, usually friends or family of the patient who were there at the hospital, but that didn’t always work.
Blood transfusion requires matching blood types, and there wasn’t always a ready volunteer who had the right blood type. It also took quite a while to test anyone to find out their blood type. By the 1930s, the solution had become “professional-donor” registries. These might be run by a hospital, or free-standing institutions, either for-profit or non-profit. They kept lists of willing blood sellers, who had been pre-screened by a physical exam (most importantly, to make sure they did not have syphilis or malaria, which could be transmitted by blood) and whose blood type had been determined. When a transfusion was needed, a doctor could call the registry, and they would send a “donor” of the correct type. That donor expected payment, and the patient got the bill—a blood transfusion involved a direct sale from a particular professional donor to the patient.
Fantus’ patients did not have the money for that bill—usually $25 to $50 dollars. And they often did not have available volunteer donors either. At Cook County, as at other public hospitals around the country, patients were literally dying for lack of blood—deaths that doctors knew could be avoided if blood was available to transfuse them.
This is the context for the introduction of the bank metaphor as a means of understanding body product exchange. Fantus’ innovation was to break the direct person-to-person means of getting blood and to reconceive blood for transfusion, that is, blood as a body product, into an abstract unit of credit. He set up a refrigerator full of units of blood.
This seems common sense and ordinary to us today, but it was a big conceptual shift. When a doctor needed blood, he requested a unit of typed blood from the refrigerator—which Fantus came to call his “bank.” The innovation was that the doctor needed to replace that blood. But the replacement no longer needed to be immediate, but could be later in time. And the replacement need not match the type of the blood withdrawn. It just needed to be a usable unit of blood (about a pint) that would restock the inventory. Almost any patient, even the indigent, could provide a pint of their own blood once recovered, or find a friend or family member to provide one—when that replacement did not need to be provided at the time of urgent need or match the patient’s blood type.
Fantus called his refrigerator a “bank” because he wanted the hospital’s doctors to take their repayment obligation very seriously. He told them it “was not a mere metaphor.” Just like a bank could only pay out money if it received money (a concept very familiar after all the bank failures of the early 1930s), his “bank” could only have blood available for their patients if they put equal amounts back. It needed to be "balanced."
The metaphor was thus a way of solving a medical problem—how to get this life-saving body product to all patients who needed it, not just those who could afford to buy it? His solution was successful at Cook County, and as soon as he publicized it, doctors all over the country, who hated the idea that patients were dying needlessly, rushed to adopt it. Large urban public hospitals opened “blood banks” in the late 1930s and early 1940s, and after the idea of blood donation became much more publicly understood during the WWII national blood program, blood banks became the ubiquitous feature of hospitals they are today during the late 1940s and 1950s.
That, as I said, was the easy part. What I aim to do in the book is to understand how the metaphor spread, which it did in two ways. As I just described, it became the way we understood the blood supply, which was a crucial feature of the rise of modern hospital-based medical care. Modern surgery depends on the blood bank. But the metaphor proved so powerful as a way of thinking about how a body product is exchanged between strangers that it colonized other body products. Both those that predated the blood bank, that is, breast milk, which was exchanged through mothers’ milk stations beginning in the 1910s, and those that came into medical use later, such as sperm, beginning in the 1950s.
In your book, you argue that, like Fantus said, the “bank” terminology has never been “mere metaphor.” Can you talk about the ways that the bank metaphor has shaped our understanding of these systems? How has the connection between medical banks and financial institutions manifested?