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Facing up to our deepest fears

by James McConnachie

It is 10 years since I last read a book that tackled taboos so fearlessly. It was also by Rose George, also excellent, and its subject was The Big Necessity —or human waste and how we get rid of it.


Excrement troubles us for obvious reasons. But why should blood, the stuff of life, bother us? We should love it. Rose George certainly does. She calls it "wondrous" and describes its marvellous status as at once a bodily tissue and an organ —a liquid one that travels 12,000 miles a day, regulating temperature, getting rid of waste and defending us against infection.

Blood itself is not the problem. It is visible blood that makes our toes curl and lips tighten. As the anthropologist Mary Douglas famously put it, dirt is "matter out of place", and blood is out of place whenever it is out of the body. Nine Pints is not a study of blood itself, then, it is a study of misplaced and displaced blood: of blood spilled in trauma, shed in menstruation and sucked by leeches; of blood banked and blood transfused.

That and blood sold. While UK blood banks have successfully relied on donation since the 1930s, most of the rest of the world pays for the stuff, and sells it on. "Blood," George writes, "is the new crop." She tells a horrifying story of a human blood farm in India and describes how American "plassers" are allowed to sell their blood plasma as often as twice as week, for $30-$50.

The US now earns some $19bn a year for exports of blood derivatives such as plasma, and plenty of it comes to the UK. We should worry about that, George says, because paid donors are more likely to tell lies about their blood status than volunteers, and people willing to sell their blood are "sometimes, the kind of people you want nowhere near a safe blood supply". Grifols, the global leader in plasma products, has 150 clinics in the US, 13 of which are located along the Mexican border.

There's nothing wrong with Mexican blood; there is something wrong with targeting donors who are desperate. And it is British blood that is regarded as uniquely tainted, internationally, because of variant Creutzfeldt-Jakob disease, or "human mad cow disease". Would-be donors who lived in Britain for more than six months between 1980 and 1996 have "pariah status".

vCJD is not a taboo but a real medical threat. The same is not true of menstruation, but it is a subject veiled in anxiety and ignorance all the same. (The word "taboo", George notes, might come from the Polynesian tabu, meaning "apart" but it might also come from tapua, or "menstruation".) George visits a chaupadi in Nepal, a hut or cow shelter where menstruating women, in some remote rural areas, are shamefully sequestered for fear that they will pollute, cause illness or bring misfortune. Lack of knowledge is not restricted to the developing world. Who knew that, alongside humans, only apes, Old World monkeys, the elephant shrew and four varieties of bat menstruate at all? Who knew that only half of the menses consists of blood, the rest being made up of healthgiving mucus and endometrial tissue? And who knew that the "menses" means the flow? The menstrual taboo is starting to topple, though. In 2015, a Time cover championed the "year of the period" and, that same year, British tennis star Heather Watson said she lost a match at the Australian Open because of "girl things". Other sportswomen followed her lead.

Research into menstruation is underway —but still has a lot of ground to make up. George searches PubMed, the leading medical research database, and finds almost 22,000 citations for "erectile dysfunction", and fewer than 6,000 for "premenstrual". Higher-tech menstrual products such as organic tampons, absorbent menstrual discs and cycle-tracking apps are now on the market or in development, but not before time. The technology "for something that affects three billion people", George points out, has barely advanced since the adhesive strip on a sanitary pad and the Tampax applicator patent in the early 1930s.

(Advertising has not advanced much either. A 2011 Always advert did finally show a spot on a sanitary pad that was blood red rather than toilet-cleaner blue but, as one journalist sniffed, it still looked like a "You Are Here dot on an airport map".) If Nine Pints was just a pop-science-meets-culturalhistory book about blood donation and periods it would be excellent. But this is also a travel book themed, like The Big Necessity, around issues of public health. Beyond Nepal and India, George visits the Cape Town township of Khayelitsha, to learn why rates of HIV infection remain so high. In part, it's because many older men have sex with multiple, younger partners, often without using condoms. A 15-year-old girl in parts of KwaZulu-Natal has an 80% chance of acquiring HIV.

That is distressing. So, in another way, is George's trip to a leech farm in Wales, one of only six in the world. Wild leeches were harvested almost to extinction during the medical blood-letting mania of the 19th century; today's farmed creatures are used pragmatically, to help manage bleeding and to help blood vessels reattach following traumatic injuries. Terrorism and bear attacks cause spikes in demand, the latter because bears tend to rip your scalp off.

Most viscerally shocking, though, is George's visit to the Royal London hospital, where she discovers that death from bleeding after trauma kills many more people than malaria, TB and HIV-Aids combined. She observes emergency trauma surgery on a cyclist who had been horrifically run over by a bus and arrived in hospital with her chest already cracked wide open by the helicopter team, right there on the roadside —or "prehospital" as it is known in the jargon. George is slightly traumatised herself, but her eyes stay wide open right through.

This is a brave book, then. It is also powerfully feminist. Not just for how it tackles women's issues and women's history but for the coolly radical way it thinks, and its agitatory enthusiasm. As George herself puts it, describing campaigns against menstrual discrimination in India, "struggling against stupid taboos was also a fight against entrenched misogyny". This fierce and forensic book wrestles our taboos to the ground and tears off the plaster; what it exposes is strangely beautiful.

It is a brave book and a powerfully feminist one.

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