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Are blood groups only for use in blood transfusion?

One of the greatest medical accomplishments of the early 20^th century, the discovery of the process of haemagglutination and three initially identified blood groups by the Austrian physician, immunologist and infectiologist Karl Landsteiner (1868‒1943), paved the way to safe blood transfusion. Landsteiner established that the individual properties of blood manifest in antigenic peculiarities, which he deemed sufficient to enable identification of each unique human being (serological identification), similarly to fingerprints. He then thought that perhaps blood groups could help distinguish between unwell persons and healthy ones. 

It was, however, eventually established that agglutination was not a symptom of ill health; rather, it could be used to divide people into four large groups or blood types, which for the purposes of clarity were designated I (O), II (A), III (B) and IV (AB). Soon after that, Reuben Ottenberg (1882‒1959) hypothesized that these four specific blood groups were inherited according to a certain law ‒ Mendel’s principles of inheritance; this idea was fully confirmed in 1924 by Felix Bernstein (1878‒1956). These discoveries further led to blood group testing being applied not only in medicine but also in forensics and legal proceedings, including paternity determination in child support cases. Abandoned children and child support evasion have sadly been a reality in all times and places. This has been and, regrettably, still is the case in Latvia today.

The pioneer of applying blood group typing in paternity testing in Latvia was Miķelis Veidemanis (1895‒1945), assistant, later (from 1937) ‒ Director of the Institute of Forensic Medicine of the University of Latvia (LU), Dean of the Faculty of Medicine of the University of Latvia (in 1943 and 1944). On 13 February 1929, Veidemanis presented his scientific paper “Role of Blood Groups in Paternity Testing in Latvia and their Consistency” and was awarded a Doctor of Medicine degree. 

Born in 1895, Miķelis Veidemanis started his medical studies at the Academy of Military Medicine in Petrograd (1915‒1918), finishing his training, interrupted by the war, only in 1923, at the Faculty of Medicine of the University of Latvia. He worked from 1922 as a sub-assistant at the LU Institute of Forensic Medicine headed by the Austrian-born Ferdinand Edler von Neureiter (1893‒1945), assistant and prosector at the University of Vienna. The board of the LU Faculty of Medicine elected Neureiter to the post of Director of the Institute of Forensic Medicine on 9 December 1922, appointing him associate professor. Under Neureiter, five subdivisions (departments of thanatology, forensic biology and forensic psychiatry, as well as ambulatory centre for correction of alcoholics and laboratory of blood type research) and a methodological centre of applied forensic medicine were formed at the institute.

Veidemanis’ work was mainly based at the blood group research laboratory, focusing on blood group testing and using the technique as evidence in court. His research verified the serological method of identification, and blood group testing was accepted as a routine procedure in child support cases from 1928. In 1940, Veidemanis wrote: “…to date, the method has been used in 635 cases, in 22 of which it served as explicit proof to the fact that the defendant was not the father. On two occasions, blood group testing had to be used as crucial evidence in solving cases of switched newborns. In one of the cases, it was possible to establish the truth unequivocally and the child was returned to its real parents.” [M. Veidemanis, Antropoloģiskā izmeklēšana…, p. 604]

It has to be noted that from the very beginning blood group testing was not used just by physicians. Almost immediately after the discovery this method was adopted and deployed in their research by anthropologists. During the First World War, husband-and-wife physicians Ludwik and Hanka Hirszfeld, working in Greece near Thessaloniki, where they studied the blood groups of 16 different nations, noticed that every nation has a different ratio of blood types A and B. They found that group II (A) is more frequent in Europeans and dominates among people from Middle East, China and Japan. Group III (B) is more frequent in India, Central Asia and the Valley of the Nile, but is not found in the indigenous population of the Americas and Australia. The first anthropological classifications based on blood types emerged in the 1920s. The best known of these were W. C. Boyd’s (1903‒1983) classification with six haematological races. In 1926, L. Wagner published his table of blood type distribution among the ethnic groups of the world. Blood group studies were also conducted in Latvia’s neighbouring country of Lithuania; the results were compiled in 1935 by Jurgis Žilinskas (1885‒1957).

Gradually, Miķelis Veidemanis arrived at the conclusion that for blood groups to be of genuine help in paternity testing, a so-called “formula of a nation’s blood groups” is required. Veidemanis’ attempts to come up with at least an approximate ‘blood group formula’ for ethnic groups living in Latvia through research led him to the field of anthropology. At the time, the ratio or so-called formula of blood types had been found for almost every nation; there was none for the population of Latvia, and the fact motivated him to launch his study.

Considering that blood groups do not depend on climatic and other conditions of life, they were thought to be an ethno-anthropological feature. In his research, Veidemanis divided his patients according to their place of birth (regions), trying to explore the possibility that the dominant blood groups in people from various Latvian regions might also be traced to their descendance from different tribes, based on data of population in the 12th century. In this regard, considering the meandering path of the Latvian history over the course of eight centuries, M. Veidemanis’ conclusion that “… it is impossible to include a people into a certain tribe and prove their kinship based on the blood type formula alone” strikes as an anthropologically crucial finding. The blood type formula must be considered an objectively ascertainable ethno-anthropological feature that must be always applied in combination with the rest of ethno-anthropological features.” [M. Veidemanis, Par asinsgrupu nozīmi…, p. 108]

In his research conducted at Riga City Hospital No. 1, Veidemanis determined the blood group of 1160 patients, aged between 9 months and 80 years. Both healthy and unwell persons were included, and the name, patronymic, age, nationality, faith, occupation, marital status and diagnosis of each patient were recorded. Testing the stability of blood groups, in 52 cases a repeated test was carried out, demonstrating that a person’s blood type does not change. Similarly, in 50 cases the blood type was tested before and after the patient’s death, establishing that the blood group does not change under these circumstances either.

Veidemanis summarized the results of the study in 25 findings, anthropologically most significant of which are findings 11 to 18. He concluded that:

1. A relatively large percentage of the III (B) blood group is found in the Latvian population as an aggregate; therefore, its blood formula is similar to the blood group formulae of Poland and Russia;
2. Based on the blood group formula and the biochemical index of race, the Latvian population and Latvians along Poles and Russians should be categorized as the intermediate type of Hirszfeld’s classification.

The credibility of Veidemanis’ findings was verified by studies conducted by physicians Nikolajs Cauna, Kārlis Dolietis (1900‒1986) and Eduards Spilners (1906‒?), as well as the studies of Latvian and Lithuanian blood types carried out after the Second World War by Professor Raisa Denisova (1930‒2019).

Veidemanis was also the author of the first (sadly ‒ unpublished) Latvian-language forensic medicine textbook for students, physicians and lawyers, whichh”worked on in the late 1930s; it was scheduled for publication in the 1940s at the Latvju Grāmata publishing house. The manuscript was completed in 1940. It was even edited and prepared for printing. However, the political turmoil of the early 1940s, the Second World War and events of the final years of the war forced the author to flee Riga and head for Courland as a refugee. He managed to get as far as Irlava; as the artist Jurģis Skulme wrote in his ‘odd job man’s memories’ of himself, the town of Irlava and Doctor Krišjānis Katlaps, “Dr Katlaps was unable to save his typhoid patient, the forensic doctor ‒ a fellow refugee ‒ Miķelis Veidemanis. After the unsuccessful operation, the surgeon told us that the patient’s intestines had ruptured as if made of paper.” [J. Skulme, Izpalīga piezīmes…, p. 33] Thus the physician’s life came to a sudden end on 1 April 1945, leaving the Latvian medicine a rich legacy.

Following 50 years of oblivion, an event dedicated to the centenary of Miķelis Veidemanis was hosted by Pauls Stradiņš Museum of the History of Medicine in 1995. Veidemanis’ daughter Biruta Veidemane-Liepiņa handed over mementos of her father’s life and the manuscript of his textbook of forensic medicine to Pauls Stradiņš Museum of the History of Medicine, where these items are still stored today. As for the textbook of forensic medicine written by Miķelis Veidemanis, it is still waiting for its researcher.

BIBLIOGRAPHY

Cauna, N., ‘Par latviešu asins grupām’ [‘On Latvian Blood Groups’], Ārstniecības žurnāls, 1943, no. 4, pp. 254‒265

Dolietis, K., ‘The Blood Groups of the Latvians’, Latvijas Bioloģijas biedrības raksti, 1934, vol. IV, pp. 57‒63

Hirszfeld, H., Hirszfeld, L. ‘Serological Differences between the Blood of Different Races’, Lancet, 1919, II, pp. 675‒678

Skulme, J., ‘Izpalīga piezīmes par sevi, Irlavu un dakteri Katlāpu’ [‘An Odd Job Man’s Memories of Himself, Irlava and Doctor Katlāps’], Daugavas vanagu mēnšraksts, 1998, no. 2, pp. 27‒38

Spilners, A., ‘Par latviešu asins grupām’ [‘On Latvian Blood Groups’], Ārsts, 1940, no. 4, pp. 240‒241

Veidemane-Liepiņa, B., ‘Mans tēvs Miķelis Kārlis Veidemanis (1895—1945)’ [My Father Miķelis Kārlis Veidemanis (1895—1945)], Acta Medico-Historica Rigensia, vol. 4, Riga, 1999, pp. 315‒322

Veidemanis, M., ‘Antropoloģiskā izmeklēšana kā tiesu medicīnas paņēmiens bērna tēva identificēšanai’ [‘Anthropological Examination as Forensic Method of Paternity Testing’], Tieslietu ministrijas vēstnesis, 1940, no. 3, pp. 603‒610

Veidemanis, M., ‘Asinsgrupu nozīme paternitātes noteikšanai Latvijā un viņu konstance’ [‘Role of Blood Groups in Paternity Testing in Latvia and their Consistency’], Latvijas Ūniversitātes Raksti. Acta Universitatis Latviensis, Faculty of Medicine Series I.3. Riga, 1929, pp. 65­­‒126

Veidemanis, M., ‘Par asinsgrupu nozīmi tēva noteikšanā Latvijā un šo asingrupu pastāvību’ [‘Role of Blood Groups in Paternity Testing in Latvia and their Consistency’], Tieslietu ministrijas vēstnesis, 1929, no. 3/4, pp. 106‒111

Vesperis, M., ‘Profesors Miķelis Kārlis Veidemanis (1895—1945)’, in Medicīnas profesūra Latvijā: tapšana un attīstības tendences [Medical Professorship in Latvia: Formation and Development Trends], Riga, 2009, pp. 56‒57

Vīksna, A., Latvijas Universitātes Medicīnas fakultāte 1919‒1950 [Faculty of Medicine of the University of Latvia 1919‒1950], Riga, 2011, pp. 315‒317, 442‒443

Žilinskas, J., Serologinis Mažosios Lietuvos gyventojų (ir kitų baltų rasės tautų) giminiškumas [Serological kinship of the Population of Lithuania Minor (and Other Baltic Peoples)], Kaunas, 1935

Denisova, R., ‘Izuchenie grupp krovi sistemy ABO i MN u latyshej i litovtsev’ [‘Studies of System ABO and MN Blood Groups in Latvians and Lithuanians’], in Morfogenez kletki, tkanej i organizma [Morphogenesis of Cell, Tissue and Organism], Vilnius, 1980, pp. 47‒48

Published: June, 2021