The Charles R. Drew Papers
- Report of the Blood Transfusion Association Concerning the Project for Supplying Blood Plasma to England, Which Has Been Carried
on Jointly with the American Red Cross from August, 1940, to January, 1941
- Number of Image Pages:
- 64 (6,628,615 Bytes)
- 1941-01-31 (January 31, 1941)
- Drew, Charles R.
- Stetten, DeWitt Jr
- Rhoads, Cornelius P.
- Scudder, John
- Blood Transfusion Betterment Association
- Original Repository: Howard University. Moorland-Spingarn Research Center. Charles R. Drew Papers
- Reproduced with permission of the Moorland-Spingarn Research Center.
- Exhibit Category:
- Becoming "the Father of the Blood Bank," 1938-1941
- Unique Identifier:
- Document Type:
- Physical Condition:
- Narrative Account of Work and Medical Report
- January 31, 1941
- Blood Transfusion Association
- 2 East 103d Street
- New York, N.Y.
- Table of Contents
- Preliminary Statement . . . 1
- Part I -- Narrative Account of Work . . . 1
- Part II -- Medical Report . . . 2
- Part I
- Narrative Account of the Work, Problems Encountered and Conclusions Therefrom:
- The Association . . . 3
- Research in Plasma Field . . . 3
- Origin of Project . . . 3
- Program Agreed Upon . . . 5
- Project Begun . . . 6
- Appointment Office . . . 6
- Administrative Steps . . . 7
- Medical Control . . . 7
- The Cooperating Hospitals . . . 8
- Publicity and Campaign for Donors . . . 9
- Regulating the Supply of Donors in Relation to Hospital Capacities . . . 9
- Donor Response . . . 10
- Development of list of Donors . . . 11
- Word from England as to Termination of Need . . . 11
- Plasma Produced . . . 11
- Financial . . . 11
- Volunteer Nature of the Project . . . 13
- Miscellaneous Problems Which Have Been Encountered, and Suggestions Derived from Them for Any Future Program:
- Fear of Donors . . . 16
- Care of Donors . . . 17
- Blood grouping . . . 18
- Buttons for Donors . . . 18
- Peak Loads of Calls Following Broadcasts . . . 18
- Lapsed Appointments . . . 19
- Need of Development of New Publicity Material . . . 19
- Training of Personnel . . . 19
- Research Aspects of the Program, Medical Problems and Relation to National Defense Needs . . . 20
- Liaison with the National Research Council and the Plasma Work Carried on in England and Canada . . . 21
- Certain Limitations of the Program Relative to Research . . . 22
- Difficulties Encountered Relative to Maintaining Sterility of the Plasma . . . 23
- Problems from Clotting and from Cloudiness of Plasma . . . 25
- Methods of Separating Plasma from the Red Blood Cells . . . 25
- What is the Best Blood Substitute? . . . 26
- Further Research as to Therapeutic Values of the Products in Liquid and Dry Form . . . 27
- Experiments in Drying Plasma . . . 28
- Importance of a "Pilot" Laboratory to Carry on the Research Now in Progress and Perhaps as an Additional Production
Unit . . . 28
- Wastefulness Due to Loss of Red Blood Cells . . . 29
- Alternative Problems Inherent in Extension of Such a Program to Other Cities . . . 30
- Three Main Divisions of the Work in Any Such Program . . . 32
- Position of the Association . . . 33
- Conclusion . . . 33
- Note: It was not deemed necessary to print Appendices A, B, C, D and E, referred to in the report and containing voluminous
statistical, financial and other details of the work, together with the forms used, and these have therefore been bound separately.
- Part II
- Medical Report Submitted in Behalf of the Board of Medical Control by the Medical Supervisor of the Blood Plasma Division,
the Chairman of the Board, the Chairman of the Blood Plasma Committee, and the Assistant to the Board, Blood Plasma Division:
- I. Introduction and General Statement . . . 35
- Origin of Project . . . 35
- The Choice of a Blood Substitute . . . 36
- Proposed Organization . . . 37
- Relation to National Research Council . . . 38
- Purpose . . . 38
- Medical Committees and Personnel Directing the Project . . . 39
- Initial Steps Taken to Protect Sterility . . .39
- Compliance with Laws and Regulations Applicable to Biological Products . . . 40
- Duration of Project . . . 41
- Disposition of the Plasma . . . 42
- II. Routines . . . 42
- (1) Reception and Care of Donors . . . 42
- (2) Collection of Blood and Preparation of Plasma . . . 45
- (3) Serology . . . 49
- (4) Bacteriology . . . 50
- (5) Uniform Records of Blood and Plasma Shipments . . . 61
- III. Equipment and Processing . . . 62
- (1) Containers . . . 62
- (2) Plasma Processing Room . . . 68
- (3) Work Room . . . 70
- (4) Plasma Drying Unit . . . 70
- (5) Preparation of Equipment for Use . . . 70
- (6) Floor Space . . . 72
- (7) Storage Space . . . 73
- (8) Refrigeration . . . 73
- IV. Plasma vs. Serum . . . 75
- V. Dried Plasma and Serum . . . 87
- VI. Research . . . 92
- VII. Facilities for the Collection of Blood and the Preparation of Plasma in the Larger Cities . . . 72
- VIII. Plan for Collecting 100,000 Bloods . . . 112
- IX. Conclusions . . . 115
- X. Bibliography . . . 118
- Report of the Blood Transfusion Association Concerning the Project for Supplying Blood Plasma to England, Which Has Been Carried
on Jointly with the American Red Cross from August, 1940, to January, 1941
- Preliminary Statement
- In accordance with the request to make the essential information gained by this experiment immediately available for purposes
of national defense, this report is submitted in advance of entire completion of the work. Because of this factor and the
pressure of time under which it has been prepared, the medical portions of the report, and the statements thereon, should
not be understood as any attempt to express final scientific conclusions, but are intended only to give in clear form the
best practical information and suggestions which are immediately possible in a field which is still in the experimental stage
and subject to rapid development.
- The financial report will be supplemented later by a fully audited statement of the entire project, certified by Messrs. Haskins
- The Blood Transfusion Betterment Association is in process of changing its corporate name to the "Blood Transfusion Association"
and has been described in this report by the latter title.
- The report consists of:
- Part I
- A narrative account of the project with a discussion of the difficulties encountered, the lessons which these have taught
applicable to future work in this field, and certain recommendations. Comment, conclusions and recommendations in this part
of the report which deal with medical or scientific subjects are based upon the medical report [Part II hereof]. Appendices
separately bound are submitted covering:
- A. Report as to the administrative setup, procedures, forms, etc.
- B. Report of the numbers of donors enrolled, of blood taken and plasma produced and the disposition thereof.
- C. Financial statement based upon actual figures to December 31, 1940, and estimates to the expected completion of the project
at about January 31, 1941.
- D. List of all individuals and organizations assisting in the project.
- E. Estimate, submitted pursuant to request of American Red Cross, of expenses involved in equipping and staffing a laboratory
for the bacteriological control of plasma.
- Part II
- A full medical report by the Medical Supervisor of the Blood Plasma Division, the Chairman of the Board, the Chairman of the
Blood Plasma Committee, and the Assistant to the Board, Blood Plasma Division, which is bound herewith.
- Part I
- Narrative Account of the Work, Problems Encountered and Conclusions Therefrom
- The Association
- The Blood Transfusion Association is a non-profit membership corporation, organized in 1929 for the principal purpose of improving
the supply of blood for transfusion purposes in New York City. To this end it has since conducted a Blood Donor Bureau, and
it has also among other activities more recently supplied a special high-titred serum for matching blood groups. Such surplus
funds as the Association has had above a modest reserve have been devoted to the financing of research in the transfusion
field, including the development of blood substitutes. The medical and research work of the Association has been throughout
conducted under the advice of a Board of Medical Control including the leading hematologists and transfusionists in this City.
- Research in Plasma Field
- Part of the research program which the Association financed last year dealt with blood plasma. Such work was carried on by
Dr. John Scudder and Dr. Charles R. Drew, and was done at Presbyterian Hospital in conjunction with certain work in the same
field simultaneously in progress at the Rockefeller Institute. These research workers also, of course, kept in close touch
with similar work done elsewhere.
- Origin of Project
- As a result of this, it was felt in June, 1940, that knowledge of blood plasma had reached a point at which it might be used
effectively for saving life in the warfare then going on in the low countries and France, as information had been received
that casualties were high, both in the armed forces and among the civilian population, as a result of shock from continued
bombing, strafing and exposure. The idea of shipping plasma to France and England was suggested by Dr. Scudder to the President
of the Association in June, 1940.
- On June 12, 1940, the President called a joint meeting of the Association's Trustees and Board of Medical Control to consider
this general subject, and invited Dr. Alexis Carrel, who had recently returned from France, as well as experts in the field
representing the Army, Navy, National Research Council, Rockefeller Institute, New York Academy of Medicine, and the large
pharmaceutical and biological companies, including Burroughs-Wellcome, Lederle Laboratories, Sharp & Dohme, Parke-Davis
- At the meeting Dr. Carrel pointed out the great need and usefulness of plasma for war shock cases in France; Captain Kendrick
of the Army spoke favorably as to the efficacy of plasma; and Dr. Scudder presented some results of the recent research.
- It was the sense of the meeting that, although the use of plasma was still in an experimental stage, enough knowledge was
available to justify an effort at quantity production to save lives of war casualties in the emergency then existing.
- Immediately following the joint meeting, a special meeting of the Board of Trustees was held. The Trustees felt that the project
should be submitted to the American Red Cross as the dean of humanitarian agencies in war relief work, and it was voted to
sponsor the production and shipment of plasma to the Allies, and to appropriate $15,000 from the Association's funds to
start the project immediately, provided the Red Cross was willing to cooperate.
- It was also decided to place at the disposal of the Red Cross all technical knowledge and experience which the association
had gained in its research for such use as the Red Cross might wish to make of it.
- Mr. Voorhees, one of the Trustees, was designated to assist the President, Mr. Bush, and the Chairman of the Board of Medical
Control, Dr. Stetten, in formulating the program and presenting it to the Red Cross.
- It was also voted to make an immediate preliminary survey of hospitals in Greater New York which might be willing to cooperate
in such a program, and also that a similar survey be made as to the extent of cooperation which might be possible from the
major commercial laboratories.
- Since there was a lack of adequate data concerning preparation of dried plasma and its efficacy, it was decided that liquid
plasma would be utilized for the time being.
- Pursuant to such authorization of the Board of Trustees, a tentative memorandum, with the preliminary information then available
and rough estimates of what might be possible in this field, was prepared and presented to the Red Cross by the President,
Dr. Stetten and Mr. Voorhees. Such proposals contemplated cooperation in the work by various voluntary hospitals in New York.
- By the time of such meeting with the Red Cross, France had fallen, and England, with the impending threat of invasion, represented
the center of immediate need.
- Investigation promptly disclosed that statistics based on casualties in the last war would be of little use in estimating
requirements for plasma transfusions, and that the quantities produced would have to be worked out largely without the benefit
of past experience.
- A committee consisting of Drs. Corwin, Drew and Scudder, was appointed by the President to make recommendations as to what
equipment and personnel might be made available by the cooperating hospitals and as to what might have to be supplied by the
Association. This committee submitted a report dated July 1st covering the subjects of personnel, requisite floor space, supplies,
preparation of equipment, serology, bacteriology, supervision, routines for non-centrifuge technique for the preparation of
pooled plasma, and criteria for the selection and protection of voluntary donors.
- It was also ascertained that the Surgeons General of the Army and Navy had taken up the subject of blood transfusions and
treatment of shock with the National Research Council, and that the problem had been entrusted by the latter to a special
committee of which Dr. Walter Cannon of Boston was the Chairman and in which Dr. Cyrus C. Sturgis of Ann Arbor, Michigan,
headed a Subcommittee on Blood Substitutes. Contact was, therefore, at once made with Dr. Sturgis to obtain his views and
to coordinate any program with the work of his Subcommittee.
- Program Agreed Upon
- After some consideration of the possibilities of larger production, it was finally proposed to the Red Cross that the initial
program should be limited to an expenditure of about $40,000 since the first work must be essentially if an experimental character.
In addition to the contribution of $15,000 which the Association had voted to make, as above noted, the American Red Cross
was therefore asked to advance $25,000 and to conduct the campaign for donors through its Chapters in the Metropolitan Area.
This proposal in substance was accepted by the Red Cross, which later added to its appropriation $5,000 more for special purposes,
and the Association also added $5,000 further from its treasury for research.
- Project Begun
- Promptly upon the completion of such arrangements, the American Red Cross and the Association commenced the joint program
in August, 1940.
- The Association secured office space in the New York Academy of Medicine Building at 2 East 103d Street, such space being
donated by the Academy.
- The assistance of six of the leading voluntary hospitals was initially enlisted to take the blood and to prepare the plasma,
as follows: Presbyterian, New York, Memorial, Mount Sinai, Post-Graduate, and Long Island College.
- Appointment Office
- The Association and the New York and Brooklyn Chapters of the Red Cross mutually agreed that all public appeals for donors
should ask that response be made directly to the office at the Academy of Medicine, which would be constituted as a central
bureau to make appointments for donors at all of the cooperating hospitals.
- A complete administrative outline for the setup and telephone arrangements of this office had been previously prepared and
charted. Pursuant to this plan the telephone number given to the public was separate from the number used for other administrative
and routine calls. The former was not connected through a switchboard, but outside lines, under consecutive numbers, were
connected directly to ordinary telephone instruments so that the calls would come in automatically in the first instance to
the appointment clerks, without a switchboard bottleneck.
- The appointment clerks were trained to give a full explanation in answer to all inquires concerning the object of the program,
the nature of plasma, the need, the method of taking the blood, the effects of giving blood, etc. Many persons who telephoned
to make inquires because of interest in the program who were doubtful or timid about giving blood were thereby persuaded to
- Administrative Steps
- Standardized procedures and forms for confirming the appointments to the donors and the hospitals were adopted; and appropriate
card-indices, records of donors and of appointments kept and lapsed were set up and filing systems installed. A system for
financial control and accounting was established as promptly as possible, and arrangements were made with Messrs. Haskins
and Sells to audit the work.
- Forms of releases to the Red Cross, the hospitals and the Association, to be signed by donors, were prepared, and appropriate
instructions were prepared and given the hospitals as to administrative steps and medical and technical procedures for safeguarding
the donors, maintaining sterility of the plasma and standardizing the process as far as possible.
- The plan contemplated utilization of the hospitals to supply laboratories and other facilities, equipment, and the technical
personnel requisite to take the blood, preserve it and process it into plasma. This was necessary as the hospitals contained
the only laboratories, equipment and personnel available. It was recognized that such a plan entailed the disadvantage that
taking the blood and preparation of the plasma would be carried out in several different widely scattered laboratories, with
consequent difficulty of control, but this was unavoidable. The hospitals and most of their staffs, including doctors and
nurses, volunteered their services. This help made the program possible, but the volunteer nature of it, and the large numbers
of persons consequently participating, of course increased the difficulty of controlling technical procedures.
- A detailed report as to the administrative setup of the program, with an organization chart and copies of all forms utilized,
is submitted as Appendix A hereto, and is bound separately.
- Medical Control
- The Association, having agreed with the Red Cross to assume responsibility for taking the blood and preparing the plasma,
arranged through its Board of Medical Control, of which Dr. Rhoads was then acting as Chairman during the absence in vacation
of Dr. Stetten, to supervise and check as closely as possible the work done in the several hospitals. In this work the Board
was aided by Dr. Scudder. It was found at an early date that it was necessary, both for adequate control and for study of
improvements in the procedures, to engage a full-time Medical Supervisor, as Dr. Scudder could devote only part of his time
to the work of supervision on account of his hospital and research duties. Dr. Drew, who with Dr. Scudder had previously been
associated in the conduct of the research work on which the program was in part based, was recalled in September from teaching
duties in Washington which he had just assumed, and was made a full time Medical Supervisor. Dr. Stetten, on his return early
in September, resumed and continued thereafter his duties as Chairman of the Board of Medical Control, and Dr. Rhoads became
Chairman of a Blood Plasma Committee created by such Board.
- The Cooperating Hospitals
- Before the experiment began, some twenty hospitals had evidenced to the Association their willingness to cooperate. However,
detailed studies of the respective hospitals' facilities and personnel available for the task made it seem desirable to
limit the program at first to the six institutions above named, particularly as the doctors in charge of this work in most
of these hospitals were members of the Board of Medical Control and could, therefore, readily test the procedures and exchange
information. Such limitation of the number of hospitals in which work was almost immediately begun was also indicated as
desirable because of initial difficulties in procuring donors, as a result of which the hospital capacity was for some time
more than adequate for the supply of blood.
- Purchases of refrigerators and other equipment as needed were promptly made by the various hospitals at their own cost, and
the Association supplied equipment of a character which the hospitals would not require for ordinary work, such as special
glassware and, in certain instances, centrifuges where they were not already available. The order and dates on which these
hospitals started work were as follows:
- Presbyterian Hospital . . . Aug. 15
- Mount Sinai Hospital . . . Aug. 16
- New York Hospital . . . Aug. 27
- Long island College Hospital (Brooklyn) . . . Aug. 27
- Memorial Hospital . . . Sept. 4
- New York Post Graduate Hospital . . . Sept. 4
- Later the following hospitals also joined in the work:
- Lenox Hill Hospital . . . Sept. 23
- Hospital for Joint Diseases . . . Oct. 1
- Jewish Hospital of Brooklyn . . . Dec. 2
- Publicity and Campaign for Donors
- Since the New York and the Brooklyn Chapters of the American Red Cross, which were under separate direction and had separate
publicity departments, were both asked by National Headquarters to assist in the program, it was initially necessary for them
to coordinate such dual efforts and determine their respective spheres of activity, particularly in publicity. Cordial cooperation
on the part of the publicity representatives of the two Chapters went far to solve problems which under such a divided organization
setup might well have proved serious.
- Early in September executive charge of the work of obtaining donors by the New York Chapter was taken over by Captain Scully
and was carried forward with the greatest effectiveness and a most helpful spirit of cooperation. In this work he was assisted
by Mr. Sinclair of the Publicity Department, and most favorable publicity was obtained.
- The work of the Brooklyn Chapter was under the competent direction of Colonel Bigley, the Executive Director, who was effectively
assisted by Miss Coxson and by Mrs. Warner, the latter being in charge of publicity.
- Through the publicity avenues open to the Red Cross, this joint work by both Chapters resulted in obtaining adequate radio
time as well as dignified and effective publicity in the metropolitan newspapers and national magazines.
- As a result of this, the flow of donors gradually increased, so that at the peak of the program appointments for 1,200 to
1,300 donations per week were being made at the hospitals.
- Close liaison was maintained at all times between the Association and both the New York and Brooklyn Chapters, and a spirit
of the friendliest cooperation prevailed throughout.
- Regulating the Supply of Donors in Relation to Hospital Capacities
- Such close cooperation between the New York and Brooklyn Chapters of the Red Cross and the Association was especially necessary
in order to keep some approximate balance between the flow of donors and the capacities of the hospitals, a subject which
presented for a time a serious problem. In the early weeks the number of prospective donors was unpredictable, and the supply
varied widely from time to time. There were periods during which an insufficiency of donors discouraged the hospitals and
tended to diminish the interest of volunteer doctors and nurses. On the other hand, prospective donors' interest was lost
if an early hospital appointment could not be made, but hospital capacities under the volunteer program were inelastic and
could not be quickly expanded to meet temporary peaks.
- The principal credit for progress in solving this very real problem belongs to Captain Scully, who after several weeks became
able to gauge with considerable accuracy the effect of particular publicity efforts in producing donors and thereby to keep
the supply more nearly in balance with hospital capacities.
- Donor Response
- It is believed that the knowledge gained in this experiment as to the attitude of possible donors will itself prove of great
value in any future program. Prior to this experience, there was no method of estimating how donors would respond to appeals
for mass volunteer blood donations. Opinions varied form an expectation of an overwhelming response to beliefs that there
would be great difficulty in obtaining any considerable number because of apprehension on the part of the public, and the
revulsion which many people feel at the sight of blood or even the thought of bleeding.
- Experience proved that the truth lay perhaps midway between those estimates. Initially there was great difficulty, but, as
the public became educated, there grew a genuine enthusiasm on the part of many to make this a very personal gift for war
sufferers. it is believed that the program demonstrated that blood can be obtained on a volunteer basis in large quantities,
but that this can de done only by intensive and continued newspaper publicity and radio appeals.
- It is also believed that the greatest difficulty in obtaining donors arises from the necessity of having them come to hospitals
or some other central place, instead of its being possible to go to many of them at plants, large offices and stores to take
the blood there. Certain suggestions on this subject for future programs are set forth later in this report.
- Development of List of Donors
- A very important aspect of the work has been the development of a list of about 17,000 donors who have been educated to give
their blood and whose continued interest and cooperation may be expected in large part in any future program. The names, addresses,
ages, telephone numbers and blood groups of these donors, and the fact that they were disease-free are all known. This supplies
an invaluable nucleus for any new program.
- Word from England as to Termination of Need
- It had been planned further to expand the program to other hospitals when early in November a letter was received by the Association
from England, saying that the maintenance of the existing supply of donations to about February 1, 1941, would be sufficient,
and that thereafter England could take care of the situation herself. Because of this no further efforts were made to equip
additional hospitals (with one exception where preparation was already in progress).
- The bleeding schedule, accordingly, continued at a rate of about 1,200 per week until December, when final advices from england
were received that beelding could stop about January 1st. The program was therefore brought gradually to a close, and the
last blood was taken January 17, 1941.
- Plasma Produced
- Detailed statistics as to appointments, donations and plasma produced are set forth in Appendix B hereto, which is bound separately.
The total appointments made for donors were 18,861. The total donations actually taken were 14,556. The total plasma saline
solution produced and either passed by the Association as satisfactory subject to the completion of tests, is conservatively
estimated to be approximately 5,500,000 cc, or 5,500 liters. (The exact amount can of course not be determined until the completion
of tests, and the total figure may somewhat exceed this amount.)
- Detailed figures are given in Appendix C hereto -- bound separately -- and a very general statement is all that is, therefore,
necessary her. The Association paid in full the $15,000 appropriation which it had made. The Red Cross paid over in full its
$25,000 original appropriation. It has not yet been necessary to ask for the additional $5,000 appropriation by the Red Cross
above referred to. The Association's own additional appropriation of $5,000 for research has been approximately fifty
per cent utilized, and expenditures chargeable against this are continuing.
- Arrangements for the division of any unexpended balance of the appropriations for this project were incorporated in the agreement
between the Association and the Red Cross last summer, and such adjustment will, of course, await the final figures and audit.
- Exclusive of special expenses for research from the separate fund mentioned, the total cost of the program based on actual
figures to December 31st and estimates to the completion of the work, will it is believed be about $40,500.00.
- Since this amount is in part estimated, and subsequent figures mentioned herein are partially based upon the same estimate,
all of the figures must be understood to be merely approximations which will be subject to revision on final audit. The present
figures will, however, serve to give a general idea of the cost of plasma produced by a volunteer project of this kind.
- Even if the capital charges for equipment purchased are treated as written off entirely as an expense during the project,
the cost per liter of plasma saline solution produced and passed under the Association's tests as satisfactory, or which
is on hand and, subject to completion of tests, is believed to be satisfactory, is about $7.35. This is equivalent to a cost
per liter of plasma without saline addition of about $14.70. Such costs, excluding capital charges, are $6.35 and $12.70 per
liter, respectively. The above figures of $14.70 and $12.70 for the cost of a liter of plasma without the saline addition
compare with a commercial market price of plasma at $138.00 (Cutter Laboratories) and a non-commercial price of $70.00 from
the Deutsch Serum Laboratories of Chicago, which is a non-profit organization, and which it is understood gets blood at very
- It should also be noted that the fact that the commercial market price for plasma is procured in the far west at a fraction
of the rates prevailing in New York for professional blood donations.
- At such commercial market price, the value of the plasma produced for England, based upon actual figures to December 31st
and estimates thereafter, is approximately $400,000. This plasma has, therefore, been obtained through the volunteer program
at a cost, including capital charges, of slightly more than 10%, and, excluding capital charges, of less than 9% of its commercial
value, this extremely low relative cost being due, not only to the donation of blood, which is of course the largest item,
but to the volunteer character of the work throughout.
- Volunteer Nature of the Project
- All officers of the Association served without pay, as did the Director and the doctors on the Board of Medical Control. Dr.
Scudder also contributed his services without compensation from the Association. The Association's only paid medical staff
has consisted of the full-time Medical Supervisor who, however, made a great personal sacrifice in order to return to this
- Some of the services even of the office staff were of an entirely or partially volunteer nature, and the only paid force consisted
of the stenographic, clerical and appointment staff who, however, worked with great devotion to the cause, and put in long
overtime hours without extra pay.
- All of the extensive research work done by the members of the Board of Medical Control and their staffs was, of course, upon
a volunteer basis.
- The hospitals contributed equipment, facilities, and salaried personnel without charge to a substantial extent; the balance
of the hospitals' costs of doing the work being met by a flat payment per liter of plasma, the amount of which was fixed
by the Association as equitable. The hospitals enlisted many volunteers from their medical staffs to take the blood and process
the plasma. Also nurses in large numbers, after completing their paid work-day on their regular hospital assignments, contributed
their services for extra hours in the project. The work of the hospitals was also very effectively supplemented by Red Cross
Grey Ladies, who were made available by the Chapters to serve as receptionists and hostesses, and gave help and confidence
to the donors and generally assisted the hospitals in all ways possible. Also, certain Red Cross staff assistants were assigned
to the central appointment office, there they were most helpful.
- The entire program has, therefore, represented an outpouring of humanitarian effort of a novel kind and on a large scale.
It has been a spontaneous expression of a deep public sympathy for, and of a keen desire to lend help to, war sufferers in
England. In more than one sense it has been unique among relief projects; It has represented a gift which is literally a part
of each donor; and has been, therefore, of a more personal nature than any contribution of money or articles could be. It
has also represented a form of aid which England could not buy or otherwise obtain, since the cost would have been prohibitive
even if the blood in sufficient quantities had been obtainable on a commercial basis. It is felt, therefore, that the Red
Cross, the Association, and the cooperating hospitals, may look with justifiable pride upon the record which has been made.
- While the system of taking the blood and processing the plasma in the voluntary hospitals is not ideal -- because the highly
technical work was scattered instead of being centralized, and was done by many volunteers instead of a relatively small paid
staff -- it was only by the hospitals' generous cooperation that this work for England could be done at all. Through their
chief doctors, many of whom were members of the Board of Medical Control of the Association, the hospitals also furnished
a sum total of medical knowledge which was a prerequisite to the conduct of the program in the first place, and which has
constantly developed new knowledge on the subject.
- The project has been, not only an experiment in the mass collection and handling of blood and in the widespread use of a
relatively new extension of blood transfusion therapy, but also a concrete demonstration of the ability of large numbers
of volunteers to integrate themselves unselfishly into a working unit to carry on a program which required very close coordination,
considerable technical skill and large sacrifices of time, money and effort on the part of each individual.
- Approximately two thousand volunteer workers have taken part in the portion of the work carried on by the Association and
the hospitals, which, of course, does not include the very extensive work done by the Red Cross itself.
- A full list of those who contributed their services in the portion of the program for which the Association assumed responsibility,
together with the corporations, agencies and individuals contributing to or participating in the work, has been compiled as
Appendix D hereto and is bound separately.
- However, mention should be made here of a few organizations and individuals rendering outstanding service such as:
- The New York Academy of Medicine, which donated office space and supplied furniture and other facilities.
- Messrs. Haskins & Sells, who did all the accounting work for the project without charge.
- Messrs. Pettit & Reed, who without charge supplied refrigerated storage place for the plasma throughout the project, remodeled
the storerooms so that the plasma from the respective hospitals might be kept separate, provided refrigerated trucking for
the plasma from the various hospitals to the warehouse and, through their Mr. Edward Levy, took complete and wholly satisfactory
charge of the records of shipment.
- Mr. Morris M. Davidson, who served as a full-time volunteer as Director of the Blood Plasma Division in charge of the administrative
work of the project.
- And the following who were responsible for heading the medical and technical side of the work:
- Dr. DeWitt Stetten, Vice-President of the Association, who assisted in launching the program, and is the Chairman of the Board
of Medical Control.
- Dr. C. P. Rhoads, Medical Director of the Memorial Hospital, who served during the summer as Acting Chairman of the Board
of Medical Control during Dr. Stetten's absence, and throughout as Chairman of the Blood Plasma Committee of the Board,
and who also participated in the work of Mr. Folsom hereinafter mentioned.
- Dr. John Scudder, who first proposed the shipment of blood plasma to the Allies, helped to get the project started, served
as Assistant to the Board of Medical Control, and who also acted as Director of the work at Presbyterian Hospital.
- Dr. Charles R. Drew, who, as, Medical Supervisor, had charge of coordinating the medical aspects of the program, establishing
uniform records, standard equipment and criteria in order to insure the safety of the final product.
- Dr. Frank L. Meleney, who served as Bacteriological Consultant, and his associate in such work, Miss Balbina Johnson, who
together did a great volume of work of an indispensible character in making all bacteriological tests of the plasma.
- Dr. Nathan Rosenthal, Director of the Department of Hematology at Mount Sinai Hospital, who organized a large hospital unit
which did over 3,000 phlebotomies and which both in the quantity and quality of its work was throughout outstanding.
- Dr. Lester J. Unger, Director of the Plasma Laboratory and Blood Bank at the Post-Graduate Hospital, who directed the collection
of blood and the processing of plasma both at that hospital and at the Hospital for Joint Diseases, and who carried out important
experiments for improvement of techniques.
- Dr. Ralph G. Stillman, Director of Laboratories at the New York Hospital, who took over the responsibility for the entire
- Dr. E. R. Marzullo, who directed the program at the Long Island College Hospital in Brooklyn.
- Dr. Perry J. Manheims, who directed the work at the Lenox Hill Hospital.
- Dr. Alexander S. Weiner, who established at the Jewish Hospital a second center for drawing blood in Brooklyn.
- Dr. William Thalhimer, Director of Manhattan Convalescent Serum Laboratory, who furnished the facilities of his laboratory,
and who worked assiduously in the experimental program.
- In addition to the above mentioned services of these doctors, almost all of them made important contributions to the research
work connected with the program.
- Mention should also be made of the contribution of Mr. Theodore R. Folsom, a physicist on the staff of Memorial Hospital,
who created a new apparatus for drying plasma.
- Miscellaneous Problems Which Have Been Encountered, and Suggestions Derived from Them for Any Future Program
- Fears of Donors
- Many persons who were interested feared the operation involved in giving blood or the effects of the loss, or both. It was
therefore found important to have receptionists or hostesses to greet the donors, excuse delays if necessary, give explanations
desired, allay fears, and generally to look after their comfort after the donation. This was done for the most part by Red
Cross Grey Ladies. This phase of the work is especially important in securing repeat donations.
- Care of Donors
- Pursuant to the policy stated by the Chairman of the American Red Cross at the inception of the program, every possible precaution
has been taken to protect the donors. The Board of Medical Control considered this subject at once, and the hospitals were
instructed, in addition to a physical examination, to determine the donor's blood pressure, temperature and hemoglobin.
No person was permitted to give if in a condition such that harm might have resulted. To protect elderly persons offering
blood, it was decided as a matter of fixed policy not to accept donations from anyone more than sixty years old. Donations
from minors were also declined, both for their own protection and because they were not in a position to execute valid releases
- For the protection of donors, rigid instructions were given to all hospitals that under no circumstances was it permissible
to "cut down on the veins" -- that is, to make an incision to expose the vein.
- To guard against a sensation of weakness on the part of donors during or after the giving of blood, donations were in most
instances taken while the donor was lying down. The hospitals furnished milk, egg-nog, whiskey or other light refreshments
to the donors following bleeding, and a reasonable rest period after the donation was prescribed.
- Some donors felt faint after giving blood, and there were a few instances of donors fainting. Some of such after-effects were
thought to be psychological in origin, although nevertheless real. There were isolated instances, in spite of precautions,
of donors fainting after leaving the hospital, where they left without notifying the hospital authorities that they were not
feeling all right, but in all instances where there was any indication that donors were experiencing weakness after giving
blood, care was at once given to them by the medical staff of the hospital.
- Due to all of these precautions, the outstanding fact in this aspect of the work is that, of the many thousands of donors
who gave their blood, no instance was reported of any serious or prolonged after-effects of the donation, and there was no
report of any infection developing.
- In any future program, continuation of these methods of care and personal solicitude for the welfare of donors is believed
to be of primary importance, and it is thought that this will be of great help in securing repeat donations from the same
- Tests to make certain that the donors were not syphilitic were performed after the blood was taken, and any contaminated blood
was discarded. Where disease was discovered, the donors were advised by the hospital which took the blood that a condition
had been found which made it important for them to consult a physician.
- Blood Grouping
- It was found that the donors were very interested in knowing their blood group -- sometimes referred to as blood type. The
work of grouping the blood was not absolutely essential to the production of plasma, and was done primarily as a courtesy
to donors, and cards were later sent by the American Red Cross certifying the blood group to which they belonged.
- Buttons for Donors
- The Association recommended early in the experiment that a lapel button or other similar insignia be given to donors, but
the Red Cross decided against this and in favor, for this project, of the personal certificate above referred to giving the
donor's blood group. In England's volunteer blood giving system, badges are used for repeat donors, who however must
pay for them. It is believed that, if a large body of donors is to be built up who will give repeat donations, an appropriate
button or other suitable insignia would be most helpful in stimulating the interest not only of the donor who wears it but
of others who will notice it and inquire about it.
- Peak Loads of Calls Following Broadcasts
- One difficulty presented was the great number of proffers of blood which would immediately follow a radio appeal, making it
impossible at times to answer all calls. This was partially met by having an excess reserve number of direct lines and telephone
instruments available in the series of consecutive telephone numbers of the prospective donors, and to inform them that the
appointment office would call back and make the appointment as soon as the peak load was passed, In view of the value of the
blood was compared with the administrative cost, it was felt that every effort should be made not to lose offers of blood
through inadequate office facilities or personnel.
- Lapsed Appointments
- Another problem concerned the failures of donors to keep appointments. Experience throughout indicated an average of about
15% who failed to appear. Since this ran fairly uniformly, allowance was made for this in making the appointments.
- Need of Development of New Publicity Material
- A conspicuous handicap under which the Red Cross labored in the program for procuring donors was the lack of pictures and
publicity stories from England of the use of the plasma, or reports or letters from persons in high official position which
could be used for publicity purposes to show it usefulness in saving life. The story of the project itself was a very simple
one, and once told there was little which could be added to create new publicity material. A cable from one of the English
Army Medical Officers, requesting that an amount of plasma, the production of which would have required 20,000 blood donations,
be shipped in thirty days, was the most helpful publicity material received from England. However, it would have been too
much to expect that the sufferings which the English people were undergoing during these months they could find the opportunity
to create publicity material of this character. In any continued program, however, such pictures and stories to keep the public
plasma-conscious would be most useful.
- Training of Personnel
- In the belief that a national defense program for the production of plasma might soon be needed, the Association has kept
constantly in mind the development of medical and technical as well as administrative personnel.
- The New York and Brooklyn Chapters of the Red Cross have also developed personnel with invaluable training for a campaign
to procure donors elsewhere.
- A limited number of experienced personnel is therefore now available to the Red Cross or the Army or Navy, as a result of
the program just closing, for use as needed.
- Research Aspects of the Program, Medical Problems and Relation to National Defense
- It has been throughout borne in mind by the Association and the doctors connected with it in this work that the knowledge
gained might be useful for national defense as well as for general civilian peacetime purposes. Attention has therefore been
focused throughout upon the research aspects of the program and the development of new and improved techniques, and it was
to this end that the Association made the extra appropriation of $5,000 for research.
- Not only has research been carried on as part of the program, but in a very real sense this entire enterprise was in effect
itself a research project in the possibilities of mass production of plasma from volunteer donors.
- Except for the urgency of the need, it would have been more normal to have spent many months in experimentation before attempting
large scale production, and we were on this account, as well as because of the newness of the entire field, prepared to experience
the unavoidable mistakes and hard lessons of any pioneering program.
- But the interest in such a large production program itself served to stimulate research and improvements, and the experience
gained in mass production also brought much necessary knowledge. Such forced hothouse growth of the plasma-plant has brought
it nearer to maturity in these few months than would have otherwise been possible, even though there were certain limitations
which the conditions of this program placed upon research work, to which reference is hereafter made.
- Based upon the experience so gained, various proposals for continued experimentation and work have been formulated and are
herein discussed, and certain suggestions relative to plasma production for national defense are made.
- The medical and scientific aspects of the work and the problems connected therewith are, of course, more scientifically and
completely considered in the medical report, which forms Part II hereof, but it may be helpful in the present portion of the
report, written by laymen primarily for laymen, to include a brief mention of some of them based on the information contained
in the medical report.
- Liaison with the National Research Council and the Plasma Work Carried on in England and Canada
- Pursuant to the general purpose above stated, the Association, even before the institution of the project, sent one of its
doctors to Ann Arbor to discuss the plan with Dr. Cyrus C. Sturgis, as the head of the Subcommittee on Blood Substitutes of
the National Research Council. Thereafter contact was maintained with Dr. Sturgis to make the project here a helpful part
of the work of his subcommittee, and he twice visited New York at the invitation of the Association to study the work.
- Contact has been preserved throughout with the similar program being carried on in Canada, where for approximately a year
some plasma and serum have been produced under Dr. Charles H. Best, who has developed valuable knowledge upon the subject,
although the number of donors has until recently been relatively small compared to the scope of the project here.