Blood and war

Abstract

In 1894 Ulsterman and pathologist Almroth Wright described the citation of blood. Twenty-one years later it was introduced into wartime and clinical practice. Harvard Medical School had a large part in providing Colonel Andrew Fullerton, later Professor of Surgery, Queen's Belfast, with the intellectual and practical help for the Allies to deploy blood on the post-Somme Western Front and in Salonika. The key investigators and clinicians were Americans and Canadians who with Fullerton and Wright instructed the Allies. The key enablers were two Harvard-trained surgeons surnamed Robertson-Oswald H. ("Robby") and L. Bruce (no relation). Physician Roger I. Lee of Harvard, surgeon George W Crile of Cleveland, Peyton Rous of the Rockefeller Institute and Richard Lewisohn of Mount Sinai Hospital, both located in the Upper East Side of New York City, played key roles.By Armistice in 1918, indirect citrated nutrient-enhanced blood transfusion was widely used by the Allies. Geoffrey Keynes was taught the techniques of blood transfusion by Dr. Benjamin Harrison Alton of Harvard at a Casualty Clearing Station near Albert at the time of the Battle of Passchendaele. Professor "Robby" Robertson, DSO, Sir Geoffrey Keynes and Sir Thomas Houston established blood banking.

Fig 1

Collage of commemorative postage stamps and Austrian thousand-schilling note honoring Karl Landsteiner (1868-1943), by Lubush Stepanek, from the collection of Rockefeller University, New York, NY, and reproduced with the permission of the Trustees. Landsteiner was born in Vienna of Jewish parents, and graduated from the University of Vienna Medical School in 1891, already having published on the constitution of incinerated blood. He then trained under Hantsch of Zurich, Emil Fischer at Würzberg and Bamberger of Munich—five years as a chemist. Landsteiner then became a pathologist and published extensively on the transmission of syphilis and poliomyelitis. He journeyed first-class by train with inoculated monkeys to the Pasteur Institute in Paris. Peyton Rous, his colleague at the Rockefeller Institute, has written, “The fate of Landsteiner's effort to call attention to the practical bearing of the group differences in human bloods provides an exquisite instance of knowledge marking time on technique. Transfusion was still not done because (until at least 1915), the risk of clotting was too great”. Between 1915 and 1921 Landsteiner's papers, many in German and some in Dutch, were at last frequently read and he accepted appointment as a member of the Rockefeller Institute. He built his family a house on Nantucket Island, Massachusetts, but after a few years “summer people” began to press near on their way to the lighthouse. The Landsteiners then moved to Newfane, Vermont, and Karl commuted by train to New York City. In 1939 Landsteiner became a Member Emeritus of the Rockefeller Institute, “an immaterial change”, and he went on to mentor Linus Pauling on “The Nature of the Chemical Bond”. Pauling liked to say he was given by Landsteiner, “The best four day course in immunology in the history of the world”. Just after having completed another edition of The Specificity of Serological, Reactions, KL died in 1943 of a coronary obstruction; his beloved wife survived but a few months. Their son, a graduate of Harvard Medical School, became a renowned surgeon in Boston.

Fig 2

George Richards Minot (1885-1950). Oil on canvas, dimensions: sight: 126 × 100.5 cm (49 5/8 × 39 9/16 in.), by Charles Sydney Hopkinson, 1943. Harvard Art Museum, Fogg Art Museum, Harvard University Portrait Collection, Gift of the former students and friends of Dr. Minot to the Medical School, 1948, HNA 70. Photo: Junius Beebe © President and Fellows of Harvard College. G.R. Minot was born in Boston, to which his family had emigrated from Saffron Walden in 1630. His father, James Jackson Minot, was a physician on the staff of the Massachusetts General Hospital, and his mother a Whitney. An early published lepodopterist, he graduated from Harvard College and thereafter its Medical School in 1912. Minot trained at the Massachusetts General Hospital and then at Johns Hopkins Hospital and Medical School under W.S. Thayer andW.H. Howell. In 1915 he was appointed as a Staff Physician at the Massachusetts General Hospital, and on June 29^th, 1915 married Marian LinzerWeld. His Nobel Prize biography states “Minot early became, when he was a medical student, interested in disorders of the blood… Further he studied the coagulation of the blood, blood transfusion, the blood platelets, and the reticulocytes…”. Minot's Nobel lecture of December 12, 1934 is a fascinating accountof his work as a 1910 Harvard Medical School student, “In my father's wards at the Massachusetts General Hospital” that led to the development of liver therapy in Pernicious Anemia,” and concluded “Thus, upon the foundations, laid by previous investigators, do medical art and science build a structure which will, in its turn, be the foundation of future knowledge”.

Fig 3

Oswald Hope (“Robby”) Robertson (1886-1966). Photograph from the U.S. National Archives, Washington D.C. , courtesy of the U.S. Department of the Army, Surgeon General, Armed Services Blood Program Office, Robertson Blood Center, Fort Hood Texas. O.H. Robertson was born in Woolwich, England but moved to California's San Joaquin Valley at the age of 18 months. He graduated from Polytechnic High School in San Francisco. After study in Germany he entered the premedical course at the University of California in 1906. In 1910 he obtained his M.Sc. before transferring to Harvard Medical School. Winner of the Dalton Scholarship at the Massachusetts General Hospital, he became an intern there in 1913-14. After his house officership he was appointed an Assistant in Bacteriology and Pathology at the Rockefeller Institute, in Peyton Rous' department. He was the creator of the World's first blood bank in World War I in Belgium and France; later Professor of Medicine and Department Head at Peking Union Medical College, and from 1927 at the University of Chicago. Elected to the U.S. National Academy of Sciences in 1943, Oswald H. Robertson ended his career as Professor of Zoology at Stanford, specializing in the study of Californian habitats and especially the endocrinology of Pacific salmon,. King George V elected him, an American, a DSO in 1918.

Fig 4

Roger Irving Lee (1881-1965) Oil on canvas, dimensions: actual: 130.81x 107.95 cm (51 ½ × 42 ½ in.), by Robert Hale Ives Gammell, 1954. Harvard Art Museum, Fogg Art Museum, Harvard University Portrait Collection, Gift of Dr. Roger I. Lee to the Harvard School of Public Health, 1954, H547. Photo: Junius Beebe © President and Fellows of Harvard College. Lee was a graduate of Harvard College and Medical School, trained at the Massachusetts General Hospital, where he became an attending physician. He there conducted research on blood with Paul Dudley White, George R. Minot and O.H. Robertson. Appointed Professor of Hygiene, Harvard University, he became Chief of Medical Service, U.S. Army Base Hospital Number 5. On February 28^th, 1918, he succeeded Colonel Patterson as Commanding Officer of U.S. Army Base Hospital No. 5. On September 6^th, 1918 he was detached for duty with the American Expeditionary Force as Senior Divisional Consultant in General Medicine, attached to the 3^rd Corps.

Fig 5

Francis Peyton Rous (1879-1970), Oil on canvas by Gordon Stevenson (1892-1984), a student of John Singer Sargent. From the collections of Rockefeller University, and reproduced with the permission of the Trustees. Born in Texas, his father who was a Baltimorean of English descent, died young. His mother was left with three young children and did not return to Texas. Peyton went as a scholar to Johns Hopkins where he scraped his finger during an autopsy, and a “corpse tubercle” formed. His axillary glands were removed and he returned to Texas. He was sent west from there as a ranchero; for a year he never had a bed. He returned, having lost a year, and graduated from Johns Hopkins Medical School in 1905 and was appointed an instructor in the University of Michigan Department of Pathology. He was sent to Dresden for 1907 and in 1909 joined the research team of the Rockefeller Institute. After only a few months he was asked by Dr. Simon Flexner to be his successor as director of the Laboratory for Cancer Research at the Rockefeller Institute, where he remained for 61 years. Both Peyton Rous and his son-in-law Alan Hodgkin received Nobel Prizes and were Fellows of the Royal Society. A late addendum to his 1966 Nobel Biography states “Rous has not mentioned the pioneer research on blood transfusion with J.R. Turner and O.H. Robertson which led to the establishment in 1917 of the world's first blood bank near the front line in Belgium”. Rous was a Fellow of Trinity Hall, Cambridge.

Fig 6

The Harvard Unit at the American Ambulance (World War I Hospital) at Lycee Pasteur Neuilly, Paris, April 1915. Standing: Wilson, Benet, Barton, Rogers, Coller, Cutler, Smith-Petersen. Nurses: Wilson, Cox, Martin, Parks. Seated: Boothby, Beth Vincent, Greenough, Harvey Cushing, Strong, Osgood. Harvey Cushing's journal today fills nine bound volumes (one million words) in his library at Yale. Elliott Cutler succeeded Harvey Cushing as Moseley Professor of Surgery at Harvard, and during World War II was on the Allied Surgical Consultants committee with Sir Ian Fraser and my father.

Fig 7

Alexis Carrel receives the Order of Leopold from King Leopold III of Belgium, June 19, 1937. From the Rockefeller Archive Center and reproduced with their permission. Alexis Carrrel was born at Lyons, France on June 28^th, 1873. His father died when he was very young and he was educated by his mother. In 1889 he became Bachelor of Letters at the University of Lyons, then B.Sc. (1890) and M.D. (1900). In 1902 Carrel began experimental work on transplantation at Lyons, but two years later he emigrated to the U.S. and worked in the Physiology Department of the University of Chicago for two years. In 1906 he was called to the Rockefeller Institute, where he remained for 33 years, apart from service as a Major in the French Army Medical Corps with command of a Rockefeller-supported Base Hospital at Compiègne. Carrel died in Paris on November 5, 1944 Carrel received the Nobel Prize in 1912 for his work on operations on blood-vessels and anastomoses in man. In his Nobel Lecture, Carrel states ,“In his admirable method for the transfusion of the blood, Crile first used suture for the anastomosis of the blood vessels. Although the suture is difficult in very small vessels, it has, nevertheless, been used with success in the transfusion of the blood in infants. The study of the circulation of the blood through metallic tubes has led to a simpler technique… which will increase the efficiency of Crile's method“.

Fig 8

Some of the officers of U.S. Base Hospital Number 5 at Boulogne, 1917. The middle row: Capt. J.L. Stoddard, Capt. H.M. Clute, Capt. Arlie V Bock, Capt. H. Lyman, Capt. A. Hepburn, Capt. Oswald (“Robby“) Robertson, Capt. G.P. Denny, Capt. S.C. Haney, Capt. IP. Wall, Capt. G.A. Horrax. Front Row: Capt. IS. Forbes, Capt. Leonard Colebrook F.R.S., R.A.M.C., Maj. H. Binney, Maj. Prof. Harvey Cushing, Commanding Officer Designate Maj. Prof. Roger I. Lee, Maj. H. Binney, Maj. Albert E.B. Wood, R.A.M.C., Quartermaster Capt. C.E.T. Richmond, R.A.M.C., Capt. F.R. Ober, Chaplain Malcolm E. Peabody.

Fig 9

Harvard's 5^th Base Hospital Nurses' Group, Boulogne, June 1918. Of the 65 nurses shown, 25 were temporarily detached individually to other units to teach the use of Robby Robertson's bottled blood transfusion. Many of the 25 had as many as ten different detachments to ten different Allied units as far forward as Dressing Stations. The U.S. awarded decorations other than Purple Hearts to two, the British decorated eleven. The British decorations included the M.M.,.

Fig 10

The Interior of a Hospital Tent, by John Singer Sargent, 1918, watercolour on paper (393 mm × 528 mm), IWM ART 1611; gift of the artist, 1919, © Imperial War Museum and reproduced with their permission.“While gathering material for Gassed near Peronne, Sargent was struck down with influenza and taken to a hospital near Roisel. Here, he spent a week in a hospital bed next to the war wounded, which inspired this work“. Roger I. Lee recounted his war time encounter in France with the artist, “an old friend in Boston“.