There was an old four-story building on the campus of Cook County Hospital that had long served as its outpatient department. It had on each floor crowded clinics where patients waited long on hard benches to be seen. It had clinics for high blood pressure, where pills were prescribed, but not necessarily taken; clinics for the gastrointestinal and genitourinary tracts; clinics for having babies and later also for not having them; and clinics where doctors treated rashes and asked if they itched or not before applying Greek, grease, and steroids. There was also, at the entrance, a plaque commemorating the founding of the first blood bank in America. Officially it was the Fantus Clinic. Some patients called it the Fantasy Clinic.
The clinic was named after Dr. Bernard Fantus. He had been born in Budapest, educated in Vienna, and had come to America with his parents at age fifteen, first to Detroit, then to Chicago. There he became a doctor in 1902; studied some more in Strasbourg, Berlin, and Michigan; then took an internship at Cook County Hospital. Later in life he was professor at various universities, and notably worked to make medicines for children more acceptable by having them nicely colored and better tasting. In 1915 he published a book called Candy Medication. He was also director of therapeutics at Cook County Hospital, presiding over the dispensing of medicines of which some are still used, such as aspirin and acetaminophen, and also barbiturates, cocaine, and heroin.
At the time of the Spanish Civil War in 1937, Dr. Fantus conceived the idea of making blood readily available, on the battlefield and in civilian life. He set up what he first called a Blood Preservation Laboratory, changing it on the suggestion of his daughter Ruth to the catchier name Blood Bank.
A blood transfusion in those days was a dangerous affair, carried out directly between donor and patient. Having blood in a laboratory or bank would allow it to be stored in large quantities and made available for emergencies. Dr. Fantus had read that the Soviet doctor Yudin had set up such a bank using blood obtained from cadavers. But he thought that such an idea would get little traction in the United States and decided that the blood would have to come from the quick, not the dead.
It is interesting to read the detailed instructions on how blood was to be collected and used.1 The intern was to draw it in sodium citrate and have it tested for syphilis and sterility. The name of the donor, his address, his color (of the donor, not of the blood) was to be noted, as well as that of the intern. Cross matching was to be done by the resident supervising the transfusion. The stored blood was to be taken out of refrigeration when needed and heated in a water bath until too warm for the hand to handle. Staff physicians could deposit blood for credit in the bank, to be used when needed but subsequently replaced, the necessity for such rules being obvious, “just as one cannot draw money from a bank unless one has deposited some.”1
But where was the blood to be obtained from? Mainly from healthy volunteer donors. But also from cardiac and hypertensive patients in need of treatment by venesection, women attending the prenatal clinic (who were to be bled anyway, apparently to have their babies immunized with their blood against hospital infections), patients scheduled to have an elective operation (in case blood were to be needed for themselves during surgery), and patients who had recovered after hospitalization and whose plain duty was to help in their turn to save other’s lives. Paid donors were later also used.
Indications for blood transfusion were to be strictly followed, especially as in the first year of the bank one third of recipients died (presumably from their underlying disease). Transfusions were not to be used for incurable diseases or to prolong the agony of the dying in hopeless cases, nor in sepsis, Hodgkin’s disease, leukemia, pulmonary edema, “myocarditis,” nephritis, and only in special cases of pernicious anemia. The main indications listed were dangerous hemorrhage and shock, mainly in surgical cases, also for preparing anemic patients for surgery, “grave trauma,” profuse hematemesis, jaundice (to minimize oozing of blood), or severe pernicious anemia before liver therapy became effective. The article ended with the disclaimer that it was written “prematurely,” to “secure the better cooperation of the staff of the hospital,” and that questions or problems were to be referred to a committee chaired by Chicago’s most prominent thyroid surgeon. All this was published as a classic article in the July 1937 issue of the highly prestigious Journal of the American Medical Association.1
The idea of a blood bank caught on quickly.2 Within one year, fifty other hospitals in the United States had established such units, and by the fourth year Cook County Hospital averaged seven-hundred transfusions a month. By the time of World War II and the blitz on England, many blood banks had already been established to care for casualties, and there were blood banks all over the world.
By the end of his career, Dr. Fantus had expanded his curriculum vitae to over fifty publications on human pharmacology, cancer medicines, the distillation of water with chlorine, observations on infusions, prescription writing, the role of alcohol in the welfare of the human race, the use of catheters, and many others, showing he was a man of wide interests. He died of a heart attack in 1940, two years after starting his blood bank. And now even the Fantasy Clinic is no more, having recently been demolished and replaced by a modern building made of steel and glass.
- Fantus B. The therapy of the Cook County Hospital. JAMA 1937; 109:128 (February3).
- Smith HM. The first blood bank. MD 1987; p.107, (August).
GEORGE DUNEA, MD, Editor-in-Chief