Barnabas Pastory
Dar es Salaam, Tanzania

Providing medical care to suffering humankind constitutes an important part of the Red Cross’ service scope. History records an important connection between the Red Cross and pioneers in the subject matter of blood.

The humanitarian service of the Red Cross began between 1859 and 1863 with the advocacy efforts of Swiss businessman Henry Dunant. Dunant campaigned for the establishment of volunteer organizations that could impartially attend to war-wounded soldiers and other victims of armed conflicts.¹ That campaign has grown into a world-wide service, namely The International Red Cross and Red Crescent Movement.² Today, the movement forms a network of 80 million people with a presence in almost every country.² The service mission is “to prevent and alleviate human suffering wherever it may be found.”³

But did the work of this international organization originate with Henry Dunant and the establishment of the International Committee of the Red Cross in 1863? The answer is both yes and no: yes in the scope of service that the Red Cross would bring into existence; no in terms of the sources of human and technological capacity that would create that service. When the Red Cross came into official operation in 1863, it did not begin without a basis in history, but rather as a beneficiary of the successive works of medical practitioners who came earlier. Here attention is given to the history of the medical domain of blood and hematology.

One of the earliest practices that focused on blood is venesection, also called bloodletting and phlebotomy. Venesection is the act of removing blood from the circulatory system through a cut or puncture.⁴ This practice is considered one of medicine’s oldest techniques, thought to have originated in ancient Egypt and Greece.^5,6 Physicians, such as Erasistratus in the third century B.C., believed that all illnesses stemmed from an overabundance of blood or plethora.⁵ In the second century A.D., the influential Galen of Pergamon expanded on Hippocrates’ earlier theory that good health required a perfect balance of the four “humors”—blood, phlegm, yellow bile, and black bile. In Hippocrates’ view, each humor was centered in a particular organ—brain, lung, spleen, and gall bladder.⁷

Although venesection as a therapy was practiced for a long time, several controversial cases in history caused later practitioners to doubt its effectiveness. Two well-known examples include: Charles II (1630–1685) who, after suffering a seizure, had about 24 ounces of blood taken before he died; and George Washington (1732–1799) who, after developing a fever and respiratory distress, had abundant amounts of blood drawn before dying the next night of what has been diagnosed retrospectively as epiglottitis and shock.⁸

Venesection continued until the second industrial revolution.⁶ When nineteenth century scholars such as Louis Pasteur and Robert Koch began to demonstrate that germs were responsible for many of the diseases formerly attributed to humors,⁶ venesection was used more for purposes of analysis and blood donation rather than a way of treating diseases. Today, hematologists use venesection for a few conditions such as hemochromatosis, polycythemia vera, and porphyria cutanea tarda.⁹ Still, one should not lose sight of the legacy of the ancient practice of venesection for later practitioners, including the Red Cross: to lay the foundation for the idea that blood can be taken out of the circulation for useful purposes.

Another significant historical practice was that of the barber surgeons. First recognized around 1000 A.D., barber surgeons were considered the medical and grooming experts in Europe throughout the Middle Ages and into the Renaissance.¹⁰ Barber surgeons were responsible for shaving and giving people a haircut, but also performed simple surgical procedures such as bloodletting and tooth pulling.¹¹ These surgeons were also frequently called on to perform wound management, especially for soldiers, a practice which continued at least until the sixteenth century. A noted example was Ambroise Paré, who travelled with the French army as a barber surgeon, applying boiling oil on soldiers’ wounds to counteract the purported poisonous effects of gunpowder.¹² Thus, barber surgeons pioneered methods of wound management and simple surgeries for victims of violent battles. Some of these methods would be built upon in Henry Dunant’s call, “to bring assistance without discrimination to the wounded on the battlefield.”³

Much later, significant breakthroughs in the study of blood were realized. Anthony van Leeuwenhoek identified blood cells under his microscope in 1674.¹³ In 1770 William Hewson, the “Father of Hematology,” introduced the clotting features of blood and explored lymphatic circulation. James Blundell successfully completed the first recorded blood transfusion between humans in 1818 for postpartum hemorrhage¹⁰ and the first successful whole blood transfusion to treat hemophilia was performed by Samuel Lane in 1840. Blood cell staining was developed by Paul Ehrlich in 1878.^13,14

Many outstanding achievements in hematology occurred in the twentieth century, including the identification of blood groups by Karl Landsteiner and his associates in 1901,^13,14 the description of sickle cell disease by James Herrick in 1910, and the first description of sternal puncture to obtain bone marrow by Mikhail Arinkin in 1929.¹⁴ Later, Maxwell Wintrobe classified anemias based on RBC indices in 1934.¹⁴ Two years later the first blood bank was opened in Chicago.¹⁰ In the last part of the century, blood tests for hepatitis B and human immunodeficiency virus (HIV) were developed, which became essential tools for maintaining the safety of donated blood.¹³

The work of pioneers in hematology created the foundation on which modern health care workers and organizations such as the Red Cross are able to provide their humanitarian work in alleviating human suffering. As of 2018, the Red Cross was present in more than 90 countries; there were 191 National Societies and around 17,700 staff members working in different roles.¹⁵ Millions of people receive services through the Red Cross, including primary health care, obstetrical care, disaster relief, and trauma care in conflict zones.

Although the detailed scope of Red Cross operations cannot be wholly captured here, its contributions to the alleviation of human suffering is commendable. These achievements of the Red Cross and those of modern medicine were built in part on the work of blood pioneers, who deserve our notice and respect.

References

1. History.com Editors. Red Cross. History. https://www.history.com/topics/19th-century/red-cross. March 16, 2018. August 21, 2018. Accessed December 20, 2019.
2. International Committee of the Red Cross. The International Red Cross and Red Crescent Movement. International Committee of the Red Cross. https://www.icrc.org/en/who-we-are/movement. Accessed December 19, 2019.
3. International Committee of the Red Cross (ICRC), International Federation of Red Cross and Red Crescent Societies (IFRC’s). Handbook of the International Red Cross and Red Crescent Movement. 14^th ed. Geneva, Switzerland: ICRC & IFRC’s; 2008. https://www.icrc.org/en/doc/assets/files/publications/icrc-002-0962.pdf. Accessed December 17, 2019.
4. Terrace R. Venesection. Mater Hospital Brisbane. http://brochures.mater.org.au/brochures/mater-hospital-brisbane/venesection. 2011. Accessed December 20, 2019.
5. Cohen J. A Brief History of Bloodletting. History. https://www.history.com/news/a-brief-history-of-bloodletting. May 30, 2012. August 29, 2018. Accessed December 20, 2019.
6. Begum N, Ansari AA. Venesection (Fasd). Hamdard Med. 2012; 55(1): 1-7. http://applications.emro.who.int/imemrf/Hamdard_Med/Hamdard_Med_2012_55_1_97_103.pdf. 2012. Accessed December 18, 2019.
7. Magner LN. A History of Medicine. New York: Marcel Dekker, Inc; 1992:66-74.
8. Parapia LA. History of bloodletting by phlebotomy. Brit J Haemat 2008;143:490-495.
9. Lee GR, Foerster J, Lukens J, et al. Wintrobe’s Clinical Hematology. 10th ed. Baltimore, MD: Williams & Wilkins; 1999:1063,1079,1539.
10. Hue DL. THE HISTORY OF THE BARBER SURGEON: A noble service from the Middle Ages. Barber Surgeons Guild.https://barbersurgeonsguild.com/a/dispatch/history-barber-surgeon/?bypasscache=1. November 6, 2017. Accessed December 12, 2019.
11. Berkovitz B. Two Notorious People with Dental Connections. In: Berkovitz B. Nothing but the Tooth. Philadelphia, United States:  Elsevier Inc; 2013:189-206. https://www.sciencedirect.com/topics/nursing-and-health-professions/barber-surgeon. Accessed December 17, 2019.
12. Weller C. Interactive dressings and their role in moist wound management. In: Weller C. Advanced Textiles for Wound Care. Cambridge, United Kingdom: Woodhead Publishing Limited; 2009:97-113. https://www.sciencedirect.com/topics/nursing-and-health-professions/barber-surgeon. Accessed December 17, 2019.
13. Haak D. What is Hematology? -Definition & History.Study.com. https://study.com/academy/lesson/what-is-hematology-definition-history.html. Accessed December 19, 2019.
14. Coller BS. Bloodat 70: its roots in the history of hematology and its birth. Blood. 2015;126(24). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671105/. December 2, 2015. Accessed December 14, 2019.
15. International Committee of the Red Cross: Resource Mobilization Division. Annual Report 2018 Facts and Figures. Geneva, Switzerland: ICRC; 2019. 5-14. https://www.icrc.org/data/files/annual-report-2018/icrc-annual-report-2018-facts-and-figures.pdf. Accessed December 14, 2019.