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Chapter V

Contents

CHAPTER V

The American National Red Cross

THE FIRST STEPS OF THE PROGRAM

At the first meeting of the Committee on Transfusions, NRC (National Research Council), on 31 May 1940 (3), part of the discussion concerned the establishment of blood banks, the use of dried and liquid plasma, and the sources of supply for blood and plasma. The questions were not answered.

The same questions arose at the first meeting of the Subcommittee on Blood Substitutes, on 30 November 1940 (4), after discussion of the Blood for Britain project of the New York Blood Transfusion Association (p. 13). Dr. Max M. Strumia, with remarkable prescience, recommended the plan that was, in effect, carried out later; namely, the standardization of equipment and techniques, the establishment of centers for collecting blood, and the commercial preparation of dried plasma.

Dr. William DeKleine, then the medical assistant to the Vice Chairman in Charge of Domestic Operations, American Red Cross, stated that the Red Cross would be glad to assist in such a program but that the Army and the Navy must decide whether they wished his agency "to organize the problem." After further discussion, the following recommendations were made:

As a matter of National Defense the Surgeon General of the Army and Navy request the Red Cross to take steps immediately looking forward to the formation of civilian groups to provide human blood so that in case of a definite National emergency local units would be in a position to supply the blood needed by the armed forces.

It is recommended to the American Red Cross that its support in the matter of providing blood donors for a study of the use of blood and of blood substitutes be continued and extended. In the opinion of this committee this assistance is essential to the solution of the problem. The committee expresses its appreciation.

As a matter of fact, as the second of these recommendations implied, steps to collect blood had already been taken by the Red Cross. In addition to the participation of the New York Chapter in the Blood for Britain project:

1. On 14 June 1940, The Surgeon General, U.S. Army, had requested the Red Cross to procure about a thousand volunteer donors for a research project undertaken by a number of investigators, including Cdr. Lloyd R. Newhouser, MC, USN, and Capt. Douglas B. Kendrick, MC, to determine the best methods of processing and preserving dried plasma and its clinical use. Mr. Norman H. Davis, Chairman, American Red Cross, had assented to the proposal, realizing that this project was the forerunner of the large-scale operations that would

1Unless otherwise indicated, all data in this chapter are from Dr. G. Canby Robinson's final report of the Red Cross Blood Donor Service in July 1946 (1) or report of Col. James A. Phalen MC, on the Blood Plasma Program in July 1944 (2).


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be necessary "in the event of war involving the United States." A similar request, in September 1940, by The Surgeon General, Navy, was also acceded to.

2. In September 1940, the Southeastern Chapter of the American Red Cross, in Philadelphia, undertook to procure donors for the studies on plasma then being conducted by Dr. Strumia, at the Bryn Mawr Hospital, under the auspices of the Committee on Transfusions, NRC (3).

IMPLEMENTATION OF THE PROGRAM

The Surgeons General of the Army and the Navy sent identical letters to Mr. Davis on 7 January 1941, requesting the cooperation of the American Red Cross in the collection of blood for plasma, as follows:

The national emergency requires that every necessary step be taken as soon as possible to provide the best medical service for the expanded armed forces. Even though the need for proper blood substitutes may not be immediate, there seems every reason to take steps now which shall provide in any contingency for an adequate supply of these substances for use in individuals suffering from hemorrhage, shock, and burns.

To this end, in order to assure this adequate supply of the blood substitutes for the use of the United States Army, I am asking the American Red Cross and the Division of Medical Sciences, National Research Council, to organize a cooperative undertaking which shall provide the armed services with human blood plasma. In this cooperative effort, I request the American Red Cross to secure voluntary donors in a number of the larger cities of this country, to provide the necessary equipment, to transport the drawn blood rapidly to a processing center, to arrange for separating the plasma and for storing the resulting product in refrigerated rooms.

I am also requesting the Division of Medical Sciences, National Research Council, to assume general supervision of the professional services involved in this collection and storage of blood plasma, and to provide competent professional personnel, both for a national supervising group and for the local collecting agencies. I am also urging that the National Research Council continue to encourage investigation of the various methods of preparation of blood substitutes, preferably in dried form.

While it is impossible to estimate the requirements of the armed forces at the present time, because of the uncertainties of the international situation, I feel strongly that a large quantity, a minimum of 10,000 pints, of blood plasma should be placed and maintained in refrigerated storage. This feeling is based upon the fact that not only will the plasma be of greatest service if a military emergency arises, but also of ultimate use in any national catastrophe.

I am also writing to the National Research Council making this identical request, and am expressing the hope that the cooperative undertaking may receive approval, with prompt organization of the whole enterprise.

On 9 January 1941, Mr. Davis replied as follows:

The American Red Cross will be glad, as requested in your letter of January 7th, to cooperate with the Division of Medical Sciences of the National Research Council and the Army and the Navy in providing the armed services with human blood plasma.

Representatives of the Red Cross will confer with representatives of the National Research Council and the Army and the Navy immediately in order to formulate the necessary plans for getting the project underway.

On 7 January 1941, Maj. Gen. James C. Magee and Vice Adm. Ross T. McIntire, MC, USN, wrote Dr. Lewis H. Weed, Chairman, Division of Medical


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Sciences, NRC, requesting the cooperation of his agency in this project. On 9 January, Dr. Weed replied as follows:

I wish to acknowledge receipt of your letter of yesterday requesting that the American Red Cross and the Division of Medical Sciences, National Research Council, cooperate in an undertaking which will lead to the procurement of large quantities of human blood plasma.

I can assure you at once that the Division of Medical Sciences will do everything possible to make this cooperation effective. In fact, I am sure that I speak for the members of the Division in telling you that every effort will be made to accelerate the whole mechanism of obtaining and processing the necessary blood.

The Division of Medical Sciences has already taken the initial steps leading to the formation of an operating subcommittee under the general Committee on Transfusions and will probably select Dr. C. P. Rhoads of Memorial Hospital as the chairman of this committee. No time will be lost in undertaking the necessary organization so that a supply of human plasma may be in storage for the use of the armed forces.

On 12 May 1941, a formal agreement was signed by Dr. Weed for the Division of Medical Sciences, NRC, and Mr. Davis for ARC (American Red Cross). This agreement listed specific details concerning the nature of the project, the plan of operation, the joint responsibilities of the two agencies, the responsibilities of NRC through its Division of Medical Sciences, the national and chapter responsibilities of ARC and the functions of the Army and the Navy.

This agreement, which served as the charter of the Blood Donor Service, ARC, was completed only after numerous conferences among all the organizations and personnel concerned. It contained the following provisions:

1. The joint responsibilities of the Red Cross, National Research Council, and Army and Navy consist of the determination of principles and policies of operation; the establishment of budgets for technical operations; the designation of cities in which collecting centers are to be set up; and the control of publications.

2. The Red Cross agrees to establish and maintain facilities in selected cities to procure blood from voluntary donors, to recruit and enroll these donors, to arrange for the proper handling of the blood drawn, and to transport it under proper precautions to laboratories selected by the Army and the Navy for processing into dried plasma.

3. The Red Cross also agrees to provide, on a national scale, the necessary funds for all technical and other personnel needed in the collection of the blood, its transportation, and other technical operations. Red Cross chapters participating in the program will provide the necessary funds for personnel and for other expenses incurred in recruiting and enrolling volunteer donors. The Red Cross also assumes responsibility for maintaining direct contact between the national organization and chapter operations, for keeping the National Research Council informed of problems and progress, and for obtaining adequate monthly reports from participating chapters and processing laboratories.

4. The Division of Medical Sciences, NRC, assumes the general supervision of the professional services involved in the collection of blood and the provision of competent professional personnel for a national supervisory group and for local collecting facilities. It also assumes responsibility for determining the type of equipment to be used for collecting blood and for maintaining direct contacts with the technical supervisors of the program in each community.

5. The Army and the Navy agree that their representatives will work closely with the National Research Council on the technical aspects of each project and with the Red Cross in connection with the quantities of blood needed, its delivery, and other phases of Red Cross concern.


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At a meeting of the Subcommittee on Blood Procurement, NRC, on 18 August 1941 (5), the principal agenda dealt with the best methods of bleeding donors and collecting blood for plasma on a nationwide scale. Decisions were reached concerning equipment, examination and handling of donors, technique of bleeding, organization of the technical staff, handling and transportation of blood, and publicity. These various points are discussed in detail under the proper headings. This conference was attended by members of the Subcommittee on Blood Substitutes; representatives of the Red Cross Blood Donor Service; Dr. G. Canby Robinson, National Director, ARC Blood Donor Service; the technical supervisors of the Red Cross collection centers then in operation; representatives of the Army and the Navy; representatives of the National Institute of Health; and personnel of two of the seven commercial laboratories then participating in the plasma program.

The decisions made at this meeting were published in September 1941, in ARC Manual 784, "Methods and Technique of Blood Procurement as Prescribed by the National Research Council for Use in the Red Cross Blood Procurement Centers" (6). In the ensuing months, a number of supplements and special directives were issued, but the practices prescribed in it remained in effect until January 1943, when a revision, "Methods and Technique Used in Red Cross Blood Donor Centers" (7), was issued. The first of these manuals was based largely on theory. The second was based on a very extensive practical experience.

ORGANIZATION AND PERSONNEL

In the agreement drawn up between the Red Cross and the Division of Medical Sciences, NRC, in May 1941, a national supervisory group was provided for. The Subcommittee on Blood Substitutes became this supervisory body. It originally acted chiefly through its own Subcommittee on Blood Procurement, which was appointed on 19 April 1941 and which served until 12 May 1942, when it was voted out of existence (8).

The initial phases of the program were directed and supervised for the Red Cross by Dr. DeKleine. In July 1941, he was succeeded by Dr. Robinson (fig. 17) with the title of National Director, Blood Donor Service. At the same time, Dr. Earl S. Taylor (fig. 18) was appointed Technical Director. Dr. Taylor, who was a qualified general surgeon, had worked in the blood bank at the Presbyterian Hospital, New York City, and therefore came to his duties with a wide experience in this field. When he was later commissioned in the Medical Corps in April 1943, he retained his position as Technical Director of the ARC Blood Donor Service so that medical officers, who were then working in the blood collection centers (p. 109), would be under the supervision of another medical officer. On 15 August 1944, in response to his request for oversea duty, Major Taylor was replaced as Technical Director by Lt. (later Lt. Cdr.) Henry S. Blake, MC, USN, who served until the end of the war.


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FIGURE 17.-Dr. G. Canby Robinson, National Director, Blood Donor Service, American Red Cross.

Dr. William Thalhimer was appointed Associate Technical Director of the Blood Donor Service on 1 December 1942 and served until 1 December 1944.

Initial Organization

In following the activities of the Red Cross Blood Donor Service, it must be borne in mind that the American Red Cross is not a cohesive organization with a unified central direction. It consists of a group of chapters which are largely autonomous and each of which is governed by its own board of directors.

As the Blood Donor Service was set up in the summer of 1941 (chart 2), it consisted of the following personnel (9):

1. A national director.
2. A technical director.
3. An assistant national director.
4. Area managers.

Under the original plan of organization, before the United States entered World War II, the national technical director served on a part-time basis, while continuing to serve as technical supervisor of the New York Blood Donor Center. Through liaison with the local technical supervisors, he directed the initial technical operations of each new center as it was organized and thus standardized all operations to conform with the techniques agreed upon in August 1941. With the outbreak of the war, however, and the rapid expansion


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FIGURE 18.-Dr. (later Major, MC) Earl S. Taylor, Technical Director, American Red Cross Blood Donor Service, July 1941-August 1944.

of the Blood Donor Service, it became necessary for the technical director (Dr. Taylor) to assume full-time duties in the national organization.

The Subcommittee on Blood Substitutes appointed competent professional personnel who served in a voluntary capacity for the technical supervision of the collecting facilities in each of the blood donor centers. Each chapter selected its own executive and technical directors and its own publicity personnel, none of whom was directly responsible to the National Director, Blood Donor Service. National Red Cross Headquarters, however, paid the medical directors and nurses. General supervision of chapter activities was conducted by National Headquarters through area directors, who were not responsible to the National Director, Blood Donor Service.

REORGANIZATION

As the Blood Donor Service expanded and became more complex, certain weaknesses in the original structure and operation became apparent, particularly the need for greater centralization. Changes under discussion for some time


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CHART 2.-Organization chart, American Red Cross Blood Donor Service, 1941

(9) and put into effect in November 1942 (chart 3) were described in the manual issued in December 1942 (10) entitled "The Organization and Operation of the American Red Cross Blood Donor Service." These changes-

* * * abolished the position of area director and established direct communication between the national director and the center directors and chairmen of chapter blood donor committees. Area representatives of the Blood Donor Service were appointed by area managers to expedite all matters that concerned chapters as such, as distinct from blood donor center operations.

The reorganization effected at this time preserved the advisory and controlling relations between the Blood Donor Service, the Army and the Navy Medical Departments, and the Subcommittee on Blood Substitutes, NRC, as set forth in the May 1941 agreement between the American Red Cross and the Division of Medical Sciences, NRC. The changes increased the measure of control exerted by the national director of the Blood Donor Service over local activities, but there were still points of inefficiency and friction. Some observers believed that truly satisfactory functioning could not be achieved until all paid chapter personnel in charge of recruitment of donors, publicity, and other activities were placed on the national payroll, under the national director of the Blood Donor Service (11).


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CHART 3.-Organization chart, American Red Cross Blood Donor Service, November 1942

Local Organization

Technical supervisor- It was stipulated in the original agreement that each chapter employ a full-time director to administer its blood donor center, to be responsible for all nontechnical activities, for the direction of nontechnical personnel, and for the maintenance of equipment and supplies. The chapter director served as the normal channel of communication between the center and the National Director, Blood Donor Service, to whom he made weekly reports of blood procurement and monthly statistical and financial reports. He had paid secretarial and other assistance as required for the enrollment of donors and his other administrative functions.

The technical supervisor of each chapter was a local physician, preferably an expert in the field of blood transfusion, who served without recompense, at the appointment of the Subcommittee on Blood Substitutes, NRC, under the direction of the National Technical Director of the Blood Donor Service. The local technical supervisor brought to the attention of the National Technical Director all problems related to the technical procedures employed and to relations with processing laboratories. He was responsible for the selection of physicians, nurses, medical secretaries, blood custodians, and other personnel engaged in the bleeding of donors and the handling and shipping of blood. He organized and directed the technical staffs of the centers and was responsible for


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technical operations and procedures according to the techniques specified by the Subcommittee on Blood Substitutes, NRC.

It was essential that the technical supervisor and the center director in each chapter work closely together. They were the only members of the local organization who received instructions concerning details of operation of the center directly from National Headquarters. Each time the director and the technical supervisor of a newly created blood donor center were appointed, they visited, and studied at firsthand, some center already in operation, preferably the pilot center in New York or the center at National Headquarters in Washington, D.C.

Professional personnel-Personnel shortages, as might have been expected, plagued the Red Cross blood donor program during the entire war. Because enough civilian physicians could not be found to man the centers, nurses were trained in bleeding techniques, and Army and Navy medical officers were later assigned to the centers. After some 6 million pints of blood had been collected, it was estimated that an average of 800 to 850 bleedings per week was the best that could be expected from a physician, while each registered nurse could be expected to produce about 120.

At the meeting of the Subcommittee on Blood Procurement, 18 August 1941 (5), it had been decided that there was nothing in the regulations drawn up by the National Institute of Health that would prohibit the collection of blood by nurses, though a physician must be present and available for consultation at all times. This was an important decision: Nurses were in short supply, but they were easier to secure than physicians. In addition, physicians working in the blood donor centers had little time to collect blood; they were kept busy carrying out physical examinations on donors. Policies concerning the use of nurses varied from chapter to chapter. In some chapters, nurses performed the entire procedure. In others, physicians made the original venipuncture and nurses completed the collection of the blood.

At the Conference on Blood Procurement on 14 February 1942 (12), Dr. Robinson stated that the whole blood procurement program was being jeopardized because civilian physicians were leaving the centers to enter the Army or for other reasons. He wondered whether it might be possible to have a number of Army officers, perhaps 15, assigned to the Red Cross Blood Donor Service. Brig. Gen. Charles C. Hillman thought it unlikely.

Dr. Robinson introduced the matter again at the meeting of the Subcommittee on Blood Substitutes on 23 June 1942 (13). The centers were still losing physicians. An attempt to secure women physicians had failed numerically. If the blood procurement program were to succeed, the Armed Forces must make some provision for the assignment of competent physicians to it. For the 1.4 million bleedings so far requested for the year beginning 1 July 1942, 56 bleeding teams would be needed, each to procure 500 bleedings per week. This number would provide only for the plasma program then contemplated and the pilot order of 51,000 units of albumin, not for any expansion which might occur in the latter program. Dr. Robinson hoped that the Army and


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the Navy would each assign 19 officers to the centers, to bring the professional staffs up to the 56 physicians just specified.

The subcommittee recommended to the Surgeons General of the Army and the Navy that they give favorable consideration to the assignment of a small number of medical officers to temporary duty in the Red Cross bleeding centers, on the ground that shortages of personnel were already jeopardizing the entire program. A point made in the recommendation was that losses occurred when blood was collected by untrained and incompetent personnel. A report from the Pittsburgh Blood Donor Center, in which the rate of clotting had previously been very low, showed that it had suddenly become very high, apparently as the result of the employment of four inexperienced phlebotomists.

By November 1943, when 35 centers were in operation (14), it was estimated that 135 physicians were the bare minimum with which they could be conducted, without any allowance for illness or other unforeseen emergencies. At this time, these centers were being operated by 34 civilian physicians, 40 Naval medical officers, and 60 Army medical officers, who were under the operational control of the Transfusion Branch, Office of The Surgeon General.

An attempt to utilize officers separated from service for physical disabilities did not succeed. They often proved unable to tolerate duty in the centers and entirely unable to withstand the hardships of work in mobile units. Many had to be relieved because of reactivation of their physical disabilities. With no replacements available for them, appointments had to be canceled, and, in view of the urgent appeals made for blood donations, this was bad public relations.

From the standpoint of public relations, it was probably unwise to have accepted some of the medical personnel in both the civilian and the military groups. At the Conference on Blood Preservation on 19 January 1945 (15), many of the volunteer physicians serving as local technical supervisors expressed the opinion that a number of Army medical officers of substandard quality had been assigned to the bleeding centers and that their handling of donors had sometimes created serious breaches in public relations. These difficulties had been infrequent with Naval officers. The conference was assured that the Army Medical Department would take steps to correct the situation at once.

Essential as was the work of these blood donor centers, assignment to them was neither interesting nor desirable. Attempts to rotate the officers assigned to them were not particularly successful, and many remained in them, without chance for promotion, for 2 years or more.

As centers were closed during the last months of the war, personnel in them were released, and by 17 August 1945, 3 days after the Japanese surrender, the Transfusion Branch, Office of The Surgeon General, requested the retention of only seven officers, three in centers on the west coast, which would continue to supply blood for the Pacific; one at the center in the Pentagon, which would supply blood for Walter Reed General Hospital, Washington, D.C.; and three at the center in New York, to complete a research study on O blood (p. 259).


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Enlisted personnel-The enlisted personnel assigned to the blood donor centers played an extremely important part in their successful operation. They performed work of a highly technical nature, including blood typing, agglutinin titering, Rh tests, and Kahn tests. Reports on the blood moved overseas from the whole blood centers at New York, Boston, and Los Angeles indicated the satisfactory nature of their work. The staff sergeants at these centers were doing work usually handled in Army laboratories by commissioned medical officers or members of the Sanitary Corps, and it was with considerable difficulty that ratings of technical sergeant were finally secured for them.

Volunteers-By the most conservative estimate, at least 100,000 volunteer workers contributed full- or part-time service to the Blood Donor Service during the 4 years of its operation. Their work was usually organized by the chapter blood donor committee, in cooperation with the chairman for Volunteer Special Services. They served as staff assistants, canteen workers, Gray Ladies, nurses' aides, and drivers in the Motor Corps. Lay and professional workers also contributed to the managerial, public relations, and recruiting aspects of the Blood Donor Service.

The exact distribution of the volunteer work is not known, but returns from a questionnaire sent out to the blood donor centers at the end of the war indicated that of 52,700 volunteers who replied, 13,300 had worked in canteens; 9,700 in the Staff Assistance Corps; 5,200 as nurses' aides; 4,600 in the Motor Corps; 4,100 in the Hospital and Recreation Corps; and 15,800 in other services.

BLOOD DONOR CENTERS

Establishment-The first Red Cross blood donor center in the Blood Plasma Program of World War II opened in New York on 4 February 1941 (fig. 19, table 1). The 35th opened in Fort Worth on 10 January 1944. Eleven centers were opened in 1941, 19 in 1942, and 5 in 1943 or early in January 1944. The nine centers opened between 1 December 1941 and 1 February 1942 had all been planned or were in process of establishment before Pearl Harbor.

Centers were closed as special requirements for the Army and the Navy were completed. Four centers were closed when the Navy contracts for albumin were terminated in October 1944. Nineteen were closed after the German surrender in May 1945. By 15 September 1945, the only center still in operation was in Denver; it was kept open at the request of the Army to supply small amounts of whole blood to the nearby Fitzsimons General Hospital, Denver, Colo.

Facilities.-Five centers occupied the property of local Red Cross chapters during all, or almost all, of their period of operation. Seven occupied donated space and two others space donated for all but a portion of the time. The remainder operated in rented space in stores or office buildings, usually in downtown areas or shopping districts, with public transportation, parking space, and space for trucking facilities (fig. 19).


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TABLE 1.-American Red Cross blood donor centers in order of their establishment


Center

Date of opening

Date of closing

1. NewYork 

4 Feb. 1941 

15 Aug. 1945

2. Philadelphia 

1 May 1941 

15 Aug. 1945

3. Baltimore

19 May 1941

19 May 1945

4. Washington 

11 June 1941

15 Aug. 1945

5. Buffalo 

1 July 1941

19 May 1945

6. Rochester 

21 July 1941 

19 May 1945

7. Indianapolis  

27 Sept. 1941

19 May 1945

8. Boston 

1 Dec. 1941 

15 Aug. 1945

9. Detroit 

1 Dec. 1941 

19 May 1945

10. Pittsburgh 

1 Dec. 1941

19 May 1945

11. St. Louis 

10 Dec. 1941

19 May 1945

12. San Francisco 

2 Jan. 1942

15 Sept. 1945

13. Cleveland

8 Jan. 1942

19 May 1945

14. Los Angeles 

20 Jan. 1942 

15 Sept. 1945

15. Milwaukee 

20 Jan. 1942 

19 May 1945

16. Chicago 

1 Feb. 1942 

15 Aug. 1945

17. Cincinnati

 

1 Mar. 1942 

19 May 1945

18. Brooklyn 

9 Mar. 1942 

15 Aug. 1945

19. Atlanta 

11 May 1942 

19 May 1945

20. San Antonio 

1 June 1942 

15 Oct. 1944

21. Portland 

17 Aug. 1942 

15 Sept. 1945

22. Denver

14 Sept. 1942 

1 Dec. 1945

23. Hartford 

15 Oct. 1942 

19 May 1945

24. New Orleans 

26 Oct. 1942 

15 Oct. 1944

25. Harrisburg 

9 Nov. 1942 

19 May 1945

26. Schenectady 

23 Nov. 1942

19 May 1945

27. Columbus 

1 Dec. 1942 

19 May 1945

28. Minneapolis 

1 Dec. 1942 

19 May 1945

29. Kansas City 

7 Dec. 1942 

19 May 1945

30. St. Paul 

7 Dec. 1942 

19 May 1945

31. Oakland 

15 Feb. 1943 

15 Sept. 1945

32. Louisville 

31 May 1943 

19 May 1945

33. San Diego 

15 Aug. 1943 

15 Sept. 1945

34. Dallas 

3 Jan. 1944 

15 Oct. 1944

35. Fort Worth 

10 Jan. 1944

15 Oct. 1944

1Inception of Army and Navy project. Previous bleedings procured from Walter Reed General Hospital and Naval hospitals.
2Continued operation after closing of other centers, at request of Army, to provide blood for Fitzsimons General Hospital, Denver, Colo.

All the facilities occupied required some remodeling for the special needs of the Blood Donor Service. Most of it could be accomplished by temporary partitions. As new centers were planned, they were altered and reconstructed in the light of earlier experience. Air conditioning was necessary in some centers in the South.


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FIGURE 19.-American Red Cross blood donor centers. A. New York, N.Y. A mobile team is about to depart. B. St. Paul, Minn. C. Louisville, Ky.

The size of the facilities varied with the weekly quotas of the centers, which ranged from 1,500 to 10,500 bloods. All but 5 of the 22 centers in operation before October 1942 later had to move into larger quarters.

The following rooms were required:

Offices for the center director, the physician or medical officer in charge, the special assistant, and the recruiting and publicity staffs. In the larger centers office space was also provided for the chairman of the blood donor committee and for the committee (fig. 20).

Rooms for the reception, testing, examination, and bleeding of donors, which are described in connection with the technique of collecting the blood (p. 148).

A special telephone room for appointments and for reception of the innumerable inquiries which came into each center.

A room for files for registration cards and other donor records and for material used in recruiting and in obtaining redonations.

Workrooms for preparing, cleaning, and sterilizing equipment and supplies; handling bleeding equipment; and storage of supplies and equipment.


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Rooms for the refrigeration of blood collected at the center, for reception of blood from mobile units, and for packing of blood in refrigerated chests for shipment to processing laboratories. These rooms were preferably at the rear of the center, out of the way of donors, and with ready access to trucks.

Canteens, restrooms, and locker space for nurses, volunteers, and other members of the staff.

FIGURE 20-Committee room, American Red Cross Blood Donor Center, Fort Worth, Tex. Dr. G. Canby Robinson, Director, Blood Procurement Project, ARC, is at the head of the table, fifth from left.

MOBILE UNITS

Mobile units (fig. 21) were operated out of all blood donor centers, the numbers ranging from one to four. At the height of the program, 63 were in operation, and, in all, 47 percent of the blood donations were made through them. These units operated within a radius of 75 miles of the 35 centers, and it was estimated that their use brought 60 percent of the population of the country within range of the Blood Donor Service.

Mobile units had a number of advantages. They gave flexibility to the donor centers in filling their quotas. They materially expanded the territory and population from which donors could be drawn. They also allowed hundreds of Red Cross chapters and their thousands of members to participate in the Blood Donor Service, a participation which, for geographic reasons, would not have been possible otherwise.


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FIGURE 21.-Mobile units, American Red Cross Blood Donor Service.

Equipment.-The physical equipment of a mobile unit usually consisted of a 1-ton truck, although some centers continued to use the 1-ton panel truck, which was originally provided, till the end of the war. Many of the trucks were given by civic and other organizations.

Each unit was equipped with folding tables; 10 or 12 specially designed folding cots; four or more portable refrigerators, each with a capacity of 40 bottles of blood; and 9 or 10 boxes that contained all the supplies needed for collecting blood. On the cover of each box was a list of its contents. The


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FIGURE 22.-Setup of mobile units, American Red Cross Blood 
Donor Service. A. Los Angeles, Calif. B. Trenton, N.J.

truck was so packed that a temporary blood center could be set up almost as soon as the destination was reached (fig. 22). A variety of buildings was used-schoolhouses, assembly halls, parish houses, or available space in an industrial or military establishment.

Staff.-The technical staff of the mobile unit consisted of the physician in charge; five or six nurses; a technical secretary; and a blood custodian, who


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FIGURE 22.-Continued. C. Baton Rouge, La., where the blood was collected in the Capitol, under a statue of Bienville, Louisiana's first Governor. D. An unidentified location.


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frequently served as chauffeur. Occasionally, a few well-trained volunteers from the parent center went along, but more often the cooperating chapter supplied the volunteers. The technical staff was transported in station wagons, many of which were also special gifts.

Policies and procedures-The cooperating chapters made all arrangements for the visits of the mobile units, the preparations usually requiring several weeks of intensive work and publicity. It was necessary to recruit and enroll specified numbers of donors for each day of the operation; to secure the most suitable rent-free building available for the operation; to organize the necessary volunteer services; and to supplement the equipment from the center with locally provided tables, lights, couches, and canteen equipment.

The activities of the cooperating chapters generally corresponded with those of fixed centers except that recruitment took the form of intensive drives rather than day-after-day publicity. Since many of the towns visited were relatively small, it was often necessary to comb several counties to meet the quotas set. The wide appeal, and the relatively greater efficiency, of periodic drives as compared to routine recruitment was evidenced by the fact that only 15 percent of the donors enrolled in mobile units canceled their appointments or failed to keep them as compared to 25 percent in the fixed centers. Relations with the cooperating chapters were always cordial, and their arrangements were always efficient.

Activities.-Mobile units visited not only cooperating chapters but also branches of chapters, industrial plants within the jurisdiction of the blood donor centers, military establishments, and Federal and state penal institutions. Many times, churches, under the stimulation of their clergy, recruited donors as well as contributed blood themselves.

By the end of the war, it was estimated that mobile units had operated in 3,260 different places, including 1,100 cooperating Red Cross chapters, 1,130 branches of chapters, 590 industrial plants, 260 military establishments, and 180 other places. Many other chapters made repeated efforts to be included in the program, although they were so remote from the centers that it would have been impractical to include them.

CONFERENCES

A number of conferences on the blood donor program were held during the war. They included:

1. A conference on technical operations at Atlantic City, N.J., on 7 June 1942. It was attended by the technical supervisors of the centers then in operation and representatives of the National Headquarters, American Red Cross, the National Research Council, the National Institute of Health, the Army and the Navy.

2. A conference on general problems in Indianapolis on 19-20 January 1943, attended by the chairmen of blood donor committees; directors of all


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centers then in operation; and representatives of the National Headquarters, ARC, and the Army and the Navy.

3. A conference in New York on 15-16 December 1943 and a similar conference in Chicago on 18-19 January 1944, attended by regional technical supervisors, the directors of the centers, and the chairmen of the center blood donor committees.

The special items discussed at the meetings are described under appropriate headings.

CAMPAIGNS FOR BLOOD DONORS

General Considerations

The American Red Cross Blood Donor Service began with the enormous emotional advantage that donations of blood could save the lives of wounded men. Thousands of persons who could make no other contribution to the war effort gladly gave their blood, and many of them repeated their donations as often as they were permitted. It is ironic, therefore, that from the beginning to the end of the program, the major problem was to obtain an adequate number of donors to meet the requirements. Spontaneous, unsolicited donations were the exception rather than the rule except in special circumstances. Only unceasing efforts enabled the centers to meet their quotas, particularly during lulls in fighting.

The requirements for blood in the 10-month period between the institution of the Blood Donor Service and Pearl Harbor were negligible compared to later demands. Only 28,974 pints of blood were procured during this period, an average of 724 pints per week for the 10 centers then in operation. Only two of these centers had been active during the entire 10 months, and the average amount procured by them was 145 pints per week. Even the largest center, at peak operation during the prewar period, obtained only 441 pints per week.

Donations increased notably immediately after Pearl Harbor, and increased similarly after other severe fighting. After the Normandy invasion, donors poured in from the streets and swamped the telephone lines. During that week, 123,284 pints of blood were collected, and thousands of future appointments were made.

On the other hand, the flow of information concerning the war provided by the free press of the United States sometimes had the effect of a two-edged sword. Immediately after the Normandy landings, for instance, the happy news was received that casualties had been fewer than anticipated. Donations promptly declined sharply and did not again approach the invasion peak until the spectacular race across France began several weeks later.

The pre-Pearl Harbor period had made one thing quite clear, that general publicity must be supplemented by specific recruiting techniques. With spontaneous response apparently depending largely upon the ebb and flow of


120

battle, the greatest single problem was how to maintain an adequate number of donors when the war news was not spectacular.

A second difficulty inherent in the program and not generally clear to the public, in spite of efforts to clarify it, was the necessity for operating each center and each mobile unit on a strict system of weekly quotas. No surpluses could be built up. Planning had to envisage a regular number of donors every day. It was a serious matter when the quotas were not met and also a serious matter when collections exceeded capacity, as they did, for instance, in September 1943.

A part of this same consideration was that blood procurement facilities were necessarily located near processing laboratories. As a result, publicity which would have been gladly provided throughout the country in motion picture theaters, over radio networks, and in similar media had to be used with great care. Only a few experiences were needed to show that national appeals for donors caused confusion and frustration in communities in which facilities for processing blood donations were not available. The closing of collection centers at the height of the fighting also made for difficulties in public relations, perhaps because the reasons-that special programs, such as the serum albumin program, had been successfully concluded-were not made as clear as they should have been.

External circumstances also interfered with donations. Plasma deliveries in December 1943 were 40 percent short of the quota because of an epidemic of influenza. On 9 February 1945, a blizzard in the East almost wiped out the donations scheduled for that day and the next several days.

Cancellations of appointments and failures to appear for scheduled appointments were serious losses in themselves, and they also wasted the time of physicians, nurses, and technicians, for they kept other volunteers from using the time scheduled. Some centers found it profitable to send out reminders several days in advance of appointments. About 10 percent of donors who appeared for their appointments had to be rejected for physical reasons.

For these and other reasons, it was necessary to secure an enrollment of about 150 donors to obtain each hundred pints of blood. This meant that the 13,326,242 pints of blood collected during the war by the Red Cross required the enrollment of nearly 19 million persons.

Multiple donors-A major source of blood came from multiple donors. Most centers had a special desk at which, before they left, donors were invited to make future appointments. Some donors voluntarily phoned for second appointments. It was estimated that the average donor made two donations. About 1 million gave three donations, 150,000 gave a gallon each, and about 3,000 gave 2 gallons or more. In some centers, multiple donations ran as high as 60 percent of the blood collected. Multiple donations and the publicity which attended them did much to dispel the fear in some minds that giving blood was harmful.


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Development of Recruiting Program

Since the United States was not at war when the Red Cross Blood Donor program was begun, publicity was naturally less urgent than it became later. Promotional material was devoted chiefly to an explanation of the project and its potential value if war should come. The pamphlet issued in November 1941, entitled "Teamwork From Publicity to Plasma," was intended to stimulate general interest in the blood program; to provide information as to its origin, purpose, and objectives for those who were to cooperate in its organization and operation; and to insure accuracy and consistency of effort.

In January 1942, the importance of publicity and promotion in a country at war was recognized by the appointment of an Assistant National Director of the Red Cross, whose function was to coordinate all promotional matters and assist the blood donor centers in publicity and recruiting. This official was in direct contact with the directors of the centers, the chairmen of the local blood donor committees, and the chapter personnel in charge of local recruiting and publicity. All activities connected with promotion and public relations were thus closely coordinated with the administrative and technical aspects of the Blood Donor Service on both the national and the local levels. The office of the Assistant National Director (including his assistant, two special representatives who served as volunteers, and the secretarial staff) also acted as liaison between the Blood Donor Service, the information departments of the Army and the Navy, the Office of War Information, the War Activities Committee of the Motion Picture Industry, the Writers' War Board, and similar organizations.

This office of the Blood Donor Service prepared and distributed to the donor centers a large variety of promotional material, including posters (fig. 23), leaflets, car cards, pamphlets (fig. 24), motion pictures, photographs, radio transcriptions and announcements, recruiting plans, and publicity kits. Commercial firms generously contributed outdoor advertising space (fig. 25).

In May 1942, a revised publicity kit prepared by the Public Information Service, National Red Cross Headquarters (7), was furnished to the chapters operating blood donor centers. This kit contained information on the origin of the program; the initial activities; the increased requests for blood; the location of the 18 blood donor centers then in operation and of the laboratories processing plasma; the explanation of why the collecting centers were restricted to these special localities; the restricted use of plasma (that is, its reservation for military use only); suggestions for publicity for the individual chapters; material for promotional activities, including newspaper releases and fillers, posters, displays, folders, and leaflets; and spot radio announcements. The kit also contained information about the processing and use of plasma, including its preparation as dried plasma. Finally, it contained a talk to be used while personal appeals were made for donations from special groups in person or on the radio.


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FIGURE 23.-Posters used by American Red Cross for recruiting blood donors.


123

FIGURE 24.-Covers of pamphlets used by American Red Cross for recruiting blood donors.


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FIGURE 25.-Outdoor posters, contributed by commercial firms, advertising blood donor centers. A. San Diego, Calif. B. San Francisco Calif.


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Special Methods

In spite of the use of all possible advertising media and methods, enough donors were not attracted by these means to meet the steadily increasing demands for blood, and special plans for the recruitment of donors had to be put into effect. They included:

1. House-to-house canvasses by Red Cross volunteers, members of the Junior Red Cross, Boy Scouts, and other organizations.

2. Organized drives in schools, to persuade students to persuade their parents to give blood.

3 . Recruiting booths in department stores and office buildings.

4. Personal appeals, by well-trained, tactful Red Cross personnel, in motion picture theaters.

5. Distribution of application blanks in business firms, industrial plants, and at meetings of civic, labor, religious, and fraternal groups.

These methods all produced direct results, in addition to the general publicity they provided, but all of them had the same defect: They brought large numbers of appointments, but the percentage of so-called no-shows was much larger than when donors voluntarily telephoned for appointments. More precise methods of recruitment were obviously necessary.

Participation of labor unions-At the conference of blood donor service officials in January 1943, just after the Army and the Navy had sharply increased their requests for blood, a plan was presented for the participation of labor unions. It had been worked out, at the request of the unions, between National Headquarters, ARC, the American Federation of Labor, the Congress of Industrial Organizations, and the Railway Brotherhoods. The basis of the plan was that locals throughout the country, with the endorsement of their national organizations and in cooperation with local blood donor officials, should seek to stimulate blood donations from their members. A booklet was prepared explaining the plan in detail, and other informational and recruiting material was made available for local use.

The contacts and activities resulting from this plan led to a high degree of cooperation between the unions and the Blood Donor Service centers, which was fostered by meetings at local levels. When the group recruiting plan, to be described next, was put into effect, the groundwork for it had already been laid by the plan already in effect in labor unions.

Group recruiting-The group recruiting plan was a precise method of obtaining donors which had been introduced and perfected by some centers in the first year of the program. It was given added impetus when it was endorsed by a national conference of Blood Donor Service officials in December 1943 and in January 1944. Thereafter, it was used by all the centers and did much to maintain the necessary blood quotas, especially during the periods in the spring and late summer of 1945, when rumors of impending enemy capitulation began to lessen the effectiveness of appeals for donors.


126

The group recruiting plan was carried out as follows:

1. A card index in each center showed the larger local business firms and organizations, the name of the head of each firm, and the number of employees or members.

2. Each such organization was asked to provide a regular number of weekly donors, the number depending upon the total number employed and usually averaging 5 percent of the personnel.

3. To implement the plan, special recruiting committees were formed in each center, composed of civic and community leaders who had had experience in such drives. Each member was provided with promotional material suitable for the organization to which he was assigned. The organizations themselves assumed the responsibility for securing the pledged number of donors and for furnishing alternates if those originally scheduled could not or would not keep their appointments. The members of the recruiting committee pointed out to the officials of the organization the importance of appointing really representative labor-management committees to sign up donors. It was also recommended that the employees be allowed to donate on paid time.

This method provided a regular schedule of donors for each center each week. If a center could schedule 50 concerns or organizations which would supply an average of 10 donors each per week, it could be assured of 500 donors per week and could make up the rest of its quota from repeated donations, publicity, and other methods. Moreover, by controlling the supply of donors, the flow through the centers could be regulated and the most efficient use possible made of personnel and facilities. It was found that donors recruited by their own firms and organizations generally kept their appointments (fig. 26), because interdepartmental competition and pride of achievement were called into play. From the standpoint of the firms, the donations did not interfere seriously with their production, and they, like their employees, profited from pride of achievement. Many of the firms adopted the slogan, "A Pint of Blood for Every Star in Our Service Flag."

While precise figures are not available, it is believed that at least 20,000 business and industrial organizations participated in this phase of the blood donor program. With the possible exception of the overall publicity techniques and the repeat donors signed up in the centers, this plan produced more donors than any other used. In one city, under the leadership of an extremely able chairman, Federal agencies alone provided between 60 and 70 percent of all donors after the plan began to operate. The secret of success in every instance lay in careful internal organization and the amount of hard work devoted to personal contacts.

To complete the story of efforts to procure blood donors, two other items should be mentioned. The first is the presentation on the "Army Hour," a regular wartime radio program, on 24 October 1943, of a dramatization of blood plasma, its collection, and its uses. The second is the film entitled "Life


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FIGURE 26.-U.S. Army cadets from Marquette University ready to give blood at the Milwaukee, Wis., donor center.

Line," which was presented to the Blood Donor Service officials and others in attendance on the conferences in December 1943 and January 1944. Most of the officials present asked to borrow it for local showing.

Recognition of Donations

There were a number of proposals to offer inducements to blood donors, with the hope of increasing the number of donations. The plan was tried out in the spring of 1943, in Brooklyn, with the offer of tickets to baseball games for each donation, but the public reaction was instant and adverse. The plan was discontinued on the third day, and nothing like it was ever proposed again.

E awards-By the end of June 1942, the Red Cross had collected 461,493 pints of blood. To express their formal appreciation to the Blood Donor Service, the Surgeons General of the Army and the Navy, on 15 September 1942, presented the Army E flag and the Navy E award emblem to the Chairman of the American Red Cross, at ceremonies at the National Headquarters in Washington. All the chapters which had participated in the program up to April 1942 were represented by chapter officials and personnel of the blood donor centers.

The same production awards were later made at local ceremonies to the 18 chapters which had participated in the program up to this time and were subsequently made to chapters which entered the program later. The ceremonies at which these awards were made were arranged with great care, and the effect on recruitment of donors was usually evident.


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In 1943 and 1944, the Army-Navy Award Board added stars to the pennants of the original recipients for sustained excellent performance.

The Gallon Club-It is an interesting fact that the American Red Cross itself apparently had no realization, when the Blood Donor Service was instituted, of the magnitude the program was finally to assume. Each donor received a bronze emblem on his first donation and a silver emblem on his third. No further recognition was provided for, on the assumption, then widely held, that the project, even if expanded, would not require more than three donations from any one donor. Later, it was realized that multiple donors should receive greater recognition. Gallon Clubs were formed in several cities, and red, white, and blue ribbons were attached to the silver emblems to indicated 1-, 2-, and 3-gallon donors. In retrospect, it is unfortunate that more conspicuous recognition was not given to multiple donors.

Labeling of plasma-In December 1944, in response to numerous suggestions and as an added incentive to donations, the Red Cross label on the official Army-Navy package of dried plasma was altered to read (fig. 24):

The plasma contained in this package was processed from the blood of volunteer donors enrolled by the American Red Cross and symbolizes in part the blood gratefully donated by --- in honor of --- of the United States Armed Forces.

This plan was purely symbolic, since it was technically impossible to identify the plasma processed from any particular blood. Nonetheless, it gave donors a sense of active participation in the war effort, and about a third of them inscribed their names on the labels after the plan was put into effect.

OTHER ASPECTS OF THE PROGRAM

Local conflicts.-As pointed out elsewhere (p. 91), a number of communities attempted to collect blood for local use, and their efforts interfered with the national program to obtain blood for the Armed Forces. As late as December 1943, a large New York City hospital began an intensive campaign to recruit donors for its own blood bank, and it took the combined efforts of the Red Cross, the Office of Civilian Defense, and the Superintendent of Hospitals of the City of New York to straighten out the situation.

Offers and suggestions-During the war, the Red Cross, the Army and the Navy, and other governmental agencies received many questions and suggestions connected with the blood program. Some extremely detailed questions concerned the production and uses of plasma. Whenever there was a lull in the fighting or word of the approaching end of hostilities, there were numerous inquiries as to whether blood was still needed. One correspondent had guinea pigs whose blood she wished to sell for conversion into plasma.

Many soldiers wrote to suggest that blood banks be established on their military posts, and many lay persons wrote to propose the establishment of blood banks and processing plants for plasma in their communities. Some of them had already raised money and purchased equipment, including some


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mobile units, for these purposes. Some hospitals wrote offering plasma which they had prepared locally.

A great many of these well-meant but misdirected efforts arose from the situation already discussed, the difficulty of controlling publicity for the procurement of blood without making it clear that, for practical reasons, it could be collected and processed only in certain localities. The reply to these inquiries and offers was always the same: That the Red Cross was the sole authorized procurement agent for blood for the Armed Forces and that plasma had to be prepared under such strict specifications that it could be processed by, and procured from, only certain laboratories. Organizations and individuals who wrote offering to supply blood were told that they might give it through the Red Cross. Those who wrote proposing that the military be bled were told that voluntary donations from the Armed Forces were permitted and encouraged but that the blood program was primarily a civilian effort. Similarly, although some of the suggestions came from higher authority, the plan was not adopted of taking blood from inductees at the time of their induction. Signs were placed in all induction centers giving the location of the nearest blood donor center and suggesting that men who had been deferred or were disqualified for service might wish to take advantage of this opportunity.

Rumors and sabotage-During the entire war, rumors continued to spread that could have seriously hurt the blood program if they had not been tracked down and refuted immediately. Questions concerning the deaths of soldiers from lack of plasma were always promptly denied; they were simply not true.

One of the most persistent rumors was that the Red Cross was selling plasma. In October 1943, this particular rumor created special difficulties and great embarrassment for the mobile unit which went to the Glenn L. Martin and other plants to collect blood. When police checked the rumor, they found it to be far more widespread than it had seemed at first. As late as May 1945, it was necessary for the Office of The Surgeon General to deny the sale of plasma by the Red Cross, the correspondent who had made the inquiry being told that any person circulating such a rumor should be reported to the Federal Bureau of Investigation.

The explanation of this canard seemed, in some instances, to arise from the care of military personnel in civilian hospitals after they had been in accidents. When they were treated with plasma in these hospitals, in cities in proximity to Army Liquid Plasma centers, the plasma which had been used from hospital supplies was replaced in kind from military supplies. Otherwise, the Army would have had to pay civilian prices for the plasma which had been used. One rumor which arose in such a situation created a particularly serious situation at a hospital in Atlanta, which, so the story ran, was buying plasma from Lawson General Hospital, Atlanta, Ga.

Since the country was at war, and since blood and plasma could easily have been tampered with, special precautions against sabotage were in effect throughout the blood donor program (p. 295). No known instance of sabotage ever occurred.


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THE TOTAL PROGRAM

During the operation of the Blood Donor Service of the American Red Cross, from 4 February 1941 to 15 September 1945, a total of 13,326,242 blood donations were collected by 35 chapters (tables 2-5). The number rose from 48,504 in 1941 to 5,371,664 in 1944 and 2,302,227 in 1945, during which year the war in Europe ended on 8 May and the war in the Pacific on 14 August.

TABLE 2.-Number of blood donations, length of operation, and highest weekly procurement of each American Red Cross blood donor center

Center

Total number 
of donations

Length of operation

Highest weekly 
procurement


Years

Months

New York

1,272,931

4

6

10,733

Los Angeles

1,094,718

3

8

10,460

Boston

800,640

3

8

8,157

Philadelphia

702,488

4

3

6,704

Detroit

667,561

3

5

6,152

Chicago

642,393

3

6

6,729

San Francisco

592,198

3

8

6,146

Pittsburgh

570,541

3

5

5,478

Washington

527,400

4

2

4,907

Cleveland

492,049

3

4

4,899

Brooklyn

483,086

3

5

4,710

St. Louis

424,276

3

5

4,426

Baltimore

349,039

4

 

3,874

Milwaukee

336,589

3

4

3,674

Cincinnati

335,403

3

2

3,051

Buffalo

328,412

3

10

3,275

Portland

307,084

3

1

3,864

Rochester

303,397

3

10

3,108

Indianapolis

292,572

3

7

2,692

Hartford

279,357

2

7

3,468

Kansas City

261,621

2

5

3,065

Columbus

258,402

2

5

3,357

Minneapolis

229,410

2

5

2,482

Oakland

214,122

2

7

2,996

Louisville

190,850

2

 

2,818

Schenectady

190,232

2

6

2,220

St. Paul

177,320

2

5

2,020

Harrisburg

173,873

2

6

2,084

San Diego

173,573

2

1

2,998

Atlanta

157,956

3

 

2,022

Denver1

150,880

3

 

2,342

New Orleans

119,739

2

 

2,694

San Antonio

90,925

2

4

2,332

Dallas

77,682

 

9

2,704

Fort Worth

57,523

 

9

2,034

Total

13,326,242

---------------------

144,675

1Continued operation after closing of other centers, at request of Army, to provide blood for Fitzsimons General Hospital. Procurement 
after 15 Sept. 1945 is not included in this report.


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TABLE 3.-Production report of American Red Cross blood donor centers, February 1941-31 August 1945

Center

February 1941-December 1944

1 Jan.-28 July 1945

30 July-4 Aug. 1945

6-11 Aug. 1945

13-18 Aug. 1945

20-25 Aug. 1945

27 Aug.-1 Sept. 1945

Total August 1945

Total to date

Maximum weekly production

Boston

648,985

145,998

2,389

2,510

758

---

---

5,657

800,640

3,500

Brooklyn

376,194

101,977

2,110

2,316

489

---

---

4,915

483,086

2,750

Chicago

563,996

74,436

1,868

1,600

493

---

---

3,961

642,393

2,500

Denver

140,578

8,773

241

301

186

236

188

1,152

150,503

300

Los Angeles

839,878

241,294

4,849

5,323

1,546

574

376

12,668

1,093,840

7,500

New York

992,629

267,432

5,783

5,456

1,631

---

---

12,870

1,272,931

8,000

Oakland

136,283

71,452

2,404

2,144

835

357

246

5,986

213,721

2,500

Philadelphia

588,938

108,259

2,360

2,268

663

---

---

5,291

702,488

2,750

Portland

219,281

82,640

1,962

1,625

392

288

288

4,555

306,476

1,750

San Diego

115,718

53,660

1,229

1,423

509

336

272

3,769

173,147

2,000

San Francisco

434,327

146,819

3,790

4,013

1,076

675

563

10,117

591,263

4,500

Washington

403,284

117,031

3,135

3,076

874

---

---

7,085

527,400

2,500

(23) Closed centers

5,563,924

800,805

---

---

---

---

---

---

6,364,729

---


Total bleedings


11,024,015


2,220,576


32,120


32,055


9,452


2,466


1,933


78,026


13,322,617


40,550


Whole blood1


378,874


300,790


3,359


3,805


2,745


2,466


1,933


14,308


693,972


---

Dried plasma and serum albumin

10,645,141

1,919,786

28,761

28,250

6,707

---

---

63,718

12,682,645

---

1Including whole blood sent to hospitals in Zone of Interior


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TABLE 4.-Production report of American Red Cross blood donor centers, February 1941-31 March 1943

Center

February 1941-December 1942

January-February 1943

1-6 Mar. 1943

8-13 Mar. 1943

15-20 Mar. 1943

22-27 Mar. 1943

29 Mar.-3 Apr. 1943

Total to date

Atlanta

---
15,772

---
12,328

---
1105

425
1195

715
1112

979
---

767
---

2,886
18,512

Baltimore

54,484

12,530

1,882

2,161

2,128

2,164

2,007

77,356

Boston

96,197

27,336

4,191

4,598

4,690

4,940

4,535

146,487

Brooklyn

48,023

15,985

2,413

2,948

3,076

3,057

2,993

78,495

Buffalo

62,778

18,354

2,572

2,514

2,358

2,407

2,259

93,252

Chicago

77,350

28,679

4,941

4,931

5,180

5,251

5,646

131,978

Cincinnati

52,603

15,875

2,182

2,516

2,801

2,589

2,564

81,130

Cleveland

56,919

19,473

2,441

2,709

2,765

2,871

2,716

89,894

Columbus

2,776

11,343

1,725

1,735

1,708

1,631

1,751

22,669

Denver

14,220

14,103

1657

1747

1770

1772

1726

111,995

Detroit

103,869

28,872

4,265

5,220

4,812

4,747

4,476

156,261

Harrisburg

2,371

6,705

1,076

1,222

1,220

1,195

1,260

15,049

Hartford

8,044

11,442

1,799

1,928

1,661

2,144

1,640

28,658

Indianapolis

56,920

14,784

2,235

2,123

1,949

1,866

1,710

81,587

Kansas City

1,867

12,232

1,604

1,990

2,054

1,918

2,014

23,679

Los Angeles

95,502

32,298

5,072

4,878

6,253

6,233

6,532

156,768

Milwaukee

47,026

16,397

2,201

2,227

2,537

2,281

2,222

74,891

Minneapolis

2,396

9,836

1,429

1,893

1,660

1,833

1,831

20,878

New Orleans

11,655

13,014

1423

1515

1559

1504

1515

17,185

New York

154,419

43,230

7,258

7,408

7,486

7,236

6,909

233,946

Philadelphia

91,529

20,926

3,531

3,971

4,282

4,122

4,003

132,364

Pittsburgh

65,682

23,174

2,866

3,067

3,313

3,283

3,317

104,702

Portland

---
15,434

---
12,668

495
---

581
---

1,089
---

1,253
---

1,275
---

4,693
18,102

Rochester

66,778

14,419

1,888

2,253

2,177

2,430

2,262

92,207

San Antonio

17,471

11,864

1311

1326

1314

1311

1331

110,928

San Francisco

73,201

21,276

2,128

2,681

2,915

3,096

2,781

108,078

Oakland

---

1,777

981

1,039

1,120

1,018

1,197

7,132

Schenectady

1,971

5,802

1,219

1,062

1,366

1,350

1,370

14,140

St. Louis

75,809

21,041

2,559

2,761

3,093

3,125

3,038

111,426

St. Paul

1,319

6,047

895

905

1,279

1,024

1,488

12,957

Washington

13,547
132,221

12,642
13,172

1,936
1274

2,303
1244

2,392
1253

2,221
1458

2,386
1328

37,427
136,950

Total bleedings

1,370,163

469,624

69,554

76,076

80,087

80,309

78,849

2,224,662


Liquid plasma


56,773


17,149


1,770


2,027


2,008


2,045


1,900


83,672

Dried plasma and serum albumin

1,313,390

452,475

67,784

74,049

78,079

78,264

76,949

2,140,990

1Liquid plasma. At this time, several centers had shifted their collections from liquid to dried plasma and a few were still providing blood for both forms.


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TABLE 5.-Production report of American Red Cross blood donor centers, February 1941-30 June 1944

Center

February 1941-December 1943

1 Jan.-27 May 1944

29 May-3 June 1944

5-10 June 1944

12-17 June 1944

19-24 June 1944

26 June-1 July 1944

Total for June 1944

Total to date

Maximum weekly production

Atlanta

55,780
18,512

34,372
---

1,638
---

1,822
---

2,022
---

1,528
---

1,713
---

8,723
---

98,875
18,512

1,750
---

Baltimore

165,053

64,796

2,743

3,679

3,821

3,289

2,706

16,238

246,087

2,500

Boston

362,984

123,310

4,239

6,124

6,106

5,430

4,728

26,627

512,921

5,500

Brooklyn

182,182

76,843

3,388

4,710

4,692

4,332

3,835

20,957

279,982

4,000

Buffalo

189,160

53,578

1,426

2,597

2,388

2,394

2,132

10,937

253,675

2,500

Chicago

325,523

114,204

4,348

5,645

5,406

5,539

5,227

26,165

465,892

5,000

Cincinnati

172,530

50,940

1,678

2,717

2,456

2,327

2,198

11,376

234,846

2,500

Cleveland

223,037

83,197

3,583

4,391

3,892

3,834

3,655

19,355

325,589

4,000

Columbus

110,148

55,762

2,403

3,357

2,805

2,436

2,457

13,458

179,368

2,750

Dallas

---

39,819

1,893

2,035

2,166

2,078

1,760

9,932

49,751

2,000

Denver

163,489

134,987

11,487

11,613

11,781

11,640

11,673

18,194

1106,670

11,750

Detroit

329,389

108,603

3,363

5,667

5,340

4,824

4,766

23,960

461,952

5,000

Fort Worth

---

24,334

1,890

1,851

1,911

1,846

1,777

9,275

33,609

1,500

Harrisburg

72,450

34,659

1,375

1,542

1,753

1,720

1,599

7,989

115,098

1,500

Hartford

124,835

52,276

2,206

3,105

2,711

2,248

2,040

12,310

189,421

2,500

Indianapolis

162,180

47,605

1,464

2,219

2,145

2,002

2,025

9,855

219,640

2,000

Kansas City

101,195

53,349

2,147

3,065

2,383

2,631

2,592

12,818

167,362

2,750

Los Angeles

403,638

181,422

8,395

9,852

9,612

9,460

8,465

45,784

630,844

9,000

Louisville

51,335

40,263

1,881

1,747

2,210

1,817

1,861

9,516

101,114

2,000

Milwaukee

163,193

58,611

2,682

3,543

3,674

3,029

2,671

15,599

237,403

3,000

Minneapolis

84,731

44,882

2,151

2,380

2,196

2,152

2,088

10,967

140,580

2,250

New Orleans

8,622
127,551

45,332
---

2,260
---

2,694
---

2,433
---

2,205
---

2,188
---

11,780
---

65,734
127,551

2,000
---

New York

517,727

191,888

8,410

9,822

9,530

9,306

9,111

46,179

755,794

9,000

Philadelphia

325,651

118,017

4,797

6,053

6,048

5,912

5,523

28,333

472,001

5,500

Pittsburgh

268,104

90,908

3,353

4,965

4,932

4,030

4,330

21,610

380,622

4,000

Portland

88,932
17,293

50,176
---

2,101
---

2,590
---

2,514
---

2,506
---

2,325
---

12,036
---

151,144
17,293

2,500
---

Rochester

178,465

46,186

1,028

1,756

1,799

1,714

1,442

7,739

232,390

1,500

San Antonio

1,223
122,879

31,640
---

1,817
---

2,120
---

1,871
---

2,209
---

1,926
---

9,943
---

42,806
122,879

1,500
---

San Diego

24,325

38,537

1,236

1,364

1,403

1,756

1,698

7,457

70,319

2,000

San Francisco

226,453

81,206

3,638

4,222

4,550

4,123

3,615

20,148

327,807

4,250

Oakland

54,371

30,743

1,431

1,364

1,867

2,041

2,165

8,868

93,982

1,750

Schenectady

70,150

36,886

1,560

2,220

2,101

1,886

1,538

9,305

116,341

1,500

St. Louis

219,054

67,061

2,747

3,742

4,426

3,785

3,424

18,124

304,239

3,500

St. Paul

61,539

35,182

1,637

1,939

1,939

1,927

1,859

9,301

106,022

1,750

Washington

148,838
149,830

71,598
19,163

3,007
1473

4,006
1766

3,750
1751

3,466
1730

3,173
1682

17,402
13,402

237,838
162,395

3,500
1500

Total bleedings

5,652,351

2,322,335

95,875

123,284

121,384

114,152

106,967

561,662

8,536,348

110,500

Liquid plasma

179,554

44,150

1,960

2,379

2,532

2,370

2,355

11,596

235,300

2,250

Dried plasma and serum albumin

5,472,797

2,278,185

93,915

120,905

118,852

111,782

104,612

550,066

8,301,048

108,250

1Liquid plasma


136

The first request for blood for plasma by the Army and the Navy, in February 1941, was for 15,000 pints. In May 1941, when the completion of the first quota had convinced all concerned of the feasibility of the project, an additional 209,000 pints were requested. In December 1941, after Pearl Harbor, another 165,000 pints were requested for the current fiscal year. On 1 January 1943, the request for that calendar year was set at 4 million pints, and the request for the calendar year of 1944 was set at 5 million pints.

The impact of the attack on Pearl Harbor and of the declaration of war against Japan on the emotions and reactions of the U.S. public was reflected in the Blood Donor Service. In November 1941, blood donations had been about 1,200 per week. In December, the weekly donations rose to 4,600. By the end of April, they exceeded 50,000. By September 1943, they had reached 100,000 and they were maintained at or above this weekly level during most of 1944. The largest weekly procurement, 123,284, was for the week ending on 10 June 1945, the amount collected, as already mentioned, being the reflection of the D-day landings on the Normandy beaches. After 21 October 1944, the weekly averages progressively declined, as centers that were no longer needed were closed, and only about 2,000 donations per week were being collected when the project was concluded on 15 September 1945. At the peak of the program, the 6-month period between January and July 1944, total donations averaged 110,923 pints a week. Based on the 48-hour working week then generally in effect, this was approximately 1 pint every 2 seconds.

Distribution-Of the more than 13 million pints of blood collected by the Red Cross during World War II, 10,299,470 pints were processed into dried plasma. More than 3 million 250-cc. packages were put up, and more than 2.3 million 500-cc. packages. About 310,135 pints of blood were used in military hospitals in the Zone of Interior, as either liquid plasma or whole blood.

The largest amount of O blood, 14,928 pints, procured in any single week for shipment overseas was collected between 19 and 24 March, during the battle on Iwo Jima. This amount, a daily average of 2,497 pints, was over and above the amounts collected for plasma and serum albumin. In all, 387,462 pints of group O blood were flown overseas, 205,907 to Europe by the Army Air Transport Command, and 181,555 to the Pacific by the Naval Air Transport Service.

Costs-The total cost of the Blood Donor Service to the American Red Cross was approximately $15,870,000, about $1.19 per pint of blood collected. Of this amount, about 19 cents was paid from local chapter funds and the remainder by the National Headquarters.

In the original program, the total cost of the operation was borne by the Red Cross. When the project expanded, the costs rose so sharply that, as of 1 September 1942, the Army and the Navy assumed the costs of servicing the collecting equipment, which were added to the expense of processing the blood. As of 1 August 1943, the cost of transporting the blood to the processing laboratories was also assumed by the Government. The cost of servicing the equipment averaged about 60 cents per set, and the cost of transporting each


137

bottle of blood in a refrigerated container was about 15 cents. When blood typing was discontinued on 1 November 1942 (p. 241), for reasons other than expense, the cost fell about 7 cents per donation, for a total of about a half million dollars.

All funds expended by the Red Cross were contributed by the American people. They were carefully supervised and profitably expended, and it is not possible to estimate what they purchased in terms of human lives saved.

THE END RESULT

The Red Cross Blood Donor Service was translated, almost overnight, from a limited peacetime activity to a major national contribution to the military effort. It was enormously successful because of the fine organization of the program; the hard work of those who operated it; the hundreds of thousands of hours contributed by volunteer workers; and, most of all, the voluntary donation of millions of pints of blood by hundreds of thousands of patriotic American citizens, whose gift of themselves saved untold thousands of lives of wounded American troops.

References

1. Robinson, G. C.: American Red Cross Blood Donor Service During World War II. Its Organization and Operation. Washington: The American Red Cross, 1 July 1946.

2. Phalen, J. A.: The Blood Plasma Program. Division of Medical Sciences, National Research Council. Washington: Office of Medical Information, 1944.

3. Minutes, meeting of Committee on Transfusions, Division of Medical Sciences, NRC, 31 May 1940.

4. Minutes, meeting of Subcommittee on Blood Substitutes, Division of Medical Sciences, NRC, 30 Nov. 1940.

5. Minutes, meeting of Subcommittee on Blood Procurement, Division of Medical Sciences. NRC, 18 Aug. 1941.

6. Methods and Technique of Blood Procurement as Prescribed by the National Research Council for Use in the Red Cross Blood Procurement Centers (ARC 784). Washington: American Red Cross, September 1941.

7. Methods and Technique Used in Red Cross Blood Donor Centers (ARC 784, rev.). Washington: American Red Cross, January 1943.

8. Minutes, meeting of Subcommittee on Blood Substitutes, Division of Medical Sciences, NRC, 12 May 1942.

9. Robinson, G. C.: Blood Donor Service. 18 Dec. 1942.

10. The Organization and Operation of the American Red Cross Blood Donor Service (ARC 1217, rev.). Washington: The American Red Cross, December 1942.

11. Voorhees, Col. T. S., JAGD: Proposed Program as Evolved in Discussion Between Dr. Taylor of the American Red Cross and Captain Schwartz and Colonel Voorhees on 12 Jan. 1943, to Make Possible Increase to Approximately 80,000 per Week in Blood Donations, 15 Jan. 1943.

12. Minutes, Blood Procurement Conference, Division of Medical Sciences, NRC, 14 Feb. 1942.

13. Minutes, meeting of Subcommittee on Blood Substitutes, Division of Medical Sciences, NRC, 23 June 1942.

14. Minutes, meeting of Subcommittee on Blood Substitutes, Division of Medical Sciences, NRC, 17 Nov. 1943.

15. Minutes, Conference on Blood Preservation, Division of Medical Sciences, NRC, 19 Jan. 1945.

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