CHAPTER V
The American National Red Cross
THE FIRST STEPS OF THE PROGRAM
At the first meeting of the Committee onTransfusions, NRC (National Research Council), on 31 May 1940 (3), partof the discussion concerned the establishment of blood banks, the use of driedand liquid plasma, and the sources of supply for blood and plasma. The questionswere not answered.
The same questions arose at the first meetingof the Subcommittee on Blood Substitutes, on 30 November 1940 (4), afterdiscussion of the Blood for Britain project of the New York Blood TransfusionAssociation (p. 13). Dr. Max M. Strumia, with remarkable prescience, recommendedthe plan that was, in effect, carried out later; namely, the standardization ofequipment and techniques, the establishment of centers for collecting blood, andthe commercial preparation of dried plasma.
Dr. William DeKleine, then the medicalassistant to the Vice Chairman in Charge of DomesticOperations, American Red Cross, stated that the Red Crosswould be glad to assist in such a program but that the Army and the Navymust decide whether they wished his agency "to organize the problem."After further discussion, the following recommendations weremade:
As a matter of National Defense the SurgeonGeneral of the Army and Navy request the Red Cross to take steps immediatelylooking forward to the formation of civilian groups to provide human blood sothat in case of a definite National emergency local units would be in a positionto supply the blood needed by the armed forces.
It is recommended to the American Red Crossthat its support in the matter of providing blood donors for a study of the useof blood and of blood substitutes be continued and extended. In the opinion ofthis committee this assistance is essential to the solution of the problem. Thecommittee expresses its appreciation.
As a matter of fact, as the second of theserecommendations implied, steps to collect blood had already been taken by theRed Cross. In addition to the participation of the New York Chapter in the Bloodfor Britain project:
1. On 14 June 1940, The Surgeon General, U.S.Army, had requested the Red Cross to procure about a thousand volunteer donorsfor a research project undertaken by a number of investigators, including Cdr.Lloyd R. Newhouser, MC, USN, and Capt. Douglas B. Kendrick, MC, to determine thebest 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 operationsthat 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 warinvolving the United States." A similar request, in September 1940, by TheSurgeon General, Navy, was also acceded to.
2. In September 1940, the Southeastern Chapterof the American Red Cross, in Philadelphia, undertook to procure donors for thestudies on plasma then being conducted by Dr. Strumia, at the Bryn MawrHospital, under the auspices of the Committee on Transfusions, NRC (3).
IMPLEMENTATION OF THE PROGRAM
The Surgeons General of the Army and the Navysent identical letters to Mr. Davis on 7 January 1941, requesting thecooperation of the American Red Cross in the collection of blood for plasma, asfollows:
The national emergency requires that everynecessary step be taken as soon as possible to provide the best medical servicefor the expanded armed forces. Even though the need for proper blood substitutesmay not be immediate, there seems every reason to take steps now which shallprovide in any contingency for an adequate supply of these substances for use inindividuals suffering from hemorrhage, shock, and burns.
To this end, in order to assure this adequatesupply of the blood substitutes for the use of the United States Army, I amasking the American Red Cross and the Division of Medical Sciences, NationalResearch Council, to organize a cooperative undertaking which shall provide thearmed services with human blood plasma. In this cooperative effort, I requestthe American Red Cross to secure voluntary donors in a number of the largercities of this country, to provide the necessary equipment, to transport thedrawn blood rapidly to a processing center, to arrange for separating the plasmaand for storing the resulting product in refrigerated rooms.
I am also requesting the Division of MedicalSciences, National Research Council, to assume general supervision of theprofessional services involved in this collection and storage of blood plasma,and to provide competent professional personnel, both for a national supervisinggroup and for the local collecting agencies. I am also urging that the NationalResearch Council continue to encourage investigation of the various methods ofpreparation of blood substitutes, preferably in dried form.
While it is impossible to estimate therequirements of the armed forces at the present time, because of theuncertainties of the international situation, I feel strongly that a largequantity, a minimum of 10,000 pints, of blood plasma should be placed andmaintained in refrigerated storage. This feeling is based upon the fact that notonly will the plasma be of greatest service if a military emergency arises, butalso of ultimate use in any national catastrophe.
I am also writing to the National ResearchCouncil making this identical request, and am expressing the hope that thecooperative undertaking may receive approval, with prompt organization of thewhole enterprise.
On 9 January 1941, Mr. Davis replied asfollows:
The American Red Cross will be glad, asrequested in your letter of January 7th, to cooperate with the Division ofMedical Sciences of the National Research Council and the Army and the Navy inproviding the armed services with human blood plasma.
Representatives of the Red Cross will conferwith representatives of the National Research Council and the Army and the Navyimmediately in order to formulate the necessary plans for getting the projectunderway.
On 7 January 1941, Maj. Gen. James C. Mageeand 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 ofhis agency in this project. On 9 January, Dr. Weed replied as follows:
I wish to acknowledge receipt of your letterof yesterday requesting that the American Red Cross and the Division of MedicalSciences, National Research Council, cooperate in an undertaking which will leadto the procurement of large quantities of human blood plasma.
I can assure you at once that the Division ofMedical 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 youthat every effort will be made to accelerate the whole mechanism of obtainingand processing the necessary blood.
The Division of Medical Sciences has alreadytaken the initial steps leading to the formation of an operating subcommitteeunder 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 belost in undertaking the necessary organization so that a supply of human plasmamay be in storage for the use of the armed forces.
On 12 May 1941, a formal agreement was signedby Dr. Weed for the Division of Medical Sciences, NRC, and Mr. Davis for ARC(American Red Cross). This agreement listed specific details concerning thenature of the project, the plan of operation, the joint responsibilities of thetwo agencies, the responsibilities of NRC through its Division of MedicalSciences, the national and chapter responsibilities of ARC and the functions ofthe Army and the Navy.
This agreement, which served as the charter ofthe Blood Donor Service, ARC, was completed only after numerous conferencesamong all the organizations and personnel concerned. It contained the followingprovisions:
1. The joint responsibilities of the RedCross, National Research Council, and Army and Navy consist of the determinationof principles and policies of operation; the establishment of budgets fortechnical operations; the designation of cities in which collecting centers areto be set up; and the control of publications.
2. The Red Cross agrees to establish andmaintain facilities in selected cities to procure blood from voluntary donors,to recruit and enroll these donors, to arrange for the proper handling of theblood drawn, and to transport it under proper precautions to laboratoriesselected by the Army and the Navy for processing into dried plasma.
3. The Red Cross also agrees to provide, on anational scale, the necessary funds for all technical and other personnel neededin the collection of the blood, its transportation, and other technicaloperations. Red Cross chapters participating in the program will provide thenecessary funds for personnel and for other expenses incurred in recruitingand enrolling volunteer donors. The Red Cross also assumes responsibility formaintaining direct contact between the national organization and chapteroperations, for keeping the National Research Council informed of problems andprogress, and for obtaining adequate monthly reports from participating chaptersand processing laboratories.
4. The Division of Medical Sciences, NRC,assumes the general supervision of the professional services involved in thecollection of blood and the provision of competent professional personnel for anational supervisory group and for local collecting facilities. It also assumesresponsibility for determining the type of equipment to be used for collectingblood and for maintaining direct contacts with the technical supervisors of theprogram in each community.
5. The Army and the Navy agree that theirrepresentatives will work closely with the National Research Council on thetechnical aspects of each project and with the Red Cross in connection with thequantities of blood needed, its delivery, and other phases of Red Cross concern.
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At a meeting of the Subcommittee on BloodProcurement, NRC, on 18 August 1941 (5), the principal agenda dealt withthe best methods of bleeding donors and collecting blood for plasma on anationwide scale. Decisions were reached concerning equipment, examination andhandling of donors, technique of bleeding, organization of the technical staff,handling and transportation of blood, and publicity. These various points arediscussed in detail under the proper headings. This conference was attended bymembers of the Subcommittee on Blood Substitutes; representatives of the RedCross Blood Donor Service; Dr. G. Canby Robinson, National Director, ARC BloodDonor Service; the technical supervisors of the Red Cross collection centersthen in operation; representatives of the Army and the Navy; representatives ofthe National Institute of Health; and personnel of two of the seven commerciallaboratories then participating in the plasma program.
The decisions made at this meeting werepublished in September 1941, in ARC Manual 784, "Methods and Technique ofBlood Procurement as Prescribed by the National Research Council for Use in theRed Cross Blood Procurement Centers" (6). In the ensuing months, anumber of supplements and special directives were issued, but the practicesprescribed 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 secondwas based on a very extensive practical experience.
ORGANIZATION AND PERSONNEL
In the agreement drawn up between the Red Crossand the Division of Medical Sciences, NRC, in May 1941, a national supervisorygroup was provided for. The Subcommittee on Blood Substitutes became thissupervisory body. It originally acted chiefly through its own Subcommittee onBlood Procurement, which was appointed on 19 April 1941 and which served until12 May 1942, when it was voted out of existence (8).
The initial phases of the program weredirected and supervised for the Red Cross by Dr. DeKleine. In July 1941, he wassucceeded by Dr. Robinson (fig. 17) with the title of National Director, BloodDonor Service. At the same time, Dr. Earl S. Taylor (fig. 18) was appointedTechnical Director. Dr. Taylor, who was a qualified general surgeon, had workedin the blood bank at the Presbyterian Hospital, New York City, and thereforecame to his duties with a wide experience in this field. When he was latercommissioned in the Medical Corps in April 1943, he retained his position asTechnical Director of the ARC Blood Donor Service so that medical officers, whowere then working in the blood collection centers (p. 109), would be under thesupervision of another medical officer. On 15 August 1944, in response to hisrequest 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, NationalDirector, Blood Donor Service, American Red Cross.
Dr. William Thalhimer was appointed AssociateTechnical Director of the Blood Donor Service on 1 December 1942 and serveduntil 1 December 1944.
Initial Organization
In following the activities of the Red CrossBlood Donor Service, it must be borne in mind that the American Red Cross is nota cohesive organization with a unified central direction. It consists of a groupof chapters which are largely autonomous and each of which is governed by itsown board of directors.
As the Blood Donor Service was set up in thesummer 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 directorserved on a part-time basis, while continuing to serve as technical supervisorof the New York Blood Donor Center. Through liaison with the local technicalsupervisors, he directed the initial technical operations of each new center asit was organized and thus standardized all operations to conform with thetechniques agreed upon in August 1941. With the outbreak of the war, however,and the rapid expansion
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of the Blood Donor Service, it becamenecessary for the technical director (Dr. Taylor) to assume full-time duties inthe national organization.
The Subcommittee on Blood Substitutesappointed competent professional personnel who served in a voluntary capacityfor the technical supervision of the collecting facilities in each of the blooddonor centers. Each chapter selected its own executive and technical directorsand its own publicity personnel, none of whom was directly responsible to theNational Director, Blood Donor Service. National Red Cross Headquarters,however, paid the medical directors and nurses. General supervision of chapteractivities was conducted by National Headquarters through area directors, whowere not responsible to the National Director, Blood Donor Service.
REORGANIZATION
As the Blood Donor Service expanded and becamemore complex, certain weaknesses in the original structure and operation becameapparent, particularly the need for greater centralization. Changes underdiscussion for some time
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CHART 2.-Organization chart, American RedCross Blood Donor Service, 1941
(9) and put into effect in November1942 (chart 3) were described in the manual issued in December 1942 (10) entitled"The Organization and Operation of the American Red Cross Blood DonorService." These changes-
* * * abolishedthe position of area director and established direct communication between thenational director and the center directors and chairmen of chapter blood donorcommittees. Area representatives of the Blood Donor Service were appointed byarea managers to expedite all matters that concerned chapters as such, asdistinct from blood donor center operations.
The reorganization effected at this timepreserved the advisory and controlling relations between the Blood DonorService, the Army and the Navy Medical Departments, and the Subcommittee onBlood Substitutes, NRC, as set forth in the May 1941 agreement between theAmerican Red Cross and the Division of Medical Sciences, NRC. The changesincreased the measure of control exerted by the national director of the BloodDonor Service over local activities, but there were still points of inefficiencyand friction. Some observers believed that truly satisfactory functioning couldnot be achieved until all paid chapter personnel in charge of recruitment ofdonors, 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 RedCross Blood Donor Service, November 1942
Local Organization
Technical supervisor- It wasstipulated in the original agreement that each chapter employ a full-timedirector to administer its blood donor center, to be responsible for allnontechnical activities, for the direction of nontechnical personnel, and forthe maintenance of equipment and supplies. The chapter director served as thenormal channel of communication between the center and the National Director,Blood Donor Service, to whom he made weekly reports of blood procurement andmonthly statistical and financial reports. He had paid secretarial and otherassistance as required for the enrollment of donors and his other administrativefunctions.
The technical supervisor of each chapter was alocal physician, preferably an expert in the field of blood transfusion, whoserved without recompense, at the appointment of the Subcommittee on BloodSubstitutes, NRC, under the direction of the National Technical Director of theBlood Donor Service. The local technical supervisor brought to the attention ofthe National Technical Director all problems related to the technical proceduresemployed and to relations with processing laboratories. He was responsible forthe selection of physicians, nurses, medical secretaries, blood custodians, andother personnel engaged in the bleeding of donors and the handling and shippingof blood. He organized and directed the technical staffs of the centers and wasresponsible for
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technical operations and procedures accordingto the techniques specified by the Subcommittee on Blood Substitutes, NRC.
It was essential that the technical supervisorand the center director in each chapter work closely together. They were theonly members of the local organization who received instructions concerningdetails of operation of the center directly from National Headquarters. Eachtime the director and the technical supervisor of a newly created blood donorcenter were appointed, they visited, and studied at firsthand, some centeralready in operation, preferably the pilot center in New York or the center atNational Headquarters in Washington, D.C.
Professional personnel-Personnelshortages, as might have been expected, plagued the Red Cross blood donorprogram during the entire war. Because enough civilian physicians could not befound to man the centers, nurses were trained in bleeding techniques, and Armyand Navy medical officers were later assigned to the centers. After some 6million pints of blood had been collected, it was estimated that an average of800 to 850 bleedings per week was the best that could be expected from aphysician, while each registered nurse could be expected to produce about 120.
At the meeting of the Subcommittee on BloodProcurement, 18 August 1941 (5), it had been decided that there wasnothing in the regulations drawn up by the National Institute of Health thatwould prohibit the collection of blood by nurses, though a physician must bepresent and available for consultation at all times. This was an importantdecision: Nurses were in short supply, but they were easier to secure thanphysicians. In addition, physicians working in the blood donor centers hadlittle time to collect blood; they were kept busy carrying out physicalexaminations on donors. Policies concerning the use of nurses varied fromchapter to chapter. In some chapters, nurses performed the entire procedure. Inothers, physicians made the original venipuncture and nurses completed thecollection of the blood.
At the Conference on Blood Procurement on 14February 1942 (12), Dr. Robinson stated that the whole blood procurementprogram was being jeopardized because civilian physicians were leaving thecenters to enter the Army or for other reasons. He wondered whether it might bepossible to have a number of Army officers, perhaps 15, assigned to the RedCross Blood Donor Service. Brig. Gen. Charles C. Hillman thought it unlikely.
Dr. Robinson introduced the matter again atthe meeting of the Subcommittee on Blood Substitutes on 23 June 1942 (13). Thecenters were still losing physicians. An attempt to secure women physicians hadfailed numerically. If the blood procurement program were to succeed, the ArmedForces must make some provision for the assignment of competent physicians toit. For the 1.4 million bleedings so far requested for the year beginning 1 July1942, 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 thepilot order of 51,000 units of albumin, not for any expansion which might occurin the latter program. Dr. Robinson hoped that the Army and
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the Navy would each assign 19 officers to thecenters, to bring the professional staffs up to the 56 physicians justspecified.
The subcommittee recommended to the SurgeonsGeneral of the Army and the Navy that they give favorable consideration to theassignment of a small number of medical officers to temporary duty in the RedCross bleeding centers, on the ground that shortages of personnel were alreadyjeopardizing the entire program. A point made in the recommendation was thatlosses occurred when blood was collected by untrained and incompetent personnel.A report from the Pittsburgh Blood Donor Center, in which the rate of clottinghad 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 inoperation (14), it was estimated that 135 physicians were the bareminimum with which they could be conducted, without any allowance for illness orother unforeseen emergencies. At this time, these centers were being operated by34 civilian physicians, 40 Naval medical officers, and 60 Army medical officers,who were under the operational control of the Transfusion Branch, Office of TheSurgeon General.
An attempt to utilize officers separated fromservice for physical disabilities did not succeed. They often proved unable totolerate duty in the centers and entirely unable to withstand the hardships ofwork in mobile units. Many had to be relieved because of reactivation of theirphysical disabilities. With no replacements available for them, appointments hadto be canceled, and, in view of the urgent appeals made for blood donations,this was bad public relations.
From the standpoint of public relations, itwas probably unwise to have accepted some of the medical personnel in both thecivilian and the military groups. At the Conference on Blood Preservation on 19January 1945 (15), many of the volunteer physicians serving as localtechnical supervisors expressed the opinion that a number of Army medicalofficers of substandard quality had been assigned to the bleeding centers andthat their handling of donors had sometimes created serious breaches in publicrelations. These difficulties had been infrequent with Naval officers. Theconference was assured that the Army Medical Department would take steps tocorrect the situation at once.
Essential as was the work of these blood donorcenters, assignment to them was neither interesting nor desirable. Attempts torotate the officers assigned to them were not particularly successful, and manyremained in them, without chance for promotion, for 2 years or more.
As centers were closed during the last monthsof the war, personnel in them were released, and by 17 August 1945, 3 days afterthe Japanese surrender, the Transfusion Branch, Office of The Surgeon General,requested the retention of only seven officers, three in centers on the westcoast, which would continue to supply blood for the Pacific; one at the centerin 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 researchstudy on O blood (p. 259).
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Enlisted personnel-The enlistedpersonnel assigned to the blood donor centers played an extremely importantpart in their successful operation. They performed work of a highly technicalnature, 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. Thestaff sergeants at these centers were doing work usually handled in Armylaboratories by commissioned medical officers or members of the SanitaryCorps, and it was with considerable difficulty that ratings of technicalsergeant were finally secured for them.
Volunteers-By themost conservative estimate, at least 100,000 volunteer workers contributed full-or part-time service to the Blood Donor Service during the 4? years of itsoperation. Their work was usually organized by the chapter blood donorcommittee, 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 contributedto the managerial, public relations, and recruiting aspects of the Blood DonorService.
The exact distribution of the volunteer workis not known, but returns from a questionnaire sent out to the blood donorcenters 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 asnurses' aides; 4,600 in the Motor Corps; 4,100 in the Hospital andRecreation Corps; and 15,800 in other services.
BLOOD DONOR CENTERS
Establishment-The firstRed Cross blood donor center in the Blood Plasma Program of World War II opened in New Yorkon 4 February 1941 (fig. 19, table 1). The 35th opened in Fort Worth on 10January 1944. Eleven centers were opened in 1941, 19 in1942, and 5 in 1943 or early in January 1944. The nine centers openedbetween 1 December 1941 and 1 February 1942 had all been planned or were inprocess of establishment before Pearl Harbor.
Centers were closed as special requirementsfor the Army and the Navy were completed. Four centers were closed when theNavy contracts for albumin were terminated in October 1944. Nineteen wereclosed after the German surrender in May 1945. By 15 September 1945, the onlycenter still in operation was in Denver; it was kept open at the request of the Army to supply small amounts ofwhole blood to the nearby Fitzsimons General Hospital, Denver, Colo.
Facilities.-Five centers occupied theproperty of local Red Cross chapters during all, or almost all, of their periodof operation. Seven occupied donated space and two others space donated forall but a portion of the time. The remainder operated in rented space in storesor office buildings, usually in downtown areas or shopping districts, withpublic 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
| 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. Denver2 | 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 thespecial needs of the Blood Donor Service. Most of it could be accomplishedby temporary partitions. As new centers were planned, they were altered andreconstructed in the light of earlier experience. Air conditioning wasnecessary in some centers in the South.
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The size of the facilities varied with the weekly quotas ofthe centers, which ranged from 1,500 to 10,500 bloods. All but 5 of the 22centers 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 medicalofficer in charge, the special assistant, and the recruiting and publicitystaffs. In the larger centers office space was also provided for the chairman ofthe blood donor committee and for the committee (fig. 20).
Rooms for the reception, testing, examination, and bleeding ofdonors, which are described in connection with the technique of collecting theblood (p. 148).
A special telephone room for appointments and for reception ofthe innumerable inquiries which came into each center.
A room for files for registration cards and other donorrecords and for material used in recruiting and in obtaining redonations.
Workrooms for preparing, cleaning, and sterilizing equipmentand supplies; handling bleeding equipment; and storage of supplies andequipment.
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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 inrefrigerated chests for shipment to processing laboratories. These rooms werepreferably at the rear of the center, out of the way of donors, and with readyaccess to trucks.
Canteens, restrooms, and locker space for nurses, volunteers,and other members of the staff.
MOBILE UNITS
Mobile units (fig. 21) were operated out of all blood donorcenters, the numbers ranging from one to four. At theheight of the program, 63 were in operation, and, in all, 47 percent of theblood donations were made through them. These units operated within a radiusof 75 miles of the 35 centers, and it was estimated that their use brought 60percent of the population of the country within range of the Blood DonorService.
Mobile units had a number of advantages.They gave flexibility to the donor centers in filling their quotas. Theymaterially expanded the territory and population from which donors could bedrawn. They also allowed hundreds of Red Cross chapters and their thousandsof 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 CrossBlood Donor Service.
Equipment.-The physicalequipment of a mobile unit usually consisted of a 1?-ton truck, althoughsome centers continued to use the 1-ton panel truck, which was originallyprovided, till the end of the war. Many of the trucks were given by civic andother 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 containedall the supplies needed for collecting blood. On the cover of each box was alist of its contents. The
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FIGURE 22.-Setup of mobile units, AmericanRed Cross Blood
Donor Service. A. Los Angeles, Calif. B.Trenton, N.J.
truck was so packed that a temporary blood center could be setup almost as soon as the destination was reached (fig. 22). A variety ofbuildings was used-schoolhouses, assembly halls, parish houses, or availablespace in an industrial or military establishment.
Staff.-The technical staff of the mobile unit consisted ofthe physician in charge; five or six nurses; a technical secretary; and a bloodcustodian, who
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frequently served as chauffeur. Occasionally,a few well-trained volunteers from the parent center went along, but more oftenthe cooperating chapter supplied the volunteers. The technical staff wastransported in station wagons, many of which were also special gifts.
Policies and procedures-Thecooperating chapters made all arrangements for the visits of the mobileunits, the preparations usually requiring several weeks of intensive work andpublicity. It was necessary to recruit and enroll specified numbers of donorsfor each day of the operation; to secure the most suitable rent-free buildingavailable 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 chaptersgenerally corresponded with those of fixed centers except that recruitmenttook the form of intensive drives rather than day-after-day publicity. Sincemany of the towns visited were relatively small, it was often necessary to combseveral counties to meet the quotas set. The wide appeal, and the relativelygreater efficiency, of periodic drives as compared to routine recruitment wasevidenced by the fact that only 15 percent of the donors enrolled in mobileunits canceled their appointments or failed to keep them as compared to 25percent in the fixed centers. Relations with the cooperating chapters werealways cordial, and their arrangements were always efficient.
Activities.-Mobile units visited not onlycooperating chapters but also branches of chapters, industrial plants within the jurisdiction of the blood donorcenters, military establishments, andFederal and state penal institutions. Many times, churches, under thestimulation of their clergy, recruited donors as well as contributed bloodthemselves.
By the end of the war, it was estimated thatmobile units had operated in 3,260 different places, including 1,100 cooperating Red Cross chapters, 1,130branches of chapters, 590 industrialplants, 260 military establishments, and 180 other places. Many other chapters made repeated efforts to be included inthe program, although they were so remote from the centers that it would havebeen impractical to include them.
CONFERENCES
A number of conferences on the blood donorprogram were held during the war. They included:
1. A conference on technical operations atAtlantic City, N.J., on 7 June 1942. It was attended by the technicalsupervisors of the centers then in operation and representatives ofthe National Headquarters, American Red Cross, the NationalResearch Council, theNational Institute of Health, the Army and the Navy.
2. A conference on general problems inIndianapolis on 19-20 January 1943, attended by thechairmen of blood donor committees; directors of all
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centers then in operation; and representativesof the National Headquarters, ARC, and the Army and the Navy.
3. A conference in New York on 15-16December 1943 and a similar conference in Chicago on 18-19 January 1944,attended by regional technical supervisors, the directors of the centers, andthe chairmen of the center blood donor committees.
The special items discussed at the meetings are described under appropriateheadings.
CAMPAIGNS FOR BLOOD DONORS
General Considerations
The American Red Cross Blood Donor Servicebegan with the enormous emotional advantage that donations of blood couldsave the lives of wounded men. Thousands of persons who could make no othercontribution to the war effort gladly gave their blood, and many of themrepeated their donations as often as they were permitted. It is ironic,therefore, that from the beginning to the end of the program, the majorproblem was to obtain an adequate number of donors to meet the requirements. Spontaneous, unsolicited donations were the exception ratherthan the rule except in special circumstances. Only unceasing efforts enabledthe centers to meet their quotas, particularly during lulls in fighting.
The requirements for blood in the 10-monthperiod between the institution of the Blood Donor Service and Pearl Harborwere negligible compared to later demands. Only 28,974 pints of blood wereprocured during this period, an average of 724 pints per week for the 10centers then in operation. Only two of these centers had been active duringthe entire 10 months, and the average amount procured by them was 145 pintsper week. Even the largest center, at peak operation during the prewarperiod, obtained only 441 pints per week.
Donations increased notably immediatelyafter 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, 123,284pints of blood were collected,and thousands of future appointments were made.
On the other hand, the flow of informationconcerning the war provided by the free press of the United States sometimeshad the effect of a two-edged sword. Immediately after the Normandylandings, for instance, the happy news was received that casualties had beenfewer than anticipated. Donations promptly declined sharply and did not againapproach the invasion peak until the spectacular race across Francebegan several weeks later.
The pre-Pearl Harbor period had made onething quite clear, that general publicity must be supplemented by specificrecruiting techniques. With spontaneous response apparently depending largelyupon the ebb and flow of
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battle, the greatest single problem was howto maintain an adequate number of donors when the war news was notspectacular.
A second difficulty inherent in the programand not generally clear to the public, in spite of efforts to clarify it, wasthe necessity for operating each center and each mobile unit on a strict system of weekly quotas. No surpluses could be built up. Planning had toenvisage 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 exceededcapacity, as they did, for instance, in September 1943.
A part of this same consideration was thatblood procurement facilities were necessarily located near processinglaboratories. As a result, publicity which would have been gladly providedthroughout the country in motion picture theaters, over radio networks, and insimilar media had to be used with great care. Only a few experiences were neededto show that national appeals for donors caused confusion and frustration incommunities in which facilities for processing blood donations were notavailable. The closing of collection centers at the height of the fighting alsomade for difficulties in public relations, perhaps because the reasons-thatspecial programs, such as the serum albumin program, had been successfullyconcluded-were not made as clear as they should have been.
External circumstances also interfered withdonations. Plasma deliveries in December 1943 were 40 percent short of thequota because of an epidemic of influenza. On 9 February 1945, a blizzard in theEast almost wiped out the donations scheduled for that day and the next severaldays.
Cancellations of appointments and failures toappear for scheduled appointments were serious losses in themselves, and theyalso wasted the time of physicians, nurses, and technicians, for they kept othervolunteers from using the time scheduled. Some centers found it profitable tosend out reminders several days in advance of appointments. About 10 percent ofdonors who appeared for their appointments had to be rejected for physicalreasons.
For these and other reasons, it was necessaryto secure an enrollment of about 150 donors to obtain each hundred pints ofblood. This meant that the 13,326,242 pints of blood collected during the war bythe Red Cross required the enrollment of nearly 19 million persons.
Multiple donors-Amajorsource of blood came from multiple donors. Most centers had a special desk atwhich, before they left, donors were invited to make future appointments. Somedonors voluntarily phoned for second appointments. It was estimated that theaverage 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 somecenters, multiple donations ran as high as 60 percent of the blood collected.Multiple donations and the publicity which attended them did much to dispelthe 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 whenthe Red Cross Blood Donor program was begun, publicity was naturally lessurgent than it became later. Promotional material was devoted chiefly to anexplanation of the project and its potential value if war should come. Thepamphlet issued in November 1941, entitled "Teamwork From Publicity toPlasma," was intended to stimulate general interest in the blood program;to provide information as to its origin, purpose, and objectives for those whowere to cooperate in its organization and operation; and to insure accuracy andconsistency of effort.
In January 1942, the importance of publicityand promotion in a country at war was recognized by the appointment of anAssistant National Director of the Red Cross, whose function was to coordinateall promotional matters and assist the blood donor centers in publicity andrecruiting. This official was in direct contact with the directors of thecenters, the chairmen of the local blood donor committees, and the chapterpersonnel in charge of local recruiting and publicity. All activities connectedwith promotion and public relations were thus closely coordinated with theadministrative and technical aspects of the Blood Donor Service on both thenational 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 DonorService, the information departments of the Army and the Navy, the Office ofWar Information, the War Activities Committee of the Motion Picture Industry,the Writers' War Board, and similar organizations.
This office of the Blood Donor Serviceprepared and distributed to the donor centers a large variety of promotionalmaterial, 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 contributedoutdoor advertising space (fig. 25).
In May 1942, a revised publicity kit preparedby the Public Information Service, National Red Cross Headquarters (7), wasfurnished to the chapters operating blood donor centers. This kit containedinformation on the origin of the program; the initial activities; theincreased requests for blood; the location of the 18 blood donor centersthen in operation and of the laboratories processing plasma; the explanationof why the collecting centers were restricted to these special localities; therestricted 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 alsocontained information about the processing and use of plasma, includingits preparation as dried plasma. Finally, it contained a talk to be used whilepersonal appeals were made for donations from special groups in person or onthe radio.
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FIGURE 23.-Posters used by American Red Crossfor recruiting blood donors.
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FIGURE 24.-Covers of pamphlets used byAmerican Red Cross for recruiting blood donors.
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Special Methods
In spite of the use of all possibleadvertising media and methods, enough donors were not attracted by thesemeans to meet the steadily increasing demands for blood, and special plansfor the recruitment of donors had to be put into effect. They included:
1. House-to-house canvasses by Red Crossvolunteers, members of the Junior Red Cross, Boy Scouts, and otherorganizations.
2. Organized drives in schools, to persuadestudents to persuade their parents to give blood.
3 . Recruiting boothsin department stores and office buildings.
4. Personal appeals, by well-trained, tactfulRed Cross personnel, in motion picture theaters.
5. Distribution of application blanks inbusiness firms, industrial plants, and at meetings of civic, labor,religious, and fraternal groups.
These methods all produced direct results, in addition to thegeneral publicity they provided, but all of them had the same defect: They brought largenumbers of appointments, but the percentage of so-called no-shows was much largerthan when donors voluntarily telephoned for appointments. More precise methods ofrecruitment were obviously necessary.
Participation of labor unions-Atthe conference of blood donor service officials in January 1943, just after theArmy and the Navy had sharply increased their requests for blood, a plan waspresented for the participation of labor unions. It had been worked out, atthe request of the unions, between National Headquarters, ARC, the AmericanFederation of Labor, the Congress of Industrial Organizations, and the RailwayBrotherhoods. The basis of the plan was that locals throughout the country,with the endorsement of their national organizations and in cooperationwith local blood donor officials, should seek to stimulate blood donations fromtheir members. A booklet was prepared explaining the plan in detail,and other informational and recruiting material was made available forlocal use.
The contacts and activities resulting fromthis plan led to a high degree of cooperation between the unions and theBlood Donor Service centers, which was fostered by meetings at local levels.When the group recruiting plan, to be described next, was put into effect, thegroundwork for it had already been laid by the plan already in effect in laborunions.
Group recruiting-The grouprecruiting plan was a precise method of obtaining donors which had beenintroduced and perfected by some centers in the first year of the program. Itwas given added impetus when it was endorsed by a national conference ofBlood Donor Service officials in December 1943 and in January 1944.Thereafter, it was used by all the centers and did much to maintain thenecessary blood quotas, especially during the periods in the spring and latesummer of 1945, when rumors of impending enemy capitulation began tolessen the effectiveness of appeals for donors.
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The group recruiting plan was carried out asfollows:
1. A card index in each center showed thelarger local business firms and organizations, the name of the head of eachfirm, and the number of employees or members.
2. Each such organization was asked to providea regular number of weekly donors, the number depending upon the total numberemployed and usually averaging 5 percent of the personnel.
3. To implement the plan, special recruitingcommittees were formed in each center, composed of civic and community leaderswho had had experience in such drives. Each member was provided with promotionalmaterial suitable for the organization to which he was assigned. Theorganizations themselves assumed the responsibility for securing the pledgednumber of donors and for furnishing alternates if those originally scheduledcould not or would not keep their appointments. The members of the recruitingcommittee pointed out to the officials of the organization the importance ofappointing 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 ofdonors for each center each week. If a center could schedule 50 concerns ororganizations which would supply an average of 10 donors each per week, it couldbe assured of 500 donors per week and could make up the rest of its quota fromrepeated donations, publicity, and other methods. Moreover, by controlling thesupply of donors, the flow through the centers could be regulated and the mostefficient use possible made of personnel and facilities. It was found thatdonors recruited by their own firms and organizations generally kept theirappointments (fig. 26), because interdepartmental competition and pride ofachievement were called into play. From the standpoint of the firms, thedonations did not interfere seriously with their production, and they, liketheir employees, profited from pride of achievement. Many of the firms adoptedthe slogan, "A Pint of Blood for Every Star in Our Service Flag."
While precise figures are not available, it isbelieved that at least 20,000 business and industrial organizations participatedin this phase of the blood donor program. With the possible exception of theoverall publicity techniques and the repeat donors signed up in the centers,this plan produced more donors than any other used. In one city, under theleadership of an extremely able chairman, Federal agencies alone providedbetween 60 and 70 percent of all donors after the plan began to operate. Thesecret of success in every instance lay in careful internal organization and theamount of hard work devoted to personal contacts.
To complete the story of efforts to procureblood donors, two other items should be mentioned. The first is the presentationon the "Army Hour," a regular wartime radio program, on 24 October1943, of a dramatization of blood plasma, its collection, and its uses. Thesecond is the film entitled "Life
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Line," which was presented to the BloodDonor Service officials and others in attendance on the conferences in December1943 and January 1944. Most of the officials present asked to borrow it forlocal showing.
Recognition of Donations
There were a number of proposals to offerinducements to blood donors, with the hope of increasing the number ofdonations. The plan was tried out in the spring of 1943, in Brooklyn, with theoffer of tickets to baseball games for each donation, but the public reactionwas instant and adverse. The plan was discontinued on the third day, and nothinglike it was ever proposed again.
E awards-By the end of June1942,the Red Cross had collected 461,493 pints of blood. To express their formalappreciation to the Blood Donor Service, the Surgeons General of the Army andthe Navy, on 15 September 1942, presented the Army E flag and the Navy E awardemblem to the Chairman of the American Red Cross, at ceremonies at the NationalHeadquarters in Washington. All the chapters which had participated in theprogram up to April 1942 were represented by chapter officials and personnel ofthe blood donor centers.
The same production awards were later made atlocal ceremonies to the 18 chapters which had participated in the program up tothis time and were subsequently made to chapters which entered the programlater. The ceremonies at which these awards were made were arranged with greatcare, and the effect on recruitment of donors was usually evident.
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In 1943 and 1944, the Army-Navy Award Boardadded stars to the pennants of the original recipients for sustained excellentperformance.
The Gallon Club-It isan interesting fact that the American Red Cross itself apparently had norealization, when the Blood Donor Service was instituted, of the magnitude theprogram was finally to assume. Each donor received a bronze emblem on his firstdonation and a silver emblem on his third. No further recognition wasprovided for, on the assumption, then widely held, that the project, even ifexpanded, 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 ribbonswere attached to the silver emblems to indicated 1-, 2-, and 3-gallon donors.In retrospect, it is unfortunate that more conspicuous recognition was notgiven to multiple donors.
Labeling of plasma-InDecember1944, in response to numerous suggestions and as an added incentive todonations, the Red Cross label on the official Army-Navy package of driedplasma was altered to read (fig. 24):
The plasma contained in this package wasprocessed from the blood of volunteer donors enrolled by the American Red Crossand symbolizes in part the blood gratefully donated by ---in honor of --- of the United States Armed Forces.
This plan was purely symbolic, since it wastechnically impossible to identify the plasma processed from any particularblood. Nonetheless, it gave donors a sense of active participation in the wareffort, and about a third of them inscribed their names on the labels after theplan was put into effect.
OTHER ASPECTS OF THE PROGRAM
Local conflicts.-As pointedout elsewhere (p. 91), a number of communities attempted to collect blood forlocal use, and their efforts interfered with the national program to obtainblood for the Armed Forces. As late as December 1943, a large New York Cityhospital 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 CivilianDefense, and the Superintendent of Hospitals of the City of New York tostraighten out the situation.
Offers and suggestions-Duringthe war, the Red Cross, the Army and the Navy, and other governmentalagencies received many questions and suggestions connected with the bloodprogram. Some extremely detailed questions concerned the production and uses ofplasma. Whenever there was a lull in the fighting or word of the approaching endof hostilities, there were numerous inquiries as to whether blood was stillneeded. One correspondent had guinea pigs whose blood she wished to sell forconversion into plasma.
Many soldiers wrote to suggest that bloodbanks be established on their military posts, and many lay persons wrote topropose the establishment of blood banks and processing plants for plasma intheir communities. Some of them had already raised money and purchasedequipment, including some
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mobile units, for these purposes. Somehospitals wrote offering plasma which they had prepared locally.
A great many of these well-meant butmisdirected efforts arose from the situation already discussed, the difficultyof controlling publicity for the procurement of blood without making it clearthat, for practical reasons, it could be collected and processed only incertain localities. The reply to these inquiries and offers was always thesame: That the Red Cross was the sole authorized procurement agent for bloodfor the Armed Forces and that plasma had to be prepared under such strictspecifications that it could be processed by, and procured from, only certainlaboratories. Organizations and individuals who wrote offering to supply bloodwere told that they might give it through the Red Cross. Those who wroteproposing that the military be bled were told that voluntary donations fromthe Armed Forces were permitted and encouraged but that the blood programwas primarily a civilian effort. Similarly, although some of the suggestionscame from higher authority, the plan was not adopted of taking blood frominductees at the time of their induction. Signs were placed in all inductioncenters giving the location of the nearest blood donor center andsuggesting that men who had been deferred or were disqualified for service might wish to takeadvantage of this opportunity.
Rumors and sabotage-Duringthe entire war, rumors continued to spread that could have seriously hurt theblood program if they had not been tracked down and refuted immediately.Questions concerning the deaths of soldiers from lack of plasma were alwayspromptly denied; they were simply not true.
One of the most persistent rumors was thatthe Red Cross was selling plasma. In October 1943, this particular rumorcreated special difficulties and great embarrassment for the mobile unit whichwent to the Glenn L. Martin and other plants to collect blood. When policechecked the rumor, they found it to be far more widespread than it had seemedat first. As late as May 1945, it was necessary for the Office of The SurgeonGeneral to deny the sale of plasma by the Red Cross, the correspondent whohad made the inquiry being told that any person circulating such a rumor shouldbe reported to the Federal Bureau of Investigation.
The explanation of this canard seemed, in someinstances, to arise from the care of military personnel in civilian hospitalsafter they had been in accidents. When they were treated with plasma in thesehospitals, in cities in proximity to Army Liquid Plasma centers, the plasmawhich had been used from hospital supplies was replaced in kind from militarysupplies. Otherwise, the Army would have had to pay civilian prices for theplasma which had been used. One rumor which arose in such a situation created aparticularly serious situation at a hospital in Atlanta, which, so the storyran, was buying plasma from Lawson General Hospital, Atlanta, Ga.
Since the country was at war, and since bloodand plasma could easily have been tampered with, special precautions againstsabotage were in effect throughout the blood donor program (p. 295). No knowninstance of sabotage ever occurred.
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THE TOTAL PROGRAM
During the operation of the Blood DonorService of the American Red Cross, from 4 February 1941 to 15 September 1945, atotal 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 on14 August.
TABLE 2.-Numberof blood donations, length of operation, and highest weekly procurement of each American Red Cross blood donor center
Center | Total number | Length of operation | Highest weekly | |
| 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 inthis report.
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TABLE 3.-Production report of American RedCross 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 | --- |
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| 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 ofInterior
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TABLE 4.-Production report of American RedCross 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 | --- | --- | --- | 425 | 715 | 979 | 767 | 2,886 |
| 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 | --- | --- | 495 | 581 | 1,089 | 1,253 | 1,275 | 4,693 |
| 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 | 12,642 | 1,936 | 2,303 | 2,392 | 2,221 | 2,386 | 37,427 |
| Total bleedings | 1,370,163 | 469,624 | 69,554 | 76,076 | 80,087 | 80,309 | 78,849 | 2,224,662 |
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| 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 hadshifted their collections from liquid to dried plasma and a few were stillproviding blood for both forms.
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TABLE 5.-Production report of American RedCross 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 | 34,372 | 1,638 | 1,822 | 2,022 | 1,528 | 1,713 | 8,723 | 98,875 | 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 | 45,332 | 2,260 | 2,694 | 2,433 | 2,205 | 2,188 | 11,780 | 65,734 | 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 | 50,176 | 2,101 | 2,590 | 2,514 | 2,506 | 2,325 | 12,036 | 151,144 | 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 | 31,640 | 1,817 | 2,120 | 1,871 | 2,209 | 1,926 | 9,943 | 42,806 | 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 | 71,598 | 3,007 | 4,006 | 3,750 | 3,466 | 3,173 | 17,402 | 237,838 | 3,500 |
| 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
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The first request for blood for plasma by the Army and theNavy, in February 1941, was for 15,000 pints. In May 1941, when the completionof the first quota had convinced all concerned of the feasibility of theproject, an additional 209,000 pints were requested. In December 1941, afterPearl Harbor, another 165,000 pints were requested for the currentfiscal year. On 1 January 1943, the request for that calendar year was set at4 million pints, and the request for the calendar year of 1944 was set at 5million pints.
The impact of the attack on Pearl Harbor andof the declaration of war against Japan on the emotions and reactions of theU.S. public was reflected in the Blood Donor Service. In November 1941, blooddonations had been about 1,200 per week. In December, the weekly donations roseto 4,600. By the end of April, they exceeded 50,000. By September 1943, they hadreached 100,000 and they were maintained at or above this weekly level duringmost of 1944. The largest weekly procurement, 123,284, was for the week endingon 10 June 1945, the amount collected, as already mentioned, being thereflection of the D-day landings on the Normandy beaches. After 21 October 1944,the weekly averages progressively declined, as centers that were no longerneeded were closed, and only about 2,000 donations per week were being collectedwhen 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 averaged110,923 pints a week. Based on the 48-hour working week then generally ineffect, this was approximately 1 pint every 2 seconds.
Distribution-Of themore than 13 million pints of blood collected by the Red Cross duringWorld War II, 10,299,470 pints were processed into dried plasma. More than 3million 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 theZone 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 and24 March, during the battle on Iwo Jima. This amount, a daily average of 2,497pints, was over and above the amounts collected for plasma and serum albumin. Inall, 387,462 pints of group O blood were flown overseas, 205,907 to Europe bythe Army Air Transport Command, and 181,555 to the Pacific by the Naval AirTransport Service.
Costs-The total cost of the Blood DonorService to the American Red Cross was approximately $15,870,000, about $1.19 perpint of blood collected. Of this amount, about 19 cents was paid from localchapter funds and the remainder by the National Headquarters.
In the original program, the total cost of theoperation was borne by the Red Cross. When the project expanded, the costs roseso sharply that, as of 1 September 1942, the Army and the Navy assumed the costsof servicing the collecting equipment, which were added to the expense ofprocessing the blood. As of 1 August 1943, the cost of transporting the blood tothe processing laboratories was also assumed by the Government. The cost ofservicing the equipment averaged about 60 cents per set, and the cost oftransporting each
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bottle of blood in a refrigerated containerwas 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 werecontributed by the American people. They were carefully supervised andprofitably expended, and it is not possible to estimate what they purchased interms of human lives saved.
THE END RESULT
The Red Cross Blood Donor Service wastranslated, almost overnight, from a limited peacetime activity to a majornational contribution to the military effort. It was enormously successfulbecause of the fine organization of the program; the hard work of those whooperated it; the hundreds of thousands of hours contributed by volunteerworkers; and, most of all, the voluntary donation of millions of pints of bloodby hundreds of thousands of patriotic American citizens, whose gift ofthemselves saved untold thousands of lives of wounded American troops.
References
1. Robinson, G. C.: American Red Cross BloodDonor 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 ofMedical Information, 1944.
3. Minutes, meeting of Committee onTransfusions, Division of Medical Sciences, NRC, 31 May 1940.
4. Minutes, meeting of Subcommittee on BloodSubstitutes, Division of Medical Sciences, NRC, 30 Nov. 1940.
5. Minutes, meeting of Subcommittee on BloodProcurement, Division of Medical Sciences. NRC, 18 Aug. 1941.
6. Methods and Technique of Blood Procurementas Prescribed by the National Research Council for Use in the Red Cross BloodProcurement Centers (ARC 784). Washington: American Red Cross, September 1941.
7. Methods and Technique Used in Red CrossBlood Donor Centers (ARC 784, rev.). Washington: American Red Cross, January 1943.
8. Minutes, meeting of Subcommittee on BloodSubstitutes, Division of Medical Sciences, NRC, 12 May 1942.
9. Robinson, G. C.: Blood Donor Service. 18Dec. 1942.
10. The Organization and Operation of theAmerican Red Cross Blood Donor Service (ARC 1217, rev.). Washington: TheAmerican Red Cross, December 1942.
11. Voorhees, Col. T. S., JAGD: ProposedProgram as Evolved in Discussion Between Dr. Taylor of the American Red Cross andCaptain Schwartz and Colonel Voorhees on 12 Jan. 1943, to Make Possible Increase toApproximately 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 BloodSubstitutes, Division of Medical Sciences, NRC, 23 June 1942.
14. Minutes, meeting of Subcommittee on BloodSubstitutes, Division of Medical Sciences, NRC, 17 Nov. 1943.
15. Minutes, Conference on Blood Preservation,Division of Medical Sciences, NRC, 19 Jan. 1945.
