In 1939, far from the foxholes and firestorms of European battlefields where hundreds of thousands of soldiers were waging a world war, two doctors from UI Hospitals and Clinics were bumping around the dusty, unpaved roads of Johnson County in ambulances. Instead of transporting sick patients, though, they were hauling ten-gallon dairy cans full of ice.

Carefully packed in that ice were glass bottles full of blood. The two were on the road to a medical breakthrough that would help win the war and save millions of lives afterwards. Using these commonplace items, Elmer DeGowin and Robert Hardin, 35BS, 37MD, were conducting experiments that led to the ability to preserve and transport blood in a way that hadn't been possible before.

While blood banking and transfusions are generally considered a 20th century breakthrough that revolutionized medicine, early experiments in this field date back to the 1600s, when new knowledge about the circulatory system led to transfusion experiments on dogs in England. Physicians in England and France even transfused animal blood into humans. In the first such procedure, which was recorded in Pepys' Diary, a volunteer was first bled of several ounces of blood, then connected "via silver tubes and quills" to a live sheep's carotid artery. In two minutes, nine to ten ounces of sheep's blood were transfused into his body. Although that volunteer survived, these animal-human procedures were quickly prohibited by law because of adverse reactions.

The first human-to-human transfusion was performed in 1818 by James Blundell, an English obstetrician frustrated by the number of his female patients who had serious, sometimes fatal, hemorrhages during childbirth. Using a syringe, Blundell extracted about four ounces of blood from the arm of a hemorrhaging patient's husband and infused it into the patient. The procedure was successful, and she survived. Between 1825 and 1830, Blundell transfused ten seriously ill patients with human blood and saved five of them.

Although occasional attempts at blood transfusions continued after that, infections were common until Joseph Lister began promoting the use of antiseptics in 1867. Until 1880, physicians in the U.S. even used milk-from cows, goats, and humans-in transfusions in an effort to find a safer alternative to blood.

By the beginning of the 20th century, transfusions were taking place more frequently, but were still very crude. They were given person-to-person, either by suturing the donor's artery to the recipient's vein in a procedure called anastomosis, or by using a paraffin-coated tube to connect the two vessels. Incompatible hemolytic transfusion reactions, in which microscopic blood clots formed throughout the body, occurred frequently, usually resulting in death. A major breakthrough occurred in 1900, when Karl Landsteiner, an Austrian physician, discovered the first three human blood groups, A, B and O. The fourth, AB, was added by his colleagues in 1902.

After this, blood transfusion technology moved swiftly forward. By 1917, the first transfusion using blood typing and crossmatching had occurred, and a sodium-citrate anticoagulant preservation fluid had been developed that helped extend the life of blood. Such were the advances that during World War I the first blood depot in the world was established in Britain to treat wounded soldiers.

There were still fundamental problems, however. Blood could not be preserved for long periods of time, so in order to give a transfusion, a live donor had to be present. It wasn't feasible to collect and transport blood, and because blood typing and crossmatching was in its infancy, patients still died from incompatible transfusion reactions.

When DeGowin and Hardin were driving around Iowa in their ambulances, they were in search of a solution to those problems. Both had joined the UI Hospitals and Clinics (UIHC) in the 1930s. DeGowin, a UI internal medicine faculty member from 1932 until his death in 1980, was largely responsible for the UI's reputation as a pioneer in the field of blood preservation and banking. According to his son, Richard DeGowin, UI professor emeritus in internal medicine, it was the study of a UIHC patient who developed kidney failure from an incompatible blood transfusion that introduced DeGowin to the field. He began studying transfusion reactions and the effectiveness of preserving blood with various combinations of dextrose, sodium citrate, sodium chloride, and heparin.

Hardin was an internal medicine resident when he worked with DeGowin in the 1930s. Together, they proved that glucose helped extend the useful life span of blood and that it was safe to store blood in the cold for prolonged periods. Their studies showed that the incidence of reactions to stored blood was no greater than to freshly drawn blood, and that no new types of reactions occurred when using stored blood.

DeGowin helped establish Iowa's pioneering reputation when he set up the UI Hospitals and Clinics transfusion service in September 1938 and the blood bank in February 1939. "This was probably the first continuously supported blood bank in the U.S., and definitely the first blood bank west of the Mississippi River," says Richard DeGowin.

The creation of the UIHC's transfusion service and blood bank coincided with the beginning of World War II in Europe. Suddenly, the issue of preserving and transporting blood became critically important, in anticipation of wounded soldiers who might be saved by transfusions. Officers of the U.S. Army Medical Corps visited the UI blood service facilities to see if a large-scale blood bank operation involving transportation over long distances was feasible.

"It was thought that human blood could not be transported because it was too fragile. It was known that shaking dog blood destroyed it, so the natural conclusion was that human blood would also deteriorate under any kind of shaking or movement associated with transportation," explains Richard DeGowin. "So experiments were undertaken to discover whether it could be shipped without destroying red blood cells."

In addition to the dairy cans used for transporting blood in ambulances, DeGowin, Hardin and other colleagues also constructed wooden chests for air transport. "I can recall as a child accompanying my father to the Iowa City airport with the chests," says Richard DeGowin. "They were shipped on United Airline DC-3s to San Francisco and back, simulating the distance between the United States and Paris or London, where blood would need to be shipped during a war in Europe. These were the first studies that showed that blood could be preserved and transported long distances without destroying red blood cells."

In 1941, DeGowin and Hardin published a paper titled "A Plan for Collection, Transportation and Administration of Whole Blood and Plasma in Warfare." The experiments involving such commonplace items as dairy cans had resulted in one of the most important advances of the 20th century-blood banking-and developed the pioneering reputations of DeGowin, Hardin, and the UI.

That same year, at age 28, Hardin left his residency and entered the U.S. Army as a captain. Soon he was serving in England as commanding officer of the U.S.A. European Theatre of Operations (ETO) Blood Bank and as a transfusion and shock consultant. At that young age, he was responsible for the control and distribution of blood for the entire ETO and was the chief consultant to military hospitals for use of blood products in combating shock.

He was also one of the few people to know in advance when the D-Day landings would take place. "Bob told me he was taken into the ballroom of a large country house that served as headquarters in England, where six officers stood around him and whispered the date," Richard DeGowin recalls. "For several weeks before D-Day, he organized fake blood draws to deceive the Germans about the actual date of the invasion."

So important was blood transfusion to the war effort that plasma was often collected in secret to prevent enemy agents finding out and recognizing it as preparation for a major offensive. Servicemen, European citizens, and Americans all donated blood to aid the war effort. Britain began collecting plasma in 1939 and in June 1940 requested American aid for British and French casualties. A nationwide program to collect blood from American citizens began, and in 1941 the Red Cross started collecting plasma for the U.S Armed Forces. By the end of the war, the Red Cross had collected 13 million units of blood for U.S. and Allied soldiers.

In those early years, screening processes for blood donors were not as stringent and safety-conscious as today. Doctors acknowledged that syphilis, malaria, hepatitis and, rarely, viruses such as smallpox, measles, and influenza could be present in the blood without showing symptoms in the donor, but there were no testing methods available to tell if blood was infected. Refrigerating blood for three days was recommended to destroy the syphilis organism. Other diseases were accepted as a risk of the transfusion, with doctors encouraged simply to recognize the symptoms of the diseases after transfusion and to treat them promptly.

Hardin received a Legion of Merit award for his leadership during the war. When he returned home, he became an internal medicine professor at the UI and a world leader in diabetes research and treatment, establishing a diabetes clinic at the UI. After serving as dean of the UI College of Medicine and president of the American Diabetes Association, he returned to the Department of Internal Medicine as an instructor and clinical physician, seeing patients until his death in 1988. Elmer DeGowin also served his country during World War II. He was secretary of the Subcommittee on Blood Substitutes for the National Research Council and a technical consultant for the Blood Plasma Section, Office of Civilian Defense.

After the war, a contract with the U.S. Army-the first research grant awarded to the UI Department of Internal Medicine-allowed DeGowin to continue studying blood preservation. He headed one of the first investigations to measure the life span of red blood cells, performed groundbreaking research on blood production, and in 1949 wrote Blood Transfusion with Hardin and John B. Alsever, senior surgeon with the U.S. Public Health Services. The first modern book on the subject, it became a manual for blood transfusion, preservation, and blood center development. DeGowin served as head of the UI Hospitals and Clinics' blood bank from 1939 to 1966 and helped other hospitals set up their blood centers. He continued to see patients until his death at the age of 79.

Because of the work by DeGowin, Hardin, and others at the UI and elsewhere, blood transfusion has become a much safer treatment for hemorrhage, hemophilia, cancer, blood diseases, and other conditions. Dr. Ronald Strauss, UI professor of pathology and pediatrics and medical director for the Elmer L. DeGowin Memorial Blood Center, says blood services have made a huge impact on the treatments that are available today.

"Most transplantation services would not be possible without good transfusion and blood banking services," he says. "Liver, heart, lung, bone marrow, and kidney transplants would be impossible, and so would most extensive surgeries for cardiac problems or cancer removal. Many people with blood abnormalities would be impossible to treat without the technology to remove the blood, separate it, take out the part you want and put the rest back in."

One important treatment that has grown out of blood banking technology is stem cell transplantation for cancer patients, where the patient's blood is collected, the stem cells are removed, and the blood is replaced. The patient is given aggressive chemotherapy, a treatment that usually destroys the blood forming system and immune system. The stem cells then are replaced, stimulating the growth of healthy new bone marrow and restoring the patient's ability to produce blood cells and to combat infections and bleeding.

At UIHC, work has also been done to develop a treatment for Rh disease, a condition of incompatibility between the blood of a mother and her fetus which often proves fatal for the child. UIHC faculty and staff also developed specialty procedures for the emergency room and did early research on cell separators, further contributions to blood studies.

UI researchers are currently involved in studying hematology and transfusion practices in preterm infants, looking at ways to treat blood components to destroy all bacteria and viruses that may cause infections, and evaluating emerging apheresis technology, a process involving the infusion of a patient's own blood from which certain cellular or fluid elements have been removed.

Glass bottles of blood bouncing around in the back of ambulances may have given way to gleaming, ultra-modern laboratories and clinics, but DeGowin and Hardin's groundbreaking work in blood transfusion and banking continues today at the UIHC.

Susan L. Green, is an associate editor at the UI Office of Health Science Relations and a freelance writer in Iowa City. You can find out more about how to give blood by visiting the American Association of Blood Banks.