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L. W. Diggs, M.D. |
A Portrait of Dr. L. W. Diggs
by Ann Bell
University of Tennessee Center for the Health Sciences,
Division of Hematology, Memphis, Tennessee, September 1977
Reproduced from TABB News Vol. 3(2), Autumn 1977
The outstanding medical career of Dr. Lemuel Whitley Diggs began in 1929
in Memphis, Tennessee, when he joined the faculty of the University of
Tennessee as Assistant Professor of Pathology. His main duties consisted
of supervising the clinical laboratories, including the transfusion service,
and teaching the courses in clinical pathology and general pathology to
medical students. Other duties involved performance of autopsies, assistance
in the examination of surgical specimens, and in the training of medical
technologists.
Previous to 1938 in the old Memphis
General Hospital all cross matching of blood for transfusion and serologic
test for syphilis were performed by laboratory interns. The sets for transfusion
were prepared by nurses. Blood was drawn from donors and transfusion were
given by the interns. There were no donor lists nor funds to pay for blood.
When blood was needed, it was the responsibility of the family to obtain
donors. On the average, six donors were cross-matched before a compatible
blood could be found. The testing procedures often required more than
12 hours.
Fig. 1. Collection from donor with blood running
through rubber tubing into open enamel cup containing sodium citrate,
1938. |
In
1938 the highest maternal death rate in the United States was reported
to be in Memphis. Dr. Diggs was assigned to study the causes of death
in association with labor and delivery and found that the majority of
obstetrical patients who died bled to death. He recommended the establishment
of a blood bank as a means of providing blood promptly for mothers as
well as for other emergencies. The use of refrigerated blood had been
shown to be safe by the experiences of Russian scientists who utilized
blood from cadavers, by the experiences during the Spanish war, and by
the employment of refrigerated blood at the Cook County Hospital in Chicago
(1937) and shortly thereafter by the Los Angeles General Hospital and
the Philadelphia General Hospital.
No university funds were available
for the purchase of needed equipment and supplies to start a blood bank.
Blood transfusions were considered to be laboratory procedures and the
contract between the University of Tennessee and the City of Memphis specified
that all laboratory expenses were the responsibility of the state rather
than the city. Dr. Diggs appealed for funds to the community through a
public forum and the news media. Mr. Herbert Herff, a civic and business
leader, responded and organized his Jewish friends who promptly raised
several thousand dollars to buy a refrigerator and other essential equipment.
The blood bank was officially opened and the first blood drawn and refrigerated
in April 1938, the first blood bank in the South and the fourth in the
nation.
At the time the Blood Bank was started in Memphis it
was customary to draw blood from the arm vein of a donor by means of a
13 or 14 gauge needle and allow it to run down through a rubber tubing
into an enamel cup containing a solution of sodium
Fig. 2. Dr. Diggs filtering
blood through gauze into a Kelly flask held by Ms. Alice Jean
Keith. 1938. |
citrate (Fig. 1). The
needle was inserted from above downward in order to "meet the blood
head on." The first ten bloods that were collected and refrigerated
were grossly contaminated with bacteria and could not be used. This experience
immediately led to the adoption of a closed system of collection. To remove
fibrin clots the blood was filtered through multiple layers of cotton
gauze, spread over a funnel, into a Kelly flask (Fig. 2).
Many physicians were hesitant to use refrigerated blood.
Dr. Lucious McGehee, Chief of Surgery, and his Chief Resident in Surgery,
Dr. Charles Olim, were responsible for the early success of the blood
bank by denying typing, cross matching and serological services to those
physicians who elected to use fresh warm blood rather than stored cold
blood.
The first technologist employed, on a part time basis,
to assist with the blood bank procedures was Alice Jean Keith. She helped
to develop a simple cross-matching technique which in reality was a high
protein cross match. This test consisted of dipping a wooden applicator
stick into the blood clot of the donor and transferring a few red cells
to a glass slide containing a drop of serum from the recipient. The cells
and serum were mixed and examined microscopically for compatibility. This
simple procedure proved to be safe before the Rh and other less common
blood factors were known and before testing by the Coombs procedure came
into use.
Jeannette Spann was appointed as the first full time
medical technologist in October, 1938. She developed a new way to store
sterile needles by constricting the slides of
Fig. 3. Ms. Jeannette Spann
collecting blood from donor into a milk bottle placed on a mechanical
shaker connected to a motor. 1938. |
glass tubes so that the needle
point would not touch the bottom. She also assisted in the designing of
blood collection tables with sliding and sloping arm boards, a mechanical
shaking device for the mixing of blood from the donor with the citrate
in the flask. This shaker was made from a disk record player, a universal
joint from a model T Ford and a tin can (Fig. 3). Later more refined mechanical
shakers, using standard electric motors, were made by students at the
William R. Moore School of Technology in Memphis. Other ingenious mechanical
devices included a wire spring to prevent kinking of tubing, metal filters
and special needle adapters with wide lumens. In order to expedite the
mixing of red cells and serum in performing a cross match an agitator
device was used made by attaching the clapper of an old door bell to an
x-ray plate which slid back and forth over the smooth surface of another
used x-ray plate (Fig. 4). All transfusion equipment, including rubber
tubing, glass tubing, funnels and flasks were cleaned and sterilized after
each use. Nothing was thrown away.
While developing the bank, Dr. Diggs had numerous difficulties
such as: keeping equipment sterile and non-pyrogenic; finding safe distilled
water; maintaining the refrigerator at 4°; tests for hemolysis; and keeping
records. In spite of these and other problems, 1,415 transfusions were
given and 1,905 flasks of blood were collected during the first year of
operation. The percentage of reactions, including elevations of temperature
without chill, was 6.7 percent.
The
Blood Bank at John Gaston Hospital, as it was then called, was one of
the first in the United States to process plasma (1940). Dr. Diggs wrote
in 1942 that "with the Nation at war and preparation for civilian
defense urgent, it is imperative that every general hospital provide adequate
facilities for collecting, storing and dispensing of whole blood and plasma.
In case of increased demands for plasma for military use or for civilians
in combat areas, general hospitals may be expected to serve as collection
centers and as depots of a reserve supply of plasma. Blood and plasma
banks are also needed to supply the everyday demands of hospital patients
and particularly needed in charity hospitals to make blood in adequate
quantities available to the indigent sick at a minimum cost to the taxpayer."2
During World War II when it
was anticipated that transfusion supplies and equipment might be urgently
needed, Dr. Diggs obtained federal funds to develop rubber stoppers and
tubing connection to be used on milk bottles and to conduct studies concerning
the efficiency of various sized and types of needles an d the
merits of gravity versus suction devices. In an article for the Memphis
Medical Journal (1942), Dr. Diggs stated that "the most simple, inexpensive
and practical method for the collection of blood for transfusion is by
the closed citrate method using gravity."3 A list of articles
written by Dr. Diggs about the blood bank are given at the end of this
paper.
Fig. 4. Slide cross match placed on
an agitator device made by attaching clapper of door bell to one
x-ray plate which rotated over another x-ray plate. 1939. |
Laboratory medicine
had intrigued this Virginia-born physician since his medical student
days at Johns Hopkins University which he entered after graduation from
Randolph-Macon College in Ashland, Virginia. Interest in blood cells,
sparked by Dr. Florence Sabin and nurtured by Dr. S. Bayne-Jones and
Dr. George Whipple, and experiences as a house officer steered him into
the field of clinical pathology. As a member of the first house staff
group at Strong Memorial Hospital in Rochester, New York, his duties
included blood typing and cross matching as well as preparation and
sterilization of flasks and the administration of transfusions by the
citrate method. He demonstrated such facility for laboratory medicine
that he was asked while a second year resident in medicine to organize
and teach the first course in Clinical Pathology at the University of
Rochester in 1928. One year later he joined the faculty of the University
of Tennessee.
From January 1945 to September
1947, Dr. Diggs was the Clinical Pathologist at the Cleveland Clinic
in Cleveland, Ohio, where one of his duties consisted of remodeling
the Blood Bank. He returned to the University of Tennessee as Professor
of Medicine and Chairman of the Division of Hematology and Laboratory
Medicine, including the Blood Bank.
Dr. Diggs recommended in 1950
that a community blood bank was needed in Memphis to provide for war
and catastrophes, to provide blood for small hospitals without banks
and to supplement existing banks."4 He stated that the
bank should be self supporting and non-profit and that it require donations
of blood or funds to pay for those who use the service. During the next
several years various blood bank committees of the Memphis and Shelby
County Medical Society grappled with the problems related to the regional
procurement, storage and dispensing of blood for transfusion which ultimately
culminated in 1963 in the establishment of a non-profit "Community
Blood Plan" sponsored by the Memphis and Shelby County Medical
Society and the Hospital Council of Memphis with representatives of
other health agencies and laymen on the governing and policy making
board. In 1975 the name of this agency was changed to "The Mid-South
Regional Blood Center." The working philosophy of this group is
that those who receive blood have an obligation to furnish blood for
their own use, utilizing the principle of insurance.
Major interests of Dr. Diggs, in addition
to teaching and blood banking, included sickle cell anemia, blood coagulation
and the morphology of blood cells. During the first few days after arriving
in Memphis, he encountered his first patients with sickle cell anemia
which at that time was considered a rare disease and about which little
was known. Study of these cases launched him into a lifelong investigation
of the pathological anatomy and the clinical and laboratory manifestations
of the sickle cell trait and sickle cell disease variants. For many
years it was not possible to obtain financial support for research.
The first support come from the Blacks and from the Herff Foundation
in Memphis, followed by a grant from Mr. Abe Plough, in the name of
the American Lebanese Syrian Associated Charities (ALSAC). Continuing
funds from ALSAC, while the St. Jude Children's Research Hospital was
being built, made it possible to start the Sickle Cell Center and to
employ technical assistants and to pay the salaries of research fellows.
Major emphasis was placed on the study of the painful sickle cell crises
and hematological and chemical manifestations. Other activities of this
program included the collection of gross and microscopic photographs
of anatomical lesions, x-ray and laboratory abnormalities and of the
world's literature on sickle cell anemia. Dr. Diggs has prepared an
audio-visual film strip on the pathophysiology of sickle cell hemoglobin.
He appeared on numerous television programs to discuss the nature of
sickle cell anemia and practical procedures used in its management.
Pamphlets were prepared for school teachers, parents and patients containing
frequently asked questions about sickle cell anemia and giving answers.
In cooperation with the National Committee for Careers
in the Medical Laboratory, Dr. Diggs has made three tape recordings
together with 150 Kodachrome slides entitled "Laboratory Tests
Used in the Diagnosis of Sickle Cell Disease." Movies of patients
in painful crises have been used by him for presentation at national
meetings. A long-time major effort has been the study of the pathology
of S-hemoglobinopathies based on more than 90 autopsies at the City
of Memphis Hospitals and cases from the files of the Armed Forces Institute
of Pathology. An integral part of this anatomical study has been the
"sudden death syndrome" in patients with sickle cell trait.
Dr. Diggs has been the author of 61 indexed scientific papers dealing
with sickle cell conditions and has contributed chapters on this subject
to several textbooks.
The Sickle Cell Resource Center
was established in 1974 through aid from the Mid-South Regional Medical
Program and later from the National Sickle Cell Disease Program. Major
aims of the Resource Center were education through the assembly of every
available scientific and indexed publication concerning hemoglobin S
from 1910 through 1969, the writing of educational pamphlets and the
development of visual aids. Now, at age 77, Dr. Diggs has recently completed
copies of 543 selected transparencies with captions for each for the
National Sickle Cell Disease Program and also has directed the microfilming
of his library of articles on sickle cell conditions for the library
of NIH Research Hospital in Bethesda. Cross files according to the year
of publication, authors, and subjects were made.
Dr. L. W. Diggs has exerted a
scholarly influence on the teaching of clinical pathology to medical
residents and medical technologists through his minute descriptions
of blood cell characteristics, his advocation of practical procedures
and his enthusiastic desire to help the student correlate laboratory
findings with clinical manifestations. Because of his belief that art
is a valuable aid to teaching, he has encouraged students to sketch
unusual microscopic objects for future reference and to graphically
portray laboratory results in order to ascertain the effect of treatment.
In teaching the course in clinical pathology he has emphasized the use
of simple readily available and practical procedure. For a number of
years when the four quarter system was in vogue, he taught his course
four times a year. One of the last classes that he taught presented
him with a plaque which was inscribed with the words, "He did the
most with the least."
The Morphology of Human Blood
Cells, authored by Dr. Diggs in collaboration with Dorothy Sturm
and Ann Bell, is used throughout the world as a valuable teaching aid
in medical education and in clinical laboratories. It has been translated
into five languages. The third edition of their colored morphological
atlas was published in 1975. Another useful and practical contribution
to medical teaching was his manual, "Basic Medical Laboratory
Procedures," which has been published in eight editions. He
has been a major contributor to S. E. Miller's A Textbook of Clinical
Pathology, Gould's Medical Dictionary and "Manual of
Approved Laboratory Procedures for Use at the Medical Units of the Tennessee
Valley Authority."
For quite a few years after 1947, Dr. Diggs participated
in consultant hematology practice and in the interpretation of bone
marrow smears and tissue sections mailed in from various parts of the
country. Because of this long experience as a clinical hematologist,
Dr. Diggs is eagerly sought after as a speaker by scientific, student
and lay groups across the nation. Since 1956, he has conducted more
than 50 national workshops for pathologists and medical technologists
on abnormal blood and bone marrow material.
As a member of the executive committee and board of
governors of St. Jude Children's Research Hospital, Dr. Diggs assisted
in the formulation of policies, planning the physical plant and selecting
the initial staff. He is a member of numerous national, state and local
medical groups.
Local and national honors have
been bestowed upon this medical educator. Devoted students, alumni and
grateful patients presented his portrait to the University of Tennessee
and established a scholarship fund for medical technology students.
In 1963, he was chosen president of the Memphis Academy of Internal
Medicine and honored by the University with the endowed Goodman professorship
for his outstanding and admirable contribution to medical education.
He received the coveted Ward Burdick Award from the American Society
of Clinical Pathology for meritorious contributions to the study of
the pathology of sickle cell anemia in 1964. The National Sickle Cell
Disease Research Foundation of New York gave him the "L. W. Diggs
Meritorious Service Award in recognition for relieving suffering from
the disease of people of African descent." The Tennessee Association
of Blood Banks presented him with the "Lemuel W. Diggs Meritorious
Service Award" for his contribution to blood banking in 1973. This
award will be given annually to the individual in Tennessee who contributed
the most to blood banking.
A story of Dr. Diggs' career would
not be complete without telling of the tremendous part played by his
wife, Beatrice Moshier Diggs, not only in their home and family life
but also in his medical work. Mrs. Diggs has been his partner in many
scientific endeavors and has aided him immeasurable during the last
fifteen years in his writing and speaking engagements. Their favorite
activities are growing a large vegetable garden in Cordova, Tennessee,
and fishing, canoeing and "roughing" it on the Little Red
River near their cabin the the Ozarks in Stone County, Arkansas. Dr.
and Mrs. Diggs have two sons, one a physician and the other a hospital
administrator and professor. Two daughters and eight grandchildren make
up the Diggs' family. Their daughters and one daughter-in-law have aided
in the creation of art work for his scientific publication and teaching
material.
Physician, medical educator, hematologist, clinical
investigator, blood banker, researcher, speaker, author, humanitarian,
father, grandfather and farmer - this is my portrait of Dr. Lemuel Whitley
Diggs.
References
-
Diggs,
L. W. and Keith, A. J., Problems in Blood Banking. Amer Jour Clin
Path 9:591-603, 1939.
-
Diggs, L. W. and
Spann, J., Blood and Plasma Bank at John Gaston Hospital. Hospitals,
July, 1942.
-
Diggs, L. W., Disputed
Points Concerning Technical Procedures Used in Transfusions by the
Citrate Method. Memphis Medical Journal, Oct 1942.
-
Diggs, L. W.,
Red Cross Participation in a Community Blood Bank in Memphis for the
Mid-South Area. Memphis Medical Journal, Aug 1950.
-
Diggs, L. W. "Report
of the Blood Bank Committee of the Memphis and Shelby County Medical
Society for 1950." Memphis Medical Journal, Feb 1951.
-
Diggs, L. W. "Report
of the Blood Bank Committee of the Memphis and Shelby County Medical
Society for 1954." Memphis Medical Journal, June 1954.
Additional
Articles by Dr. L. W. Diggs
on Blood Banking
-
Diggs,
L. W. and Keith, A. J. "The Use of Clotted Blood in Typing and
Crossmatching Blood for Transfusion." S. Med. J. 32:1089-1091,
Nov 1939.
-
Diggs,
L. W.: "A Closed Citrate Method of Collecting Blood." Am.
J. Surg. 1:50-54, 1940.
-
Diggs,
L. W. Plasma Therapy. Memphis Medical Journal 16:58-61, 1941.
-
Diggs,
L. W. The Blood and Plasma Bank at the John Gaston Hospital. Progressive
Hospital, 2:9-12, 1941.
-
Diggs,
L. W. and Turner, H. B. A Shaking Device Used in the Collection of
Blood for Transfusion. J. Lab. Clin. Med. 27:1070-1071, 1942.
-
Diggs,
L. W. Improved Needle and Observation Tube for the Collection of Blood
for Transfusion. Am. J. Clin. Path. 12:91-92, 1942.
-
Diggs,
L. W. "The Efficiency of Various Types of Equipment Used in the
Collection of Blood for Transfusion." Am. J. Clin. Path. 12:518-522,
Oct 1942.
-
Diggs,
L. W. "Planning a Blood and Plasma Bank in a General Hospital."
Clinics 2:1-14, 1943.
-
Diggs,
L. W. and Smith, J. M. A Mechanical Shaker for Transfusion Flasks
Using a Standard Electric Motor. Am. J. Clin. Path. 13:67-69, 1943.
-
Diggs,
L. W. "The Milk Bottle as a Blood Transfusion Flask." Am.
J. Clin. Path. 13:101-107, 1943.
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