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Diggs Award – A Portrait of Dr. L. W. Diggs

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


 

A Portrait of Dr. L. W. Diggs

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.

Collection from donor

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 Filtering blood through a gauze into a Kelly flask.

Dr Diggs filtering blood through gauze

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 Collecting blood into a milk bottle.

Ms Jeannette Spann collection blood from donor

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.
Slide crossmatch – 1939.

Slide cross match placed on an agitator device

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

1. Diggs, L. W. and Keith, A. J., Problems in Blood Banking. Amer Jour Clin Path 9:591-603, 1939.
2. Diggs, L. W. and Spann, J., Blood and Plasma Bank at John Gaston Hospital. Hospitals, July, 1942.
3. Diggs, L. W., Disputed Points Concerning Technical Procedures Used in Transfusions by the Citrate Method. Memphis Medical Journal, Oct 1942.
4. Diggs, L. W., Red Cross Participation in a Community Blood Bank in Memphis for the Mid-South Area. Memphis Medical Journal, Aug 1950.
5. Diggs, L. W. “Report of the Blood Bank Committee of the Memphis and Shelby County Medical Society for 1950.” Memphis Medical Journal, Feb 1951.
6. 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.