Seventy-five years of banking

Banking activities date back to the second millennium BC, when the Code of Hammurabi (one of the earliest known formal laws) contained written standards of practice relating to financial transactions. Ancient Egypt also had banking arrangements that related to grain harvests and storage. Although these early transactions pertained to deposits of cattle, grain, and, later, precious metals, the concepts are somewhat similar to today’s banking system of financial deposits and withdrawals.

Figure 1: Hospital discharge status

Figure 1: Hospital discharge status

Modern-day banking practices can be traced back to the medieval Italian cities of Venice, Florence, and Genoa. The most famous medieval bank was the Medici bank of Giovanni Medici, which was founded in 1397. Medici’s business started out as a green-covered table in a marketplace before he moved it to a hall in his large palace. The Medici bank subsequently became the banker for the Pope of the Catholic church. Over the next several centuries, both the Dutch and the British refined the Italian banking techniques. Within five years of the Declaration of Independence, the first U.S. bank was chartered in Philadelphia.1

How does banking relate to trauma? The National Trauma Data Bank®, the largest aggregation of U.S. and Canadian trauma registry data ever assembled, acts like a bank. Data are submitted (deposited) by trauma centers and data requests (withdrawals), including data for the Annual Report, are performed.

Another bank that plays a prominent role in the care of the injured patient is the blood bank. Milestones for blood and transfusion therapy began in 1628 when William Harvey, a British physician, discovered the circulation of blood. Shortly after that, the first blood transfusion was attempted. Richard Lower, an English physician, performed the first successful transfusion in 1655 when he kept a dog alive by direct transfusion from another dog. In 1667, occurrences of sheep-to-human transfusions were reported in France and England. In 1818, James Blundell, MD, a British obstetrician, performed the first successful transfusion of human blood for a case of postpartum hemorrhage.

Figure 2: Emergency department discharge disposition

Figure 2: Emergency department discharge disposition

At the start of the 20th century, Austrian physician Karl Landsteiner, MD, discovered the first three human blood groups. Then, 75 years ago this month, on March 15, 1937, Bernard Fantus, MD, director of therapeutics at Cook County Hospital in Chicago, IL (and the great and great-great uncle to the authors of this article), opened the first large-scale, U.S. hospital-based blood bank.2 His 1937 landmark article titled “The Therapy of the Cook County Hospital” described his oversight of collection, storage, and indications for transfusions.3

Dr. Fantus is also credited with coining the term “blood bank” and with being the first blood bank and transfusion service medical director. In only a matter of a few years, community and hospital blood banks sprang up across the U.S.

By 1950, there were 1,500 hospital blood banks, 46 community blood centers, and 31 American Red Cross regional blood centers in the U.S.4 The collection, banking, and transfusion of blood skyrocketed over the next several decades. Today, according to the Red Cross U.S. blood facts and statistics from 2006, someone needs blood every two seconds, 38,000 blood donations are needed every day, and 30 million blood components were transfused in 2006. There were 16 million blood donations in the U.S. that year.5

In order to examine the occurrence of blood use in the NTDB research dataset 2010, admissions records were searched using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code 99.04 (transfusion of packed cells). A total of 39,154 records matched the procedure code. In all, 37,569 records contained a hospital discharge status, including 12,048 discharged to home, 9,821 to acute care/rehab, and 10,928 sent to skilled nursing facilities; 4,772 died.

These patients were 56 percent male, on average 54.8 years of age, had an average hospital length of stay of 14.2 days, an average intensive care unit length of stay of 10.2 days, were on the ventilator for an average of 9.8 days, and had an average injury severity score of 18.2. The increase in severity of this group as compared with past analyses is also represented in that their emergency department disposition included one-third going to the intensive care unit and more than 28 percent going directly to the operating room (see Figures 1 and 2).

Blood was a rare commodity in the early 1930s and experimental use of cadaver blood for transfusion was not going to meet the needs of a growing Cook County. How do you get people to donate their blood before it is actually needed? Dr. Fantus took a concept and coined a term that has held a prominent place in the medical vocabulary of the past nine decades. At a time when people did not have much money to put in a bank, they did have a precious resource that they were able to share with their loved ones. Family members and friends of hospitalized patients could preemptively deposit units of blood, and the patient could withdraw blood if the need arose.6

The Cook County Hospital blood bank, like any bank, had accounts with ledger sheets that tracked credits (deposits) and debits (withdrawals). Millions of individuals worldwide, from every ethnicity, race, and social class, have benefited from the prompt availability of banked blood. Banking may have been around since 2,000 BC, but it is the last 75 years of banking that have saved countless lives across the globe.

Throughout the year, we will be highlighting data through brief reports that can be found monthly in the Bulletin. The NTDB Annual Report 2011 is available on the ACS website as a PDF file and a PowerPoint presentation at www.ntdb.org. In addition, information is available on our website about how to obtain NTDB data for more detailed study. If you are interested in submitting your trauma center’s data, contact Melanie L. Neal, Manager, NTDB, at mneal@facs.org.


References

  1. A Brief History of Banking. Available at: http://people.brandeis.edu/~cecchett/Textbook%20inserts/A%20Brief%20History%20of%20Banking.htm. Accessed February 8, 2012.
  2. Shaz BH, Hillyer CD. Transfusion medicine as a profession: Evolution over the past 50 years. Transfusion. 2010;50:2536-2541.
  3. Fantus B. The therapy of the Cook County Hospital. JAMA. 1937;109:128-131.
  4. American Red Cross. History of Blood Transfusion. Available at: http://www.redcrossblood.org/learn-about-blood/history-blood-transfusion. Accessed February 8, 2012.
  5. AABB. Highlights of Transfusion Medicine History. Available at: http://www.aabb.org/resources/bct/Pages/highlights.aspx. Accessed February 8, 2012.
  6. Ramsey G, Schmidt, PJ. Transfusion medicine in Chicago, before and after the “blood bank.” Transfusion Med Rev. 2009;23(4):310-321.

Acknowledgement
Statistical support for this article has been provided by Chrystal Price, data analyst, NTDB.

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