Birth Story

Bernard Fantus, the Hungarian-born physician who was the director of "therapeutics" at Cook County Hospital in Chicago, Ill., established the first "blood bank" in 1937.

Until then, a donor had to be on-site at the time of a blood transfusion.

Bernard Fantus

Dr. Fantus also coined the term "blood bank," in an article in the Journal of the American Medical Association that year that set out the hospital's methodology in clear, understandable terms.

Other institutions swiftly developed their own blood-storage facilities, and helped themselves to Fantus's catchy term as well.

Cook County's blood-storage innovation came at a critical time, just a few years before the start of World War II, when blood donated by people thousands of miles from the battlefronts would make the difference between life and death for a great many injured Allied soldiers.

In 1894, Marie Francois Sadi Carnot, the president of France, was stabbed by a would-be assassin in Lyons. By today's standards, the wound was not severe; however, the knife severed the portal vein in his abdomen. Carnot bled to death because up to that point, no one had figured out how to repair blood vessels.

One man undertook to change that, Alexis Carrel, a student in Lyons who was appalled by Carnot's death, in his hometown, while a number of physicians stood by and watched.

But consider the problem — repairing a tiny, elastic, living tube, part of a network of tubes of different sizes and functions, so that it would retain its ability to channel many gallons of blood every day, birth to death, without a hitch.

The story is that Carrel — Dr. Carrel by 1900 — studied with Marie-Anne Leroudier, one of the most proficient needlewomen in Lyons (her work was exhibited at the Columbian Exposition in Chicago in 1893), learning to make minute, uniform stitches. He developed a triangular system that allowed him to rapidly close up a vein or artery end-to-end without having the stitches adhere to the opposite wall, ushering in the birth of vascular surgery.

Carrel came to the University of Chicago in 1904, where his prodigious 21 months' work as an assistant to G. N. Stewart at the Hull Laboratory laid the groundwork for transplantation surgery. That work was the basis for Carrel's becoming the first scientist working in the United States to win the Nobel Prize for medicine, in 1912. Carrel soon moved on to the Rockefeller Institute for Medical Research in New York.

(Carrel's collaborator at the U. of C., Charles Claude Guthrie, was miffed that he was not included in the Nobel Prize. Guthrie possibly lost points with the Nobel committee for his subsequent experiments in St. Louis with head transplants.)

Carrel was a complicated man, compassion and curiosity mixed up with arrogance and resentment. He was a eugenicist — that is, he subscribed to the false science of "perfecting" the human race by eliminating traits judged to be inferior — and he was also an enthusiastic believer in the miracle cures at the shrine at Lourdes. At the time of his death in 1944, in Paris, he was working on a project for the collaborationist Vichy government.

I notice that the American College of Obstetricians and Gynecologists is gearing up for its annual clinical meeting May 15 through May 19 in San Francisco.

The 2009 annual meeting was in Chicago, and I attended as many sessions as I could -- I don't want my ideas about what is going on in obstetrics to stop with my own birth experiences. (Sadly, I won't be able to attend the San Francisco meeting.)

I learned a lot last May, but one thing stayed with me in particular, Dr. Robert Wachter's keynote address.

Robert Wachter MD

Dr. Wachter,  chief of the medical service at the University of California at San Franciso, among other titles, is one of the founders of the hospitalist movement, and an expert in patient safety.

He spoke about efforts to improve safety since 1999, when the Institute of Medicine released its landmark report, To Err Is Human, which revealed that as many as 98,000 people were dying from medical mistakes every year.

Dr. Wachter's message is important for the birth story because obstetricians are the doctors most often sued for malpractice. A 2003 ACOG survey showed that 76 percent of OB-GYNs have been sued at least once.

Many of them would say that if anything ever goes wrong with a birth, they are sued whether the mishap was their fault or not. Dr. Wachter agreed that "the blame game" is "not productive."

He said, "Medicine is too complex to be error free." Some other complex industries have better safety records, though, he said, often because they have developed "systems thinking," standardizing procedures and accepting that some mistakes are a natural part of the process.

The Chicago River, ready for the parade

From Chicago on St. Patrick's Day, here is our famous green river, dyed last Saturday for the big downtown parade, captured by my friend Bill Linden.

What does this have to do with the birth story? Well, nothing, but we of Irish descent just get the one day to celebrate, you know? Or, counting parade day and the festivities on the South Side on Sunday, three days, tops.

And Ireland does have the lowest maternal mortality rate in the world at last tally, with just one mother dying per 100,000 births in 2005.

That certainly is something to celebrate, and to remark upon.

Happy St. Patrick's Day!

The Society for Maternal Fetal Medicine held its annual conference in Chicago last week, and I went to a few sessions. The physicians, who specialize in the health of mothers and their babies, spent up to six days in meetings, so I got a canape-size serving compared to theirs.

Research teams from all over the country, and from other countries as well, reported on their investigations into conditions that jeopardize mothers' and babies' health in pregnancy.  Several important findings came out of the meeting. Here are just a few:

* A simple new urine test with a cool name, the "Congo Red Dot Test," appears to be able to predict and diagnose preeclampsia, a condition that can kill mothers and babies, cause birth defects, and is a major contributor to pre-term birth. A research team from the Yale University School of Medicine found that the test accurately predicted preeclampsia in 347 women in their study. Preeclampsia symptoms include hypertension and protein in the urine. The condition affects 5 to 10 percent of pregnancies. It is commonly treated by delivering the baby.

* One of every three pre-term births is caused by a "silent" infection inside the uterus. Now it appears some women and babies are genetically more susceptible to inflammatory infections, according to a study led by Roberto Romero MD, Chief of the Perinatology Research Branch at the National Institute of Child Health and Human Development. The study won an award from the March of Dimes, a nonprofit group that works to prevent birth defects, premature birth and infant mortality.

At the SMFM meeting, the Yale U. School of Medicine also presented the results of a couple of other investigations that might lead to a decrease in preterm births as well.