From Obscurity to Legacy: Dr. Winifred Ashby’s Lasting Impact
The Story Behind the Ashby Technique and Its Lifesaving Role in Medical History
(6 min read)
In honor of National Blood Donor Month, we recognize the pivotal contributions of Dr. Winifred Ashby, a woman whose pioneering research was underappreciated during her time, but whose discoveries proved crucial in saving countless lives. Ashby's work in the early 20th century laid the foundation for advancements in blood transfusion techniques, transforming the science of blood administration and significantly improving medical practices worldwide.
The concept of blood circulation was discovered in 1628, and animal blood transfusions were attempted with varying degrees of success. The first successful transfusion of human blood was to treat a (unnamed woman’s) postpartum hemorrhage in 1818. Blood types were not identified until 1901.
At the turn of the century, blood transfusions generally failed, despite being practiced in the most controlled of environments,
“Given the difficulties and unexplained reactions, interest and trust in transfusion had significantly waned…especially among European physicians.” (Pierce, n.d.).
Many years later, the scientific knowledge required for successful transfusions was still in its infancy, though hospitals, universities, and physicians continued to advance.
Then, in 1917, as the United States joined WWI, blood transfusion science came to the forefront.
Blood transfusions, although more common, remained difficult and unpredictable. Attempting to store blood for later use increased the risk exponentially. For this reason, transfusions were commonly performed using the syringe-cannula method, which facilitated the direct transfer of blood from donor to patient. Firsthand experiences with this process are described in the accounts of nurses near the front lines, as well as in the book: Finding Themselves: The Letters of an American Army Chief Nurse in the British Hospital in France by Julia C. Stimson:
“...a man who had had a fearful hemorrhage from the wound in his shoulder that morning was very much worse. It was decided to transfuse him, a complicated job under the very best of circumstances. An up-patient was sought to volunteer to be the donor of the blood, and promised as a reward that he would be sent to England and not back to the Base.... He was brought, wide-eyed and wondering, into the brilliant, messy operating room filled with strangely garbed and bustling people and put on a table and his arm prepared. ... I went with another doctor to get ready the vein in the patient’s arm. In a few minutes we were ready and the other doctors came to insert the tiny point of their glass tube into the hole in the vein we had ready. A nurse was holding a droplight over the bed, another nurse was holding the arm, a doctor was adjusting the tourniquet so that the vein would show up well, then the two men who were working were bending over the arm, I was handing them instruments, for I was scrubbed up, since everything must be sterile. The patient was just gasping, rapidly growing worse, but the point went in successfully and the blood began to flow into his vein...” (Stimson, 1917)
Winifred M. Ashby began a Mayo Foundation fellowship in immunology and pathology in the same year the U.S. entered WWI. Within a few years, she had developed a groundbreaking serologic method to precisely measure erythrocyte (red blood cell) survival. Her technique enabled an accurate count of the remaining donor red blood cells in a patient’s bloodstream after a transfusion, providing insight into how effectively the cells functioned in the recipient’s body. It marked the first-ever technique for determining the lifespan of red blood cells in humans and would later be recognized as the Ashby Technique.
Beyond facilitating accurate cell counts in the body, the method also advanced the scientific evaluation of stored blood.
Using this technique, Ashby observed that human red cells may remain in circulation for as long as 110 days, contradicting the widely held belief that the life span of the erythrocyte was two to three weeks.
In 1919, Ashby published her research.
It was met with widespread skepticism, as noted by Eugene Cronkite, MD in his Oral History:
“...Now this was totally unacceptable to the pundits of that time ...I don't understand why nobody accepted her work. It might be that she was female. It might be that… they weren't prepared that a red cell is going to live 120 days, because...if red cells lived 120 days it means that 2 x 10 raised to the 11th power red cells are being produced per day.... That's a hell of a big number. And I think that was the thing that just sort of made the pathologists of the day say no that's not possible. You can't make that many cells a day, so her number's wrong.”
Despite the groundbreaking nature of her discovery, it was largely overlooked, and her paper infrequently cited, until the late 1930s, when the critical need for blood supplies became undeniable. In Evolution of ideas on the life-span of the red blood cell, Dacie states:
“The value of the Ashby method was brilliantly vindicated…following the outbreak of war with Germany in 1939, the question of how best to store blood for transfusion to military and civilian air raid casualties became a very urgent one. The only practical solution was to use the Ashby method to follow the survival of blood stored under different conditions. Under the stress of war, the method was quickly mastered and the technique improved. Much was learnt about the optimum conditions for the storage of blood...”
The Ashby Technique was a pivotal discovery that ultimately saved countless lives during World War II.
A few years after WWII, the Ashby Technique would be replaced by radioisotope-tagging, which offered improvements in safety, accuracy, sensitivity, and the ability to track individual red blood cells more precisely. This advancement inevitably uncovered the accuracy of the Ashby Technique as Dr. Eugene Cronkite recalls:
“In 1948 the National Research Council convened a meeting of all of the individuals concerned with red cell life span, preservation of red cells, in the National Academy in Washington DC, and sitting over in the corner was a plump lady who I'll never forget, had a big floppy purple hat on. I kept looking at her -- She said nothing. She just sat there all through the meeting and smiled. And after [the radioisotope researchers] had presented their stuff and had gone all through the mathematical interpretation of data, ([which] came out with exactly the same curve that Winifred Ashby had in 1921) the chairman of the Medical and Research Committee, said,
‘Dr. Ashby, you heard all of the data presented today about the lifespan of the red cell. And you've been very quiet. Would you like to comment on something?’
And she sort of giggled.
And she said,
‘Oh yes, it's nice to know that all these fine scientists have shown that I was correct in 1921.’
That's all she had to say.”
If you would like to join the 6.8 million people in the U.S. who donate blood annually, saving 4.5 million lives each year, find your nearest blood donation center HERE.
References and for further reading:
A Dose of History. (2017, February 22). Remembering the nurses of WWI. Retrieved from https://adoseofhistory.com/2017/02/22/remembering-the-nurses-of-wwi-1/
American Red Cross. (n.d.). History of blood transfusions. Retrieved from https://www.redcrossblood.org/donate-blood/blood-donation-process/what-happens-to-donated-blood/blood-transfusions/history-blood-transfusion.html
American Society of Hematology. (n.d.). Eugene Cronkite Q&A. Retrieved from https://www.hematology.org/about/history/legends/eugene-cronkite-bio/eugene-cronkite-qa
Ashby W. (1919). THE DETERMINATION OF THE LENGTH OF LIFE OF TRANSFUSED BLOOD CORPUSCLES IN MAN. The Journal of experimental medicine, 29(3), 267–281. https://doi.org/10.1084/jem.29.3.267
Dacie, J. V. (1979). Evolution of ideas on the life-span of the red blood cell. Journal of the Royal Society of Medicine, 72(11), 831–837. https://doi.org/10.1177/014107687907200611
History.com Editors. (2018, October 12). How World War I spurred the invention of blood banks. History Channel. Retrieved from https://www.history.com/news/how-world-war-i-spurred-the-invention-of-blood-banks
In Memoriam: Winifred M. Ashby 1879-1975: https://doi.org/10.1182/blood.V46.6.977.977
Stimson, Julia C. (1917). A nurse's story. Project Gutenberg. Retrieved December 17, 2024, from https://www.gutenberg.org/files/58684/58684-h/58684-h.htm
Pierce, S. R. (n.d.). Blood transfusion in the First World War. University of Kansas Medical Center. Retrieved from https://www.kumc.edu/school-of-medicine/academics/departments/history-and-philosophy-of-medicine/archives/wwi/essays/medicine/blood-transfusion.html