Did you know that all the great discoveries in hematology before the middle of the 20th century were made by non-hematologists? The word hematology is thought to have originated in 1748 with publication of Thomas Schwenke’s book, Haematologia, a “treatise as compete as it could then be, upon the blood considered in its state of health and of disease”.1 By contrast, the term hematologist was a relative latecomer. Until the middle of the 20th century, all physicians were considered generalists, caring for patients not only with anemia, but also with irritable bowl, headache and hangnail. Self-described clinical hematologists began to emerge from the shadows in the 1930s, but the more illustrious of these individuals cautioned against excessive subspecialization for fear that physicians would lose their ability to see the big picture when caring for patients and designing experiments. The Nobel laureate George Minot wrote in a Foreword for the 1946 inaugural issue of the journal Blood: “those interested in disorders of the blood should recall the importance of medicine as a whole”.2
We celebrate the great pioneers in hematology as fathers of the field. But, are they really one of us? The answer is decidedly no. They worked in a different time, when our understanding of human physiology was rudimentary and effective therapies non-existent, when research tools were limited, and when other duties and interests competed for their time and attention. These discoverers were polymaths who self-identified as gentleman physicians (yes, sadly, all of them were men prior to the turn of the 20th century). They were fiercely proud of their clinical acumen and were quite capable of caring for the sickest of the sick, no matter what their condition. With the ready accessibility of blood from healthy and diseased individuals, and the belated introduction of the microscope into clinical medicine in the mid- to late-1800s, they simply took advantage of low-hanging fruit and made advances in hematology that simply weren’t possible on the solid organ front.
The days of the generalist are long gone. In 1917, the American Association for the Advancement of Science declared that “it is no longer possible for one to master all… each of the subjects has so grown in complexity as to require a lifetime to master”.3 Today, it is difficult to see patients and conduct research broadly in hematology. Physicians often choose to specialize in either benign or malignant blood disorders. In academic centers, benign hematologists may further restrict their practice and/or research, for example to hemostasis and thrombosis, or more specifically to von Willebrand disease, while their malignancy-minded colleagues may confine their practice to multiple myeloma or hematopoietic stem cell transplantation. Is this a good thing? Or have we taken subspecialization too far?
We should by all means celebrate the great pioneers and their discoveries from centuries ago. But we should also avoid the temptation of seeing and portraying them through the lens of modern-day hematology. One reason to study history is to understand why people thought the way they did, what assumptions did they make and why did they make them. This should remind us to do the same about ourselves. As hematologists today, we lack the inclination, incentive or training to practice as generalists. Many of us don’t even have time to read books or pursue outside interests and hobbies. To the extent that our predecessors’ broad interests engendered a ripe and formative environment for scientific discovery, perhaps we could take a page from their book and introduce more balance into our lives and careers.
| Year(s) | Discovery | Pioneer | Comments |
|---|---|---|---|
| 1628 | Discovery of the closed circulation of blood | William Harvey (1578-1657) | General practitioner, physician at St. Bartholomew’s Hospital, Lumleian lecturer in surgery at the Royal College, Physician to King James I and Charles I. |
| 1674 | First description of red blood cells | Antoine van Leeuwenhoek (1632-1723) | Dutch draper from Delft, Holland. Self-taught microscopist who was the first to observe and describe the microscopic world, including microbes, spermatozoa and red blood cells. |
| 1770-4 | First description of white blood cells, first demonstration that coagulation occurs in the plasma, first isolation of fibrin, first recognition of red cell shape as concave; first linkage of the thymus to the lymphatic system. | William Hewson (1739-1774) | Often designated as one of the fathers of hematology. He was a surgeon and anatomist, working in London. |
| 1818 | First successful transfusion of human blood to a patient performed | James Blundell (1790-1878) | British obstetrician who worked at St. Thomas’ and Guy’s Hospital, London, where he focused solely on midwifery and physiology. He was interested in transfusion in so far as it helped his patients with obstetrical hemorrhage. |
| 1832 | First description of Hodgkin disease | Thomas Hodgkin (1898-1866) | British pathologist; curator of the museum at Guy’s Hospital in London; first lecturer in morbid anatomy and museum curator at the new Guy’s Hospital Medical School in London working at Guy’s Hospital. Performed hundreds of autopsies and cataloged thousands of specimens. Also first described acute appendicitis and aortic insufficiency. Wrote several seminal books, including one on the spread of cancer to the lungs and abdomen. |
| Mid-1880s | Introduction of microscopic analysis of blood | Gabriel Andral (1797-1876) | Considered a founder of clinical hematology. Wrote a book on hematology (Pathological Haematology: an Essay on the Blood in Disease) in 1844. Also wrote books on internal medicine and anatomical pathology, and published extensive lectures on the influenza epidemic. |
| 1868 | First description of leukemia, elucidation of mechanism of thrombosis and embolism | Rudolf Virchow (1821-1902) | German physician, anthropologist, archeologist, pathologist, biologist, writer, editor, social activist, and politician. |
| 1878 | Invention of novel blood cell staining techniques, leading to identification of 3 types of granulocytes, mast cells, polychromatophilia, and megaloblasts | Paul Ehrlich (1854-1915) | German immunologist. He discovered the first effective treatment for syphilis. He was awarded the 1908 Nobel Prize in Physiology or Medicine for contributions in immunology. |
| 1882 | First description of phagocytosis using the transparent larval starfish as a model organism | Elie Metchnikoff (1845-1916) | Russian zoologist and immunologist. Shared the 1908 Nobel Prize in Physiology or Medicine with Ehrlich. Also introduced theories on aging, and became known as the “father of gerontology”. |
| 1882 | First definitive and precise description of the platelet and their role in both hemostasis and thrombosis using intravital microscopy | Julius Bizzozero (1846–1901) | Italian pathologist |
| 1898 | First major guide to examination of blood | Richard Cabot (1868-1939) | Practiced as a generalist. Led the clinical pathological conference (CPC) that is published in the New England Journal of Medicine to this day. Founded the first American hospital-based department of social work in 1905, accepted a post as professor of social ethics at Harvard College, and wrote “Social Service and the art of healing”. |
| 1901 | Discovery of blood groups, A, B, AB, and O via isoagglutination reactions | Karl Landsteiner (1868-1943) | Austrian physician and pathologist. Made numerous contributions to pathological anatomy, histology and immunology. Awarded the 1930 Nobel Prize in Physiology or Medicine. |
| 1903 | First description of syndrome of polycythemia vera | William Osler (1849-1919) | Canadian physician, generalist, and one of the great diagnosticians of his time. Frequently described as the Father of Modern Medicine. |
| 1910 | First description of sickle cell disease | James Herrick (1861-1954) | Herrick’s main interest wasn’t blood; it was the heart; his obituary by the American Medical Association read: “[he] gave one of the best descriptions of overt coronary occlusion and angina pectoris early in this century”. His writings indicate he was more comfortable with a stethoscope than a microscope. |
| 1918 | First description of Glanzmann thrombasthenia as a defect in platelet function | Eduard Glanzmann (1887-1959) | Swiss pediatrician. Interests included haematology, infectious diseases, psychopathology, growth and development. |
| 1925 | First description of thalassemia | Thomas Cooley (1871-1945) | American pediatrician with special training in hygiene and contagious diseases. His work in public health led to the dramatic reduction of infant deaths as the medical director of the Babies’ Milk Fund in Detroit. Co-founded the American Academy of Pediatrics in 1930. |
| 1926 | First description of von Willebrand disease | Erik von Willebrand (1870-1949) | Finnish physician whose research interests included not only hematology, but also obesity, gout and metabolism. |
| 1926 | Classic report of liver as first effective treatment of pernicious anemia; first ever demonstration of a successful treatment based on pathophysiological principles | George Minot (1885-1950) | American physician, generalist. Although he expressed a special interest in hematology, he continued to see both general medicine patients throughout his career. Awarded the 1934 Nobel Prize in Physiology or Medicine. |
| 1927 | First description of Fanconi syndrome | Guido Fanconi (1892-1979) | Swiss pediatrician with an interest in cancer and infectious disease, among other areas. Published first description of cystic fibrosis in 1936. First to propose that Down syndrome might be caused by a chromosomal aberration. Discovered that polio is transmitted through fecal-oral route. |
| 1929 | Hematocrit technique refined, along with introduction of RBC indices MCV, MCH, and MCHC | Maxwell Wintrobe (1901-1986) | Austrian born American physician. Though a general internist, he was one of the first leaders in the field to self-identify as a hematologist. |
| 1929 | Identification of role of intrinsic factor in pernicious anemia | William Castle (1914-1977) | American physician. Though a he practiced as a general internist, he proudly self-identified as a hematologist. |