Fathers (and Mothers) of Hematology

David Steensma, MD
Institute physician at the Dana-Farber Cancer Institute and an associate professor of medicine at Harvard Medical School

In 1963, Boston hematologist William Dameshek wrote an essay in the journal he’d founded 17 years earlier, Blood, describing 18th-century English anatomist William Hewson’s detailed studies of the thymus.1 Before Hewson’s untimely death at age 34 from sepsis contracted during cadaver dissection, he not only linked the thymus to the lymphatic system, he also discerned the essential role of fibrin in clotting and described red cells’ discoid shape – an impressive range of scientific accomplishments. (Dutchman Antonie van Leeuwenhoek observed erythrocytes with a microscope a century before Hewson, but van Leeuwenhoek thought they were spheres.) Dr. Dameshek concluded his Blood essay with lofty praise for Hewson: “If anyone deserves to be called the ‘Father’ of Hematology, it would seem that this brilliant and lucid young experimenter should be given this long-neglected honor.”

Blood already had an international circulation in 1963. Since investigators from many nations have contributed to the field of hematology, Dr. Dameshek’s proposal to crown an 18th-century Englishman as the “father” of the discipline was not entirely welcomed in certain other countries, particularly France.

Hematology in all its balkanized glory is too large, multifaceted, and successful to ever be said to have a single “father.”

My own father spent his career as a defense contractor, and he once shared an amusing exchange highlighting the ancient England-France rivalry, which he had witnessed during a multinational meeting of military leaders in Paris at the height of the Cold War. When an American general described NATO plans for defending “the English Channel” against Soviet incursions, a French official spoke up in protest: “Monsieur General, there are indeed some who call La Manche by that name. But none of them live on this side of it.”

Dr. Dameshek’s praise of William Hewson appears to have similarly injured Gallic pride, and Francophone physicians responded by proposing several of their own deserving candidates for the title of père d’hématologie. Foremost among these are Gabriel Andral (1797–1876) and Alfred François Donné (1801–1878), who described changes in blood cell composition during various systemic diseases, and Georges Hayem (1841–1933), who is credited as being the first to count platelets in the blood and who also wrote seminal papers on hemolytic anemia and hematopoiesis. (“Seminal” papers are, after all, an essential requirement for fatherhood.)

Not to be outdone, German hematologists have made the case that Paul Ehrlich (1854–1915) – whose aniline dye–staining techniques first distinguished granulocyte subtypes and who established the concept of humoral immunity – deserves a Vater designation. If not Ehrlich, then surely Rudolf Virchow (1821–1902) deserves the credit, as he codescribed leukemia in 1845 and made so many fundamental contributions to pathology that he is often described as the father of that discipline, too. In Italy, padre honors have been proposed for Adolfo Ferrata (1880–1946) – founder of the journal Haematologica and keen observer of the complement pathway and hematopoiesis – as well as Giulio Bizzozero (1846–1901), whose early work on platelets was widely cited. In Russia, Élie Metchnikov (1845–1916) described phagocytes in 1882 and has been called the father of both hematology and natural immunity.

And so on and so forth, all across the globe.

Here in North America, there have also been numerous candidates for hematology-siring. These include Bostonian George Minot (1885–1950) and Wisconsinite William Murphy (1892–1987), who developed the first specific treatment for a hematologic malady when they cured pernicious anemia with raw liver in the 1920s, as well as Austrian-Canadian-American Maxwell Wintrobe (1901–1986), who invented the hematocrit, trained many hematology department chairs, and published the most influential hematology textbook of the 20th century. And we must not forget Canadian-American William Osler (1849–1919), who published numerous observations on platelets and vascular disorders. For a while, hereditary hemorrhagic telangiectasia was called Osler-Weber-Rendu syndrome, while polycythemia vera was Osler-Vaquez disease.

There is an old proverb that has been around since Tacitus’ Agricola, “Success has a hundred fathers; failure is an orphan.” Hematology in all its balkanized glory is too large, multifaceted, and successful to ever be said to have a single “father.”

Yet the thick trunk of this great discipline continues to generate plenty of new offshoots and branches, so we continue to see the “father” sobriquet applied, albeit to ever narrower fields within hematology. Russian-American Dameshek himself made a key contribution in 1951 when he proposed a unified concept of “myeloproliferative disorders,” and therefore is often called the father of these neoplasms; he founded Blood and the American Society of Hematology, so can also be called a father of organized hematology. Don Metcalf (1929–2014), an Australian hematologist who described the hematopoietic growth factors that revolutionized hematology clinical practice in the 1980s and 1990s, has been called “the father of modern hematology,” as has William H. Crosby (1914–2005), who made key observations in iron disorders and hereditary hemolytic anemias. Likewise, Louis Diamond (1902–1999), who gave his name to several congenital conditions with hematologic complications, is often credited as the “father of pediatric hematology.”

Notably absent among all of these paternity claims are the mothers of hematology. Centuries of systematic discrimination against women in academic and professional life, which continues in various pernicious forms today, has meant that too few women have had the chance to practice or conduct research in hematology until recent decades – an incalculable loss of talent and opportunity. Among more than 1,000 biographical notes about prominent hematologists and allied scientists in Wintrobe’s classic 1985 history, Hematology, the Blossoming of a Science: A Story of Inspiration and Effort, I count only 36 women, several of whom are mentioned only as collaborators on discoveries credited primarily to men. One woman was noted solely for her ability to grow radiolabeled vegetables! Likewise, Wintrobe’s 1980 Blood, Pure and Eloquent: A Story of Discovery, of People, and of Ideas had 19 contributors – all 19 with a Y chromosome.

Still, there are dozens of female hematology pioneers who have inspired both women and men. To name a few: Janet Rowley (1925–2013) made groundbreaking discoveries about chromosome rearrangements in leukemia in the 1970s and beyond; Judith Graham Pool (1919–1975) isolated cryoprecipitate in the early 1960s; Lucy Wills (1888–1964) first described folate deficiency in the 1930s; Dorothea Zucker-Franklin (1929–2015) did beautiful work in electron microscopy of blood cells; and Helen Ranney (1920–2010) worked on sickle cell disease for decades. With so many extraordinary female scientists and clinicians working in our field today, the future is likely to be more just, and there will undoubtedly be more “mothers” of hematology-related intellectual offspring.

Single-cell molecular analysis has recently shown that the classical model of hierarchical, branched hematopoiesis that all of us grew up with is both oversimplified and flawed. Likewise, it is silly to talk about singular parents of entire disciplines; science is just too messy for that. Some hematologists do make outsized contributions to their respective areas of study, to be sure, just as some mutant stem cells overachieve in blood cell production in the state of clonal hematopoiesis. But without contributions from the tens of thousands of the rest of us, the field of hematology would be terribly… anemic.

With so many extraordinary women working in our field today, there will undoubtedly be more “mothers” of hematology in the future.

Instead of worrying about the impossible task of assigning parentage for scientific fields, it is more fun to think in the other direction: about our own lineages within these disciplines. We each learned from our mentors, who were in turn taught by others; this web of connections represents our “hematology ancestry.”

I’ll share a part of my personal hematology genealogy. As a hematology fellow, I learned a great deal of classical hematology and practical clinical wisdom from Robert Phyliky at Mayo Clinic, who was inspired during his U.S. Army service by William Crosby, who was trained in hematology in the 1940s following a direct intervention by Dameshek with the U.S. Surgeon General. In a sense, Dameshek is my hematology great-grandfather. I am also grateful for the brilliant teaching of Ayalew Tefferi, an expert in myeloid neoplasia; Tefferi’s mentor was the late Murray N. Silverstein (1928–1998) who, as far as any of us can tell, had such a strong personality that he was his own mentor – an autochthonous hematologist.

I spent two terrific years in the laboratory group of Doug Higgs in Oxford, who was heavily influenced by Sir David Weatherall (1933–2018). “Prof” Weatherall was originally from Liverpool, but spent formative years in the early 1960s working in Baltimore with Victor McKusick (1921–2008), the “father of medical genetics,” and with Johns Hopkins’ first hematologist, C. Lockard “Lock” Conley (1915–2010). McKusick worked in the chronic disease clinic of J. Earle Moore (1892–1958), who had been recruited to the Hopkins faculty by Llewellys Barker (1867–1943), Osler’s successor as physician-in-chief and an Oslerian protégé. An Oslerian lineage extends to my other primary lab mentor, Hopkins-trained Scott Kaufmann. Finally, the incomparable Robert Kyle, who has taught me so much about the history of the field and who continues to inspire into his 10th decade, also trained with Dameshek.

What is your hematology lineage?

References

  1. Dameshek W. Editorial—William Hewson, Thymicologist; Father of Hematology? Blood 1963; 21:513-516.

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