A short history of the discovery of the erythrocyte sedimentation rate

Sir, We have read with great interest an article titled ‘ICSH review of the measurement of the erythrocyte sedimentation rate’ [1] which focused on the development of standardization of ESR. Unfortunately, the article contains incomplete information about the discovery of the erythrocyte sedimentation rate and its first application in medical diagnosis. The first scientist, who explained through experiments the pathophysiological basis of ESR and used it for the first time in clinical diagnostics, was a Polish physician Edmund Biernacki (1866–1911) [2–5]. The explanation of the essence of ESR provided by Biernacki (Figure 1) was based on proving the connection between the speed of sedimentation and the amount of fibrinogen in the blood [3, 4]. The first report on the ESR, without the assessment of its usefulness in clinical diagnostics, was presented in 1894 in ‘Wiener Medicinische Wochenschrift’ [2]. The discovery of the diagnostic usefulness of ESR and the pathophysiological explanation of the phenomenon was announced in 1897 in two articles simultaneously: one written in Polish and published in ‘Gazeta Lekarska’ [3] and the second in German and published in ‘Deutsche Medizinische Wochenschrift’ [4]. Few months before the publications describing the application of ESR in diagnostics, on June 22, 1897, Biernacki presented, before the Warsaw Medical Society, five most important conclusions from his observations [5]. These conclusions were as follows: blood sedimentation rate and volume of residue produced are different in different individuals; blood with small amounts of blood cells sediments faster; blood sedimentation rate depends on the level of ‘fibrinogens’ in the blood plasma. During the course of febrile diseases (rheumatic fever included) with large amounts of plasma fibrinogen, the ESR is increased, and in the defibrinated blood, the sedimentation process is slower. Conclusions presented by Biernacki suggested clinical usefulness of the discovery of ESR. They indicated a sedimentational importance of plasma fibrinogen found in increased quantities in febrile diseases. Biernacki designed a 20-mm-high glass cylinder to conduct repetitive assays of ESR. The first cylinders of this type were produced in C. Gerhard’s Company in Bonn (Figure 2). The volume of blood subjected to sedimentation in such a cylinder was 1cm. Biernacki measured ESR at three time periods: after half an hour, after an hour, and after 24 h. He underlined that the clinical usefulness of ESR is determined mostly by the measurement taken after an hour. As an anticoagulant, he used powdered sodium oxalate (0.0002 g on 1 cm of blood) [3, 4]. In 1906, Biernacki modified previously developed technique of a laboratory measuring of ESR, and instead of the originally used 20-mm-high cylinder, he used a capillary pipette of his own design called a ‘microsedimentator’ [5]. This LETTER TO THE EDITOR INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY