WILLIAM H. PARK 945 



ly recommend the use of fresh normal blood, which can be readily obtained from one 

 or both of the parents, or some other close relative of the patient. The intramuscular 

 injection of 4 oz. of blood in children up to the age of four years, of from 6 to 8 oz. 

 of blood in older children and adults will give most satisfactory results. These blood 

 injections may have to be repeated once or twice at intervals of four or five days. 

 Such repeated injections are made in the same muscles, since the blood is absorbed 

 with great facility. Not much specific effect is claimed for these injections of fresh 

 normal blood; but the nutritive and stimulating properties and normal antibody con- 

 tent of relatively large amounts of normal blood have shown definite beneficial results 

 in some desperately ill patients, and have convinced us that the treatment in septic 

 cases when the prognosis is doubtful or poor should invariably include the adminis- 

 tration of such a harmless and yet frequently efficient remedy. 



The method of obtaining the blood, and its injection, are very simple. With a 

 i-oz. (30 cc.) record syringe, a Luer syringe, or, in an emergency, an easy working 

 large syringe, and a medium sized needle (preferably a No. 17 or No. 18 gauge plati- 

 num iridium needle) the necessary quantity of blood is rapidly aspirated from the 

 median cephalic vein of the donor at the bend of the elbow, and immediately citrated 

 by adding the blood to a 10 per cent solution of sodium citrate in the proportion of 

 I oz. of blood to each cubic centimeter of the citrate solution. This makes the final 

 dilution of the citrate 0.33 per cent. The needle inserted into the vein of the donor 

 should not be removed; the syringe is detached when full, while an assistant carefully 

 fixes the hub of the needle and attaches a 5-cc. record syringe containing some i per 

 cent sodium citrate solution to keep the needle free of blood. Three or four syringefuls 

 of blood may thus be obtained before it is necessary to rinse out the larger syringe 

 with a I per cent solution of citrate which is kept ready in a beaker. We prefer to 

 collect the blood in loo-cc. bottles, each of which contains 2 cc. of the 10 per cent 

 citrate solution. To each bottle 2 oz. of blood are added, the bottle being shaken after 

 each addition to distribute the sodium citrate solution. In less than ten minutes the 

 required amount of blood (from 4 to 10 oz.) is obtained and is then ready for injec- 

 tion into the patient. 



The blood is injected into the following regions: triceps, outer regions of both 

 thighs (vastus externus), the calves (soleus), and both gluteal regions. In young 

 children, ^ oz.; in older children and adults, i oz. is injected into each of these 

 muscles. 



Zingher treated twenty-three patients at the Willard Parker Hospital with intra- 

 muscular injections of blood. They represent the cases with the poorest prognosis 

 selected out of a total of some nine hundred admissions. Fifteen were treated with 

 convalescent blood, which was citrated in a majority of cases. Nine received pooled 

 blood from two or more donors. The amount injected varied from 25 to 8 oz. Of the 

 fifteen patients, four died. Of the eleven patients who recovered, only five were of the 

 purely toxic type; the remaining six patients had additional severe septic complica- 

 tions, especially tonsillar and faucial exudates, and inflamed cervical glands. 



Eight patients received fresh normal blood; of this group, none died. These cases 

 were far advanced septic cases, several with a poor prognosis. The blood, which was 

 readily obtained from one or both of the parents, was citrated in six. One of the 



