828 GEOKGE K. MINOT AND ARLIE V. BOCK 



However, if both the platelets and marrow white cells increase in number 

 and remain elevated after transfusion, these rises should be interpreted 

 as evidence of increased marrow activity. With increased regeneration 

 the platelets usually begin to increase in number slightly later than the 

 white cells. With an orderly increased activity of the marrow such as 

 may occur in pernicious anemia, the reticulated red cells (young cells) 

 begin to increase still later that is, in about three to five days. 



The response of normal bone marrow to the stimulus of hemorrhage 

 is more rapid and proceeds more uniformly with respect to all of the blood 

 elements than may be seen after transfusion in cases having pathological 

 bone marrow. There may occur with regeneration of blood, with or with- 

 out transfusion, a distinct qualitative change in the process of regeneration 

 such as a disproportionate output of platelets, or of young red corpuscles, 

 in relation to the other elements produced by the bone marrow. If the 

 marrow is aplastic the response to transfusion may be very feeble or more 

 often does not occur. Distinct inactivity or depression of the bone marrow 

 following transfusion is a bad prognostic sign. Likewise the presence 

 in the peripheral blood of very large numbers of immature marrow cells 

 of the red and white series is unfavorable and indicates what may be 

 termed a dissolution of the marrow. For a further discussion of the 

 question of bone marrow activity, reference may be made to the work of 

 Drinker, Vogel and McCurdy, and Minot and Lee. 



5. The Effect upon Immune Bodies. Theoretical considerations 

 have led to the use of transfusion for the transfer from one individual 

 to another of immune bodies, particularly for the treatment of disease. 

 Experience up to the present is variable in character and, for the most 

 part, disappointing. 



In sepsis the supportive effect of fresh blood has long been thought to 

 be beneficial, but in practice little good has been accomplished by such 

 therapy, probably because normal blood has less bactericidal power than 

 the blood of the patient. Wright and Colebrook have recently sug- 

 gested a method of "immuno-transfusion" for cases of sepsis, in which the 

 blood to be transfused may be rendered bactericidal in vitro, and then 

 injected into the circulation of the patient. The vaccine used for this 

 purpose need not be specific. The blood transfused in a case reported 

 by Wright and Colebrook was thus immunized against the patient's strep- 

 tococcus ; the protective action of the serum against the patient's organism 

 was previously demonstrated by a simple laboratory study. A cure re- 

 sulted in this case in which operative and other therapeutic measures 

 had failed. 



6. The Effect upon the Basal and Nitrogen Metabolism. Trans- 

 fusion of blood in cases of anemia, according to Tompkins, Brittingham 

 and Drinker reduces the basal metabolism to a normal or diminished level. 

 They suggest that the basal metabolism may serve as a guide in knowing 



