TRANSFUSION OF BLOOD. 19! 



without injurious consequences. It follows that the vascular system possesses 

 to a certain degree the power of accommodating itself to large quantities of blood, 

 just as it is known to possess the power of adapting itself to a diminished volume 

 of blood, as, for example, after hemorrhage. 



Transfusion is practised: i. In cases of acute anemia, especially after a 

 hemorrhage when it is sufficiently great to threaten the life of the patient. 

 The object under such circumstances is to replace directly with new blood 

 (from 150 to 500 cu. cm.) that which has been lost and is necessary to main- 

 tain life. 



2 . In cases of poisoning in which the blood has been vitiated by the admix- 

 ture of a toxic substance and has thus become unfit to maintain the vital 

 functions, a large quantity of this vitiated blood may be removed by copious 

 venesection under suitable conditions and normal blood be introduced into 

 the vessels in place ,of the blood withdrawn (depietory transfusion). The chief 

 form of intoxication amenable to this treatment is that with carbon monoxid. 

 Also the admixture of other poisons with the blood, especially those that dis- 

 solve the erythrocytes or that cause marked methemoglobinemia, as, for ex- 

 ample, potassium chlorate, as well as other toxic substances (ether, chloroform, 

 chloral hydrate, opium, morphin, strychnin, snake-venom), may likewise furnish 

 an indication to replace the poisoned mass of blood with normal blood. 



3. Under certain morbid conditions, abnormal states of the blood may 

 develop in the body and threaten its integrity; these may affect both the mor- 

 phological elements, and the composition of the blood. The morbid alterations 

 in the constitution of the blood include poisoning with urinary constituents 

 (uremia) , with biliary constituents (cholemia) and with carbon dioxid. If severe 

 they may cause death. Therefore, in desperate cases of this kind, especially 

 when the cause is a temporary one, the vitiated blood may be in part replaced 

 by normal blood. Whether hydremia, oligocythemia and pernicious anemia are 

 indications for transfusion will depend on the correct interpretation of the under- 

 lying disease. 



Between a quarter-hour and a half-hour after transfusion, in accordance with 

 the amount of blood introduced, a more or less violent febrile reaction takes 

 place. 



The operative procedure varies accordingly as defibrinated or non-defibrinated 

 blood is employed. When a defibrination is to be practised, the blood obtained 

 by venesection from a healthy human being is collected in a vessel and beaten 

 with a small rod until the fibrin has been completely removed. The blood is 

 then filtered through an atlas-filter, without pressure, is heated to .the tem- 

 perature of the body by placing the vessel in warm water, and it is conveyed 

 into the opened vessel with the aid of the buret-infuser of Landois or a syringe. 

 The vessel selected may be a vein, as, for example, the basilic at the bend 

 of the elbow, or the long saphenous vein at the internal malleolus. Under such 

 circumstances the blood is injected in the direction toward the heart. The 

 blood may be injected also into an artery (the radial or the posterior tibial), 

 either in the centrifugal or in the centripetal direction. In any event, care must 

 be exercised, especially when the blood is injected into the veins, to guard against 

 the entrance of air, as such an accident might even cause death. Death occurs 

 when the air that has entered the right heart is churned up into froth by the 

 movements of the heart and in this form is pumped into the smaller branches 

 of the lesser circulation, thus arresting the flow of blood through the lungs. After 

 the injection of air into the arterial system a few small bubbles of air may possibly 

 pass through the capillaries of the greater circulation and thus be found every- 

 where in the vessels. They disappear at once, however, because the oxygen 

 enters into chemical combination and the nitrogen is absorbed. 



If defibrinated blood is not to be infused the divided vein of the donor is 

 connected by means of a tube with the vessel of the recipient, so that direct trans- 

 fusion takes place. The blood may also be taken up with an oiled syringe, to 

 which the blood does not adhere, and transfused at once without defibrination. 

 The latter procedure, however, is attended with the great danger that coagula- 

 tion may take place during the operation, in consequence of which blood-clots may 

 readily be introduced into the circulation of the recipient. The resulting obstruc- 

 tion and even more so the possible conveyance of coagula to the heart and into 

 the lesser circulation, may even threaten life. 



Landois has transfused without injury into animals the non-coagulable blood 

 that has been sucked by leeches after removal from them by stripping. From 



