832 SERUM THERAPY 



and donor; three syringes of 25-c.c. capacity were employed. The 

 syringe was filled with blood from the donor, which was then injected 

 directly into the recipient. While this injection was being made the 

 second syringe was being filled. When the first syringe was emptied of 

 its blood it was immediately washed out with sterile salt solution by an 

 assistant, so that a continuous transfusion was conducted. Lindeman 1 

 has recently elaborated on this method, and similar methods have been 

 devised by Kush, 2 Bernheim, 3 Cooley and Vaughan, 4 and Unger. 5 



Still later herudin and sodium citrate were employed to prevent co- 

 agulation and permit the performance of transfusion in a more leisurely 

 manner. The latter substance is particularly recommended by Hustin, 6 

 Dorrance, 7 Wile, 8 and Lewisohn, 9 and is being widely used with satis- 

 factory results. The blood of the donor may be kept in a refrigerator 

 for several days without loosing its oxygen-carrying capacity, and the 

 injection of a small amount of sodium citrate (should not exceed 0.2 per 

 cent.) does not appear to lengthen the coagulation time of the blood 

 of the recipient. 



As previously stated, the direct methods, consisting in suturing artery 

 to vein or using cannulas and tubes to connect the vessels of donor and 

 recipient, are being discarded in favor of the simpler methods which 

 are more likely to be successful and yield excellent results. The syringe 

 methods of Bernheim 10 and Unger 11 are particularly satisfactory for 

 the transfusion of whole blood, but require special apparatus. I have 

 used successfully the original method of Ziemssen in transfusing adults 

 when proper assistance was at hand for rapid work. More recently I 

 have used the method of Lewisohn and Wile with success, and the sim- 

 plicity of the method is particularly commendable. According to Wile, no 

 unpleasant symptoms have followed the injections of citrated blood in 

 amounts as high as 350 c.c., and the blood may be kept in a refrigerator 

 for three to five days, which is an obvious advantage in many instances. 



Technic. The technic of the citrate method of indirect transfusion 

 of Wile is very simple. Blood is aspirated from a vein and is at once 

 well mixed with sodium citrate in 10 per cent, solution in water (steril- 



1 Jour. Amer. Med. Assoc., 1914, Ixiii, 993; ibid., 1914, Ixii, 1542. 



2 Jour. Amer. Med. Assoc., 1915, Ixv, 1180. 



3 Jour. Amer. Med. Assoc., 1915, Ixv, 1278. 



4 Jour. Amer. Med. Assoc., 1913, Ix, 435. 



6 Jour. Amer. Med. Assoc., 1915, Ixiv, 582; ibid., 1915, Ixv, 1029. 



7 Ann. et. Bull. Soc. med., Bruxelles, 1914, No. 4, 104. 



6 Penna. Med. Jour., 1914, xvii, 949. 8 Jour. Amer. Med. Assoc., 1915, Ixiv, 425. 

 9 Med. Rec., January 23, 1915; Surg., Gyn., and Obstet., 1915, xxxi, No. 1. 

 "Loc.cit. * Loc. tit. 



