TRANSFUSION OF BLOOD. 201 



If non-defibrinated human blood is used, the blood may be passed directly from 

 the arm of the giver to the arm of the receiver by means of a flexible tube. The 

 tube used must be filled with normal saline solution to prevent the entrance of air. 



Peritoneal Transfusion. Recently, the injection of defibrinated blood into 

 the peritoneal cavity has been recommended. The blood so injected is absorbed 

 (Ponfick). Even after twenty minutes the number of blood-corpuscles in the 

 blood of the recipient (rabbit) is increased, and the number is greatest on the first 

 or second day (Bizzozero and Golgi). The operation, however, may cause death, 

 and one fatal case, owing to peritonitis, is recorded (Mosler). It is evident that 

 this method of transfusion is not applicable in cases where blood must be intro- 

 duced into the circulation as rapidly as possible (e.g., after severe haemorrhage or 

 in certain cases of poisoning). [Blood has been injected into the subcutaneous 

 cellular tissue of the abdomen in cases of great debility.] 



Heterogeneous Blood. The blood of animals ought never to be transfused into 

 the blood-vessels of man. Some surgeons have transfused blood directly from the 

 carotid of a lamb into the human subject. It is to be remembered, however, that 

 the blood-corpuscles of the sheep are rapidly dissolved by human blood, so that 

 the active constituents of the blood are rendered useless (Landois). As a general 

 rule, the blood-serum of many mammals dissolves the blood-corpuscles of other 

 mammals ( 5, 5). 



Solution Of the BloOd-CorpUSCleS. The serum of dog's blood is a powerful 

 solvent, while that of the blood of the horse and rabbit dissolves corpuscles rela- 

 tively slowly. The blood-corpuscles of mammals vary very greatly with reference 

 to their power to resist the solvent action of the serum of other animals. The red 

 blood-corpuscles of rabbit's blood are rapidly dissolved by the blood-serum of 

 other animals, whilst those of the cat and dog resist the solvent action much 

 longer. Solution of the corpuscles occurs in defibrinated as well as in ordinary 

 blood. When the blood of a rabbit or lamb is injected into the blood-vessels of a 

 dog they are dissolved in a few minutes. If blood be withdrawn by pricking the 

 skin with a needle, the partially dissolved corpuscles may be detected. 



Liberation of Haemoglobin and Haemoglobinuria. As a consequence of 



the solution of the coloured corpuscles, the blood -plasma is reddened by the 

 liberated haemoglobin. Part of the dissolved material may be used up in the body 

 of the recipient, some of it for the formation of bile, but if the solution of the 

 corpuscles has been extensive, the haemoglobin is excreted in the urine (haemo- 

 globinuria) in less amount in the intestine, the bronchi, and serous cavities 

 (Panum). Bloody urine has been observed in man after the injection of 100 

 grammes of lamb's blood. Even some of the recipient's own corpuscles may be 

 dissolved, as in the case where the recipient's blood-corpuscles are dissolved by 

 the serum of the transfused blood e.g., transfusing dog's blopd into man. In the 

 rabbit, whose corpuscles are readily dissolved, the transfusion of the blood-serum 

 of the dog, man, pig, sheep, or cat produces serious symptoms, and even death. 

 The dog, whose corpuscles are more resistant, bears transfusion of other kinds of 

 blood well. 



Dangers. When foreign or heterogeneous blood (i.e., blood from a different 

 species) is transfused, two phenomena, which may be dangerous to life, occur : 



(1.) Before the corpuscles are dissolved they usually run together and form 

 sticky masses consisting of 10 or 12 corpuscles, which are apt to occlude capillaries. 

 After a time they give up their haemoglobin, leaving the stroma, which yields a 

 sticky fibrin-like mass that may occlude fine vessels (p. 48). 



(2.) The presence of a large quantity of dissolved haemoglobin may cause 

 extensive coagulation within the blood-vessels. The injection of dissolved haemo- 

 globin causes extensive coagulations (Naunyn and Francken). 



The coagulation occurs usually in the venous system and in the large vessels, 

 and may cause death either suddenly or after a considerable time. 



