

TRANSFUSION OF BLOOD. 1 47 



the right side of the heart, where, owing to the movement of the blood, it forms air-bubbles and 

 makes a froth. The air- bubbles are pumped into the branches of the pulmonary artery, in 

 which they become impacted, arrest the pulmonary circulation, and rapidly cause death. 



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. 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 introduced 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. 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 some 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 relatively 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 rabbits' 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, 

 the red blood-corpuscles 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 If blood be withdrawn by pricking the 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 Hemoglobinuria. As a result 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 

 (hemoglobinuria), in less amount in the intestine, the bronchi, and the serous cavities. Bloody 

 urine has been observed in man after the injection of 100 grammes of lamb's blood. Even some 

 of the recipient's blood-corpuscles are dissolved by the serum of the transfused blood, e.g., on 

 transfusing dog's blood 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 trans- 

 fused, 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 the capillaries. After a time they give 

 up their haemoglobin, leaving the stroma, which yields a sticky fibrin-like mass that may 

 occlude fine vessels (31). 



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

 within the blood-vessels. The injection of dissolved haemoglobin causes extensive coagulations 

 (Naunyn and Francken). 



The coagulation occurs usually in the venous system and in the larger vessels, and may cause 

 death either suddenly or after a considerable time. 



Dissolved haemoglobin seems greatly to increase the activity of the fibrin-ferment ( 30), 

 perhaps by accelerating the disintegration of the colourless corpuscles. Haemoglobin exposed 

 to the air gradually loses this property ; and the fibrin-ferment, when in contact with haemo- 

 globin, is either destroyed or rendered less active (Sachssendahl). 



Vascular Symptoms. As a result of the above-named causes of occlusion of the vessels, there 

 are often signs of the circulation being impeded in various organs. In man, after transfusion 

 of lamb's blood, the skin is bluish-red, in consequence of the stagnation of blood in the 

 cutaneous vessels. Difficulty of breathing occurs from obstruction in the capillaries of the 

 lung ; while there may be rupture of small bronchial vessels, causing sanguineous expectora- 

 tion. The dyspnoea may increase, especially when the circulation through the medulla 

 oblongata the seat of the respiratory centre is interfered with. In the digestive tract, for 

 the same reason, increased peristalsis, evacuation of the contents of the rectum, vomiting, and 

 abdominal pain may occur. These phenomena are explained by the fact that disturbances of 

 the circulation in the intestinal vessels cause increased peristaltic movements. Degeneration 

 of the parenchyma of the kidney occurs as a result of the occlusion of some of the renal vessels. 

 The uriniferous tubules become plugged with cylinders of coagulated albumin (Ponfick). Owing 

 to the occlusion of numerous small muscular branches, the muscles may become stiff, or coagula- 

 tion of their myosin may occur. Other symptoms, referable to the nervous system, sense-organs, 

 and heart, are all due to the interference with the circulation through them. An important 

 symptom is the occurrence of a considerable amount of fever half an hour or so after the trans- 



