1855.] 



OxV THE TRANSFUSION OF mLK. 



189 



the testimony of M. Donne, that about two hours after its injec- 

 tion, rabbits, birds and dog.s have been opened, ' I have collect- 

 ed,' he says, ' the blood in the dilFerent organs, in the lungs, 

 the liver, the spleen, and everywhere I have found the blood 

 containing a certain number of white globules in all stages of 

 formation, and of red globules more or less perfect : invariably 

 the spleen has presented to mo special circumstances, so estab- 

 lished and constant that it behoves me to mention them.' M. 

 Donne further adds, 'that he believes that he has also traced, 

 by direct observation and experiment the transformation of the 

 minute oily and fatty particles found in the milk into white 

 globules.' He injected numerous animals, birds, reptiles and 

 mammals with various proportions of milk ; and, strange to 

 say," observes Mr. Hasaall, " the creatures thus experimented 

 upon experienced no injurious effect beyond a momentary 

 shock, with, however, the single exception of the horse, to 

 which the experiment proved fatal in seven different cases. If 

 almost immediately after the injection of milk, a drop of blood 

 be withdrawn from the system at a distance from the point 

 where the milk was introduced, a number of the globules of 

 the milk may be detected quite unaltered, and which may be 

 recognised by their general appearance, their smaller size, and, 

 lastly, by the action of acetic acid, which dissolves the red glo- 

 bules, renders apparent the granular texture of the white, but 

 leaves untouched the molecules of the milk. If the blood be 

 again examined, at about the expiration of two hours, the 

 smallest milk globules will be seen to have united themselves 

 with each other by threes and fours, and to have become 

 enveloped, by circulating in the blood, in an albuminous layer, 

 which forms around them a vesicle analogous to that which 

 surrounds the white globules ; the largest remain single, but 

 are equally enveloped in a like covering. These soon break up 

 into granules, in which state the milk globules of the blood 

 bear a close resemblance to the white globules of the blood, 

 from which finally they are not to be distinguished. The 

 blood, Donne then remarks, 'shows itself very rich in white 

 globules, but little by little these undergo changes more pro- 

 found ; their internal molecules become effaced and dissolved in 

 the interior of the vesicle, the globule is depressed, and soon it 

 presents a faint yellow colouration : they yet resist better the 

 action of water and acetic acid than the fully formed blood 

 globules, and it is by this that they are still to be distinguished. 

 At length, after twenty-four hours, or at latest after forty-eight 

 hours, matters have returned to their normal state ; no more 

 milk globules are to be seen, the proportion between the white 

 and red globules has returned to what it ordinarily was.' In 

 only one instance have I had the opportunity of noticing the 

 changes spoken of by Donne, and that in the case of the 

 man J. Pickles. Ho died about fourteen hours after transfusion, 

 and I procured some blood from veins in the feet, and from the 

 opposite arm ; on submitting this blood to the microscope it was 

 found to be loaded with white globules, presenting one of the 

 best marked cases of Lcucocythemia I ever saw. I failed, 

 however, to notice a single milk globule ; the red-corpuscles 

 were very jagged." 



Now, by reference to the Tables of Analysis of Milk and 

 Blood by Simon and Mulder, we note the very close relation- 

 ship which exists between them, and couple with this the fiicts 

 as observed by Donne, viz., the evident convertibility of milk 

 into blood, and the conclusion is almost irresistible that it must 

 be a valuable agent fur transfusion. Yet we had no precedent 

 to direct us; and although I searched all the medical records 

 within my reach I c juld not find a single case to guide u.s. 



It will bo noted by the Institute, that it was on the 10th of 



July, 1854, that the first case of transfusion with milk was 

 effected in Toronto. In the Association Medical Journal, 

 edited by Dr. Kose Cormack, under date Sept. 1st, 1854, the 

 following letter, from William Bird Herapath, M.D., F.R.S., 

 is published : — 



On the Employment of Injections of Jfilk, or Milk and Water, into the 



Peritoneal Cavity, Cellular Tissue, or Venous System, in the Collapse 



of Cholera. 



Sir. — In a, paper read to the East Surrey Cholera Society, and pub- 

 lished in the hist number of the Association Journal, by Dr. Richard- 

 son, a proposal is made to inject the peritoneum aud cellular tissue of 

 cholera patients in the stage of collapse, with large quantities of water, 

 for the purpose of rapidly supplying the loss of serum experienced by 

 the excessive discharges from the intestinal mucous membrane. This 

 extremely philosophical and ingenious suggestion is certainly highly 

 deserving of a mature consideration, and a careful digest of properly 

 conducted experiments. But it has occurred to me, whilst reading 

 these remarks, that the injection of a fluid more closely approaching 

 the character of scrum in its chemical constitution would be more 

 likely to give permanent benefit, and avoid the chances of destruction 

 of the blood-corpuscles, occasioned by the diiference existing between 

 the specific gravity of their contents and of the rapidly imbibed water. 



The most readily obtained liquid, having all the qualities we can 

 desire is most assuredly cow's milk ; it is always at hand in any quan- 

 tity, whilst its tendency to coagulate may be obviated by adding a 

 little solution of carbonate of soda or potassa , perhaps about one scru- 

 ple of the salt to a pint of milk would be sufficient. 



The only difficulties about the matter, would be the adulterations to 

 which it may be subjected by fraudulent dealers, and the accidental 

 presence of foreign bodies. Investigations at home and abroad have 

 however shown that nothing enters more largely into the adulteration 

 of milk than water. This is of no importance ; but were the world- 

 renowned " chalk and water" compound employed, fatal consequences 

 would assuredly follow. 



The entrance of foreign bodies into the circulation, or into the cavity 

 of the peritoneum, or the muscles of the cellular tissue, may be easily 

 prevented by attaching a fine muslin or gauze filter, or seive, to the 

 mouth of the injecting syringe. It remains to be proved whether this 

 fluid would be absorbed by the peritoneal vessels as readily as water, 

 or with sufficient facility to be of service. 



The specific gravity of good pure milk varies from 1.041 to 1.033 or 

 1.020; serum varies from 1.026 to 1.037, and even 1.050, according to 

 the presence of health or disease. Now to produce the difference in 

 specific gravity required by the laws of endosmosis to act in a state of 

 health, water may be added to the milk. But t' e viscidity of cholera 

 blood would assuredly indicate an increase in the specific gravity, ond 

 no dilution would be necessary in this disease ; but ifit were adulterated 

 with water only, it would be a matter of no great importance. 



It seems highlj' probable that milk, or milk and water, would be a 

 much more successful fluid for this purpose than water only, and would 

 certainly oflFer many gi-eat advantages, especially if the injection were 

 to be made directly into the venous sv-stem, as the corpuscles of the 

 blood do not suffer any material alteration in form, when examined 

 microscopically, after dilution with milk; they suffer nolhiny from the 

 admixture, especially if the milk is obtained from an animal of the 

 same kind as the blood experimented on, and if the milk used be pure 

 and unmixed with water. 



I apprehend also that the introduction of an albuminous constituent 

 is essentially necessary, to supply the waste of this vital pabulum ex- 

 perienced during the exhaustive dicharges of this disease. 



It is quite a question whether the subsequent symptoms and fever, 

 exhibited during the recovery from collapse, do not depend as much 

 upon the loss of the albumen aud salts of the scrum, as upon the great 

 difference subsequently existing in the relation between the quantity 

 of the soliils and watery Jluid of tlic blood. 



The chemical constitution of milk does not differ very materially 

 from that of the chyle obtained by healthy digestion, wliicli would of 

 course be the only means nature would employ to regenerate slowly the 

 lost liquor sanguinis. 



Art physiologii-idly directed comes to aid of nature, and, by em- 

 ploying her own Divine laws, assists her early efforts and wonderfully 

 aids the cure — yains time, an element of vital imporlnngc in this mar- 

 vellously rapid and fatal disease. 



