By this process is meant the transfer of the blood of one individual into the blood-vessels of another. It is eminently a tonic measure, as it aims to do directly what some of the most effective tonic medicines, the chalybeates, for example, do indirectly; that is, to increase the quantity, and improve the quality of the blood. The idea of this remedial measure seems to have occurred to the ancients and, according to Lamartiniere, was absolutely carried into effect by them; but, in modern times, no notice of it exists antecedent to the year 1615, when an account was published by Labavius of a case of direct transfusion from a young and vigorous man into another feeble and scarcely breathing, with the effect of restoring the strength of the latter. (Cyc. of Pract. Med., Am. ed., iv. 468.) About the middle of the same century, the measure was tried by Dr. Christopher Wren, of England, upon inferior animals, and soon afterwards (ad. 1666) by MM. Denys and Emmerez, in France, upon the human subject. Much attention was attracted to it by the experiments of the last-mentioned practitioners, and some favourable results were obtained; but two instances of death, following its employment, brought it into disrepute; and it was forbidden by law to be practised in Fiance until it should receive the approval of the Faculty of Medicine of Park, which it has never yet received. (Diet, de Med., xxix. 738.) For considerably more than a century, it remained in total neglect; nor was it till the publication of the experiments of Dr. James Blundell, of London (Physiolog. and Patholog. Researches, a.d. 1825), that general attention was again called to it, as a practical measure. By this practitioner, and by others in considerable number who have followed him, it has been satisfactorily established that transfusion, properly performed, is a perfectly safe operation, and may be employed with the happiest results in certain very dangerous cases.

* Dr. Beneke infers, from his experiments, that sea-bathing has the effect of increasing the elimination of uric acid, and of the phosphates by the urine. This is what might have been anticipated from its known tonic effects; as these are necessarily attended with an exaltation of the functions generally, and consequently that of nutrition, which implies an increased metamorphosis of tissue, and increased discharge of effete matter by the kidneys. (See B. and F. Medico-chirurg. Rev., Am. ed., Jan. 1856, p. 77.) Sea-water is thought to be more excitant to the surface than a simple solution of common salt of the same strength ; and this effect is ascribed by Dr. C. F. Sloan, of Ayr, to the existence in the sea of countless microscopic animalcules, which have the property of irritating the skin. (Med. Times and Gaz., Aug. 1858, p. 176).

It has been ascertained, as might have been anticipated, that the blood of one animal cannot be safely transfused into the vessels of another, of a different species, in which the normal character of the blood corpuscles is quite different; death, sometimes speedy, sometimes more or less protracted, having resulted from such attempts. But it is not absolutely essential to a favourable result that the animals must be of the same species, provided the blood be of a similar character; for the blood of calves has been transferred to lambs with perfect impunity; and cases have been recorded by Denys and others, in which blood abstracted from men has been replaced by that of lambs and calves, not only without harm, but with beneficial effects. (Archives Generales, 4e ser., xxx. 333.) Still, as it is quite certain that the blood of different individuals of the same species may be interchanged with safety, it is undoubtedly the best rule to confine the measure practically within these limits.

The chief dangers of the operation have been supposed to be, first, the entrance of air into the blood-vessels, and, secondly, the coagulation of the fibrin during the transfer. In reference to the former, the case of an insane man operated on by Denys is recorded, in whom, upon the third trial of the process, death suddenly occurred, in consequence, as was supposed, of the entrance of air into the veins; but no other case of a similar kind has occurred; and Dr. Blundell has shown that no danger need be apprehended from this source, with ordinary care. Indeed, from the experiments of Dr. Giovanni Polli, and others, it may be inferred that some bubbles of air thrown in with the blood have no sensible effects whatever. As to the dangers of coagulation, it has been said that small portions of fibrin, solidified in the transferring tube, might be thrown in with the liquid portion, and produce serious consequences by obstruction. But this danger may be avoided by a due degree of activity in the transfer; and, should future experience show that there is really some ground for apprehension from this cause, it may be obviated by defibrinating the blood, previously to injection, in the ordinary method of agitation with sticks. The experiments of Dumas, Prevost, Dieffenbach, Polli, and others appear to show, that blood thus treated has all the revivifying properties of that fluid unchanged, and that the absence of the fibrin is of no account. (Archives Generates, 4e ser., xxx. 208.)*

Applications

Applications. The main therapeutic application of transfusion has been for the recovery of individuals, greatly exhausted and dangerously prostrated by the loss of blood; and it is particularly in puerperal women, suffering under the effects of uterine hemorrhage, that the remedy has been tried. In these cases, it has proved highly serviceable; having in many instances rescued the patient from impending death, when no other hope apparently remained, and in no one recorded instance been productive of known evil. Of thirty-six cases in which transfusion was performed, in consequence of exhaustion or hemorrhage connected with the puerperal state collected by Mr. Soden, and published in the London Medico-chirurgical Transactions (xxxv. 415), "twenty-nine were recovered from imminent death by the operation;" and of the seven unsuccessful cases, "it does not appear that the fatal termination, in any case, was due to or hastened by the operation." Though used chiefly, as just stated, in puerperal eases, the remedy has proved not less beneficial in exhaustion from spontaneous hemorrhage, and that following wounds and operations, of which Dr. Routh gives examples in a paper published in the Medical Times (Aug. 11, 1849); and in one case at least of constitutional hemorrhage, in which the morbid tendency had existed from birth, and the patient had been reduced, by continual bleedings, for five days, to a state of extreme peril, not only were the urgent symptoms relieved, but the predisposition appears to have been eradicated by a consequent change in the character of the blood. (Arch. Gen., 4e ser., xxx. 338.) The remedy has also been found effectual in inanition, dependent on constant vomiting. (Medico-chirurg. Trans., xxxv. 434.) Indeed, this appears to me among its most promising applications. Cases now and then occur in which, without incurable disease of the stomach, this organ becomes so irritable that no food can be retained, and death sometimes results. By allowing the stomach to rest in these cases, and introducing nothing into it except a little cold water, the diseased condition may be corrected by the efforts of nature, if the life of the patient can in the mean time be sustained. This has been done, in some instances, with the effect of saving life, under apparently desperate circumstances, by means of injections of animal broths into the rectum; but, should this measure fail, nothing seems to be more clearly indicated than the occasional transfusion of blood, in such quantities as may be necessary to support the vital functions without undue excitement. In a case of poisoning by carbonic oxide, reported by Dr. A. S. Meldon, the patient was rescued from apparently impending death by the injection of blood. The case occurred in Berlin, and the operation was performed by Prof. Martin. (N. Y. Med. Journ., Nov. 1866, p. 138, from the Medical Press and Circular).

* Dr. Brown-Sequard has published some very interesting conclusions in relation to the transfusion of blood, drawn from his own experiments. It has long been known that sudden death, preceded by convulsions, was a not uncommon result of such transfusion made under unfavourable circumstances. This was ascribed to the poisonous effects of the blood of one species when injected into the vessels of another. As defibrinated blood was found to act more favourably than the original liquid unchanged, some thought that the fibrin might be the noxious agent in these cases. It would appear, from Dr. Brown-Sequard's statements, that the real poisonous agent is carbonic acid. Hence venous blood will poison, when the arterial may produce no ill effect. If carbonic acid be expelled from venous blood by impregnating it with oxygen, so as to produce a bright redness, it may then be employed with impunity. The fact that venous blood has not always done harm, is merely ascribable to the small quantity injected at a time; so as to give opportunity for the elimination of carbonic acid by the lungs. A certain proportion in the blood is necessary to fatal effects, as of any other poison. According to this physiologist, blood, whether venous or arterial, from any vertebrated animal, if sufficiently charged with oxygen to become bright-red, may be injected into the vessels of any other vertebrated animal with impunity, provided the quantity be not too great. On the contrary, the same blood, sufficiently charged with carbonic acid to darken it, cannot be injected into veins of a warm-blooded animal, without causing symptoms of asphyxia, and generally death preceded by violent convulsions, unless the quantity injected be less than a five hundredth part of the weight of the animal, and the injection also be very gradually made. These are extremely interesting results; but cannot be acted on with propriety, in the human subject, until amply confirmed by repeated experiment. (Archives Gen., Janv. 1858, p. 107.) - Note to the second edition.

Method of Operating

Under the impression that the blood would be injured by exposure to the air, the transfusion was originally effected through a tube, passing from an artery of the supplying individual into an artery of the patient. But this was a very unsatisfactory procedure, and founded, as has been fully established by experiment, upon a false basis. The short period for which the blood is exposed to the air has been found to be attended with no disadvantage. The much more convenient and efficient plan, therefore, has been adopted, of drawing the blood from a vein of the healthy person into a deep vessel, and then immediately injecting it into a vein of the patient, by means of a syringe. The receiving vessel should be placed in warm water, so as to maintain the normal temperature of the blood, and the syringe should be warmed with the same view. The syringe should be plated or tinned within, should work accurately, and should have the capacity of three or four ounces. It is better to operate upon a vein in the arm than in the neck; as there is less risk of the admission of air. The blood should be injected slowly and steadily. Occasionally some force is requisite to overcome the resistance of the vein when collapsed. The quantity of blood thrown in must be regulated by the effects, and the apparent wants of the system. From less than an ounce to more than twenty-four ounces has been employed; about four ounces, in a greater number of cases than any other precise quantity. (Ibid., 427.) In a case operated on by Mr. Soden, the happiest effects followed the introduction of a single ounce. (Ibid., 423.) A new instrument for transfusion, which spares the necessity of using the syringe, has been invented by Dr. Hamilton, of Edinburgh. The reader will find it described in the American Journal of the Medical Sciences (Jan. 18G3, p. 249).

The tonics may be most conveniently arranged for special consideration in three subdivisions; namely, 1. those of animal, 2. those of vegetable, and 3. those of mineral origin.