ADDRESS ON SURGERY.-TRANSFUSION.

By E. M. MOORE, M. D., of Monroe County.

November 18, 1884.

MR. PRESIDENT: When choosing a topic to present to your notice, a little reflection soon convinced me that an attempt to separate the discoveries of the year from the general mass of surgical literature would not only be difficult but unsatisfactory from its fragmentary character. This function is well performed by the retrospects and compendiums. Moreover, you would have a right to expect from me opinions on the subjects brought forward. These could hardly be rendered on a multiplicity of topics. I have, therefore, chosen to bring to your notice a few facts in connection with the transfusion of blood. I do this because the subject, looked at from any side, is still in a state of doubt and uncertainty. A few years, since the attention of the profession was sharply directed to this topic. Interest for a while has been abated, but much is still to be learned. Various methods have been proposed, but no one has been proved to be so much superior to all others as to displace them, or, indeed, to inspire general confidence.

When transfusion of blood was first successfully performed, it excited the highest hopes of its friends. It attracted the attention of the great. Vast possibilities of therapeutic value were surmised. Diseased blood was to be removed and the healthy was to replace it, so that sickness was to be eradicated from the organism. Old age was to receive the elixir of life by the new method. For, was not the blood of the young to course

in the veins of the old? We all know how soon the enthusiasts awakened from these dreams. Some unfortunate occurrences induced the interference of Government, and the practice of transfusion was condemned to a long sleep.

In modern times, fresh hopes of the therapeutic value of transfusion have been revived. Of this, however, it must be confessed that our knowledge is very limited. If it have any, it is the business of the profession to definitely determine it. That it possesses great value in cases of danger from profuse hæmorrhage, there can be no dispute. All surgical procedures, to be much practiced, must be simple, and the means of their execution, easy of attainment. The exigencies of the cases are great and sudden; and it is obvious that most of those that might be benefited are just such as can not be reached in time, when complicated apparatus is to be prepared. If possible, we should be able to extemporize a procedure that can be applied in the solitary cabin of the pioneer as well as in the heart of a great city. Is there any way that will obviate these difficulties? Can any simple surgical device be placed at the command of common intelligence and ordinary skill?

The history of transfusion of blood is a thrice-told tale and has reappeared through the pages of our journals within the last few years. The historians even go back to Ovid's "Metamorphoses" and find in his poetic fancy the glimmer of scientific truth. Priority in discovery is ever a source of difficulty among the practitioners of our art. Through English channels we are taught that, in 1657, Sir Christopher Wren, having made some experiments with reference to transfusion of fluids into the veins of dogs, suggested the possibility of the operation on the human subject, in a communication which he made to the Royal Society of London in the same year. But at this time the culture of Italian physicians occupied the front place in the world, and Francesca Folli da Popi first made a decisive advance in the theory and practice of this branch of our art, in 1652. It was claimed by the friends of Folli that Wren had received direct information of his experiments and repeated them as original. But these experiments were all

made on animals, and in England, twelve years later, in 1669, Drs. Lower and King instituted the first trial of transfusion of blood from an animal into the human subject on a man named Arthur Coyn. This was done by connecting the carotid artery of a lamb with the vein of the recipient by means of a silver tube. It was observed that the arterial impulse was conveyed to the vein in the arm of the man, and it was estimated that from nine to ten ounces of blood were transfused, and that no evil consequences ensued.

It is obvious that these experiments were the natural outcome of Harvey's great discovery, published in 1628; for before any attempt at transfusion was made, Dr. Wren, Professor of Astronomy at Oxford, proposed to Robert Boyle, founder of the Royal Society of London, to inject medicinal substances into the vein. This was done by Boyle, and he afterward published a pamphlet upon the utility of experimental philosophy. The method was taken up in France and Germany in the year 1656, receiving the name of infusing surgery; but all attempts to introduce venous blood into the veins of the recipient were total failures on account of its coagulation in the tubes. The way now seemed open in one direction, and at once the blood of animals of different species and genera was made to commingle. The blood of a puppy replaced some drawn from the veins of an old and decrepit dog. "The observers thought he carried himself with more spirit."

It must be admitted that the first successful transfusion performed on the human subject was by Denys, in the year 1666. His subject was a young person who had been treated on the most perfect Sangrado plan for the relief of a fever. He had been bled, made to vomit, and had been purged twenty-two times. The surface of the body was cold, the patient was pulseless, respiration was extremely rapid, and the mind delirious, when Denys proposed transfusion, which quickly revived the patient, and complete recovery followed. But I shall not take up your time with such histories. It is not to be supposed that such an extraordinary movement in surgery would fail to have its enemies. The enthusiastic reformer would be sure to be opposed by the persistent conservative. While the advocates of the plan

looked forward to great relief for humanity, its opponents denounced it as legalized murder. An unsuccessful case seemed to favor the croakings of the opponents. The acrimony of the controversy was so great, that the friends of Denys declared that the wife of the man upon whom the operation was performed had been hired to poison her husband in order that his enemies might attribute the death to transfusion. Those high in authority in France were interested spectators of the new practice; and at this stage the whole matter was laid at rest by a prohibitory order known as the Edict of Chatelet. With the English, however, no such fatal experience checked inquiries upon this subject; but the French failure seemed to have acted as a restraint, and the first period during which the medical profession were much interested in this question lasted three years. After the year 1668, interest in the question of transfusion seems to have almost entirely disappeared. Still, we find Kaufmann and Godefroy successfully practicing transfusion of blood from a lamb into an anæmic subject. We again hear of it in 1714, and still again, in 1749. The third and truly scientific period belongs to this century and, indeed, is confined to the last sixty-five years. In 1819, Blundell practiced transfusion upon a man forty years of age who was suffering from cancer of the pylorus. He injected fourteen ounces of human blood. The sick man appeared to be better for a while, but he died (the writer naïvely says, he ought to die of his cancer) some days afterward. But I do not propose to cite such cases, and I have merely mentioned the few already given for the purpose of sketching the beginning of what has now become a great movement in surgery. After Blundell came Milne-Edwards, Prevost and Dumas, Bichat, Nysten, Larrey, Magendie, and from them a long line to the present time. Some of the experiments are not very clearly stated, but down to this time (1819) the transfusion seems to have been of arterial blood into the veins, following the experience of Lower. Since this period, every possible variety of transfer of blood has been made. We have, in the first place, arterial blood conducted into the vein. Then, we have venous blood carried into the vein. Next, venous blood into an artery

and arterial blood into an artery. Last, we have defibrinated blood injected into a vein and the same into an artery. The blood of different species and different genera, as well as of different classes, has been mingled. The blood of birds has been injected into the vessels of quadrupeds and the blood of quadrupeds into the vessels of birds, that of cold-blooded animals into those of warm, and that of warm into those of cold. The blood of the fish and the reptile has been exchanged for that of the sheep and the dog. As was suspected, the experiments proved that the blood of those nearest of kin could be made most readily to mingle. Indeed, those that were remote, as the bird and the quadruped, the cold and the warm-blooded animal, acted reciprocally as poisons. The original success of Lower seems to have been the key-note to success in nearly all the cases down to the time of Blundell. And, indeed, it is hardly possible to conceive of a more beautiful means of conducting the blood into the vessels of the recipient, than the action of the heart propelling it from an artery. The experiment has become classical. It is one of the things that takes its place in the anatomical theatre for yearly illustration. It not only shows how readily the blood of one animal can supply the place of the blood drawn from another, when of the same species, but it also shows that, after the respiratory function has ceased, the heart of another animal can so distribute its blood through the empty vessels that its presence is capable of re-establishing the function of nerve-centers. Very much less blood than that which has been drawn seems to be sufficient to restore the functions. It is, indeed, astounding to see a dog, which has been bled ad deliquium so completely that respiration has ceased and could never return but for the interference of transfusion, so entirely recover as to be able and willing to quarrel with his donor for a bone, in the course of a few hours. The transfusions from the lamb to man have been conducted on this principle and have been more or less successful down to the present time. The most ardent supporter of this method is Dr. Franz Gesellius, of St. Petersburg, who published in 1873 an admirable résumé of the whole subject. Notwithstanding these successes, it is not to be