« SebelumnyaLanjutkan »
this moment a great number of red corpuscles, small but well formed, which did not exist before the transfusion. On the 13th of February, fifteen days after, the number of corpuscles in a cubic millimetre was 1,850,000. On the 4th of March, thirty-four days after, there were 2,029,500.
The following is a case in my own experience:
Mrs. A. Dunn, aged forty, had a miscarriage February 25, 1875. This was the third instance of miscarriage occurring at about the same period of gestation. The hæmorrhage was large and the exhaustion was great. During the first week, the pulse was very feeble and frequent, ranging between 120 and 130 per minute. At the end of four weeks, being much better, suddenly, wbile the patient was sitting at stool, there was profuse hæmorrhage. This left her in a very low state, with a pulse of 120 per minute during most of the time. After sleep it would occasionally drop to 110. She was obliged to keep the recumbent posture constantly. April 12th, nearly seven weeks after the miscarriage, I found her very anæmic and unable to raise her head. Transfusion was made by drawing blood from the vein of a healthy young man immediately into a rubber sac attached to Moncoq's canula, with a mandril having a long handle passing up through the sac. In order to keep the sac perpendicular so as to retain the blood, it was necessary to elevate the arm. This was found to be an awk. ward position, and I succeeded in introducing but a single ounce of blood. This operation was performed by removing the mandril then seizing the sides of the sac below the blood level and rolling it upon itself, thus driving the blood into the vein. The time occupied in receiving the blood was seventeen seconds, and in injecting, twenty-three seconds, the whole time being forty seconds. No disagreeable symptoms and no marked sensations followed the operation. Indeed, I regarded it as a failure. The next day, however, she was able to raise her head and she sat up. The pulse, which had never dropped below 108 and was seldom so low, went to 98 in an hour after the operation. During the suceeeding week, the pulse never rose above 108 and was generally at 90. The patient sat up several hours every day. In one week after, transfusion was renewed, using the opposite arm and placing the canula in the median basilic vein. Precisely
the same method was followed as in the first operation. The donor of the blood was the same person as before, and the stream furnished was not large, so that the time consumed in obtaining it was twenty-seven seconds, and but an ounce and a half was transfused. This was injected in seventeen seconds, the entire operation occupying forty-four seconds. No unpleasant symptoms followed. During the interval between the two operations, the patient, while sitting up, complained of a constant pain extending the whole length of the spine. The day after the second operation, this wholly disappeared, and convalescence was rapid.
I add another case, which illustrates the benefit of transfusion where the exhaustion was incident to a temporary trouble, and where the operation was apparently the immediate cause of improvement:
Annie Miller, aged twenty-three years, was confined March 23, 1875. She seemed well for a few days, but then began to exhibit sickness, having a fever with anorexia. Her pulse became small, ranging from 100 to 120 per minute. She continued in this state for about two weeks. Under the influence of quinine, she seemed to improve for a few days, but soon grew worse, with increase of fever and with diarrhea. Transfusion was made after the manner described in the former case, but using my canula. An ounce and a half of blood was drawn in twenty seconds. Before injecting was fairly begun, in adjusting the sac, nine seconds were consumed. The injecting process was completed in thirteen seconds. The total time of the operation was forty-two seconds. A slight rigor came on in about half an hour. This was followed by a sense of heat and respiratory effort. The next day a marked improvement was apparent. A physician who was in the habit of seeing her and had visited her the day before the operation, came to see her the next day. Not being aware of the transfusion he expressed himself surprised at the change for the better and inquired if there had been any alteration in the treatment or regimen. The pulse had dropped to 84 per minute. There had been no change in any respect in the management of the case, with the exception of the transfusion of the ounce and a half of blood. The recovery was rapid.
I add still another case, in which the benefit was temporary only, and the anæmia was not due either to hæmorrhage or to exhaustive discharges :
Mrs. McVean was a marked subject of chronic anæmia. She was pale and sallow, and had been deteriorating in health for several years, suffering much from dysmenorrhæa, and latterly from amenorrhæa. For about two months, she had marked symptoms of locomotor ataxia, rendering walking difficult and uncertain. I saw her in consultation and suggested the possibility that these symptoms were hysteroid mimicry; but the diagnosis was left in doubt. The round of tonics had been employed, and transfusion was decided upon and performed April 26, 1875.
The donor was the husband, a stout young farmer. In my previous operations, the bleeding had been carelessly done. The proper method of first exposing the vein had been omitted, but on this occasion I determined to introduce a larger amount of blood and extend the time of the operation to fifty seconds. The canula with the sac attached was introduced into the median cephalic vein of the right arm. A full stream of blood was obtained, and in seventeen seconds the sac was full. A few seconds were consumed in making the roll, and the whole was thrown in in thirty seconds, making the whole time of the operation, from the moment of drawing the blood to the closure of the canula, fifty-three seconds. The difference between the blood of the donor and that of the recipient was extreme. Hers seemed more like bloody serum than genuine blood, while his seemed unusually dark by contrast. Almost immediately, striking and alarming symptoms supervened. The face, which had been pale and sallow, suddenly became purple. The lips were dark; and, indeed, the cyanosis was extreme. She complained of distress in the thorax, a sensation of stricture, and a general “bad feeling." There was the slightest trace of a convulsion with momentary loss of consciousness. The pulse at the wrist disappeared; but the respiration continued, and, except for a few moments, was not much disturbed. The voice was natural in its force.
The unpleasant symptoms gradually abated, and in about ten minutes the pulse could be counted, and the purple hue gradually faded away. About an ounce of whisky had been swallowed in teaspoonful
doses. In about half an hour, a decided chill supervened. This was followed by a sense of heat, and, at the expiration of an hour and forty-five minutes from the time of transfusion, she broke out into a profuse perspiration.
The patient was much benefited for a fortnight or more, but she then began to decline. The alarm that was felt at the time of transfusion was so great as to prevent the patient from submitting to its repetition, in view of the fact that the improvement was not permanent. She gradually grew worse and died about six weeks afterward.
An attempt to treat of the general subject of the surgery of transfusion in a paper like this would be idle. A great deal was known with reference to the tolerance by the blood of solutions introduced into the vessels, two hundred years ago.
As I have said before, experiments on a large scale have been made on the commingling of blood from animals of different species and genera, and of that of warm and cold blooded animals. The result justified the anticipation that the nearer of kin tolerated this commingling better than the more remote. I have, therefore, had nothing to say with reference to the use of lamb's blood for transfusing the human subject, which was employed so much a few years since; nor have I thought it wise to consider the question of the transfusion of milk, which has received such a very admirable treatment in this city by Drs. Howe and Thomas. I have assumed that, if it could be accomplished, the transference of venous blood to a vein in its entirety is the thing to be desired. Defibrinated blood is not blood; and no physiology can give us a complete statement of the uses of entire blood in the functions of life. I merely desire to add a thought, perhaps a trifling one, to the general stock of knowledge upon this subject; and hope I have been able to state it with such a degree of accuracy and simplicity as to place it within the reach of any surgeon, at any time, and in any place. More perfect apparatus than mine can be made, but surely none more simple.
Dr. M. W. TOWNSEND, of Genesee County, referring to the last case mentioned in the address, confirmed the author's statements with regard to the effects of the procedure. The patient had been confined to her bed and was unable to raise her head. For several weeks after the transfusion, she was able to sit up more or less, but she did not eventually recover,