and sanguinolent urine." The appearances and the antecedent symptoms lead to the conclusion that transfusion of blood from an animal of a different species will often imperil life, if it do not lead to a fatal issue.

Ponfick also made the interesting observation that blood taken from an animal of the same species is not followed by grave symptoms; but that the globules of the donor rapidly undergoes dissolution in the serum of the individual receiving them, whether man or animal.

TRANSFUSION OF MILK.-The intra-venous injection of milk was first suggested by Dr. E. M. Hoader, of Toronto, Canada, in 1850. He employed it in three cases in the collapsed stage of epidemic cholera. One patient died and two recovered. The operation was revived in 1873 by Dr. J. W. Howe, of New York, who injected milk into the veins of seven dogs. All the animals died promptly;1 and he concludes that the milk killed them. He also injected two patients, both of whom died. Professor T. G. Thomas thinks that these deaths occurred because the milk was not fresh. Dr. Thomas has reported seven cases of intra-venous injection of milk, with four complete recoveries and several successful cases have been reported by Dr. Brinton and Dr. Hunter, of Philadelphia.

2

I have practiced intra-venous injections of milk three times, with one recovery. The operation was performed upon one patient twice. This case was one of pernicious anæmia in a laboring man of large physique. It was the same case, already referred to, in which I attempted immediate transfusion of blood with Aveling's apparatus, but failed on account of syncope of the donor. One week after, five ounces of milk, fresh from the cow, were introduced into the median cephalic vein, by means of a funnel and rubber tube. I did not see the patient again until three weeks after the operation. His appetite had re

1 Howe, "Transfusion of Milk versus Transfusion of Blood." "Med. Record," New York, vol. xiv, p. 443.

2 Thomas, "Intra-venous Injection of Milk as a Substitute for Transfusion of Blood, with Cases." "New York Med. Journal," May, 1878, vol. xiii, p. 337.

turned, his pulse was quite full and strong, and his lips and face had considerable color. His appearance had so much improved that at first I failed to recognize him.1 Three months after, he entered the Brooklyn Hospital in the same anæmic condition as before the last operation. Five ounces of milk were again injected into a vein near the ankle, with Colin's apparatus. This operation did not improve his condition, and he died from exhaustion one week afterward.

Notwithstanding the excellent results that have sometimes followed the intra-venous injection of milk, the operation, it is said, is not free from danger; and it is stated by Laborde that, if animals do not die when milk is injected into the veins, it is because only a small quantity has been used, and even this may occasion serious accidents. The "Lancet" (Feb. 2, 1884) contains an editorial on the results of a series of experiments, reported by Dr. Migliopanzo in the " Archives italiennes de biologie," in which he injected milk into the veins of dogs. This observer concludes that milk must first be digested to be properly prepared for the blood. If injected without this precaution, it simply gives up its fat-globules and casein to the kidneys and passes out of the body by the urine. Milk in the blood in notable quantity, before it has undergone the digestive process, is unassimilable and hurtful, producing vomiting, diarrhoea, prostration, and ultimately death. The butyric element of the milk transfused without previous digestion produces chyluria and fatty infiltration of the kidneys. The sudden introduction of large quantities of milk into the circulation is followed by great diminution of blood-pressure, due to the collapse of the force of the cardiac systole; and, unless the milk be filtered to prevent corpuscles larger than those of the blood from entering, obstruction may occur in the pulmonary and cerebral circulation. Albertoni has proposed the injection of the serum of milk, and has actually injected from ninety to one hundred grammes into the veins of dogs without observing any ill effects. Casein introduced into the blood-vessels, after being digested, is transformed into urea rather than into food for the tissues.

1 "Med. and Surg. Reporter," Philadelphia, March 15, 1879.

From all this it is concluded that the fat and casein of milk transfused into the blood, before being digested, represent an unassimilable material which is discharged from the organism.

SALINE INJECTIONS INTO THE VEINS.-The intra-venous injection of saline solutions was extensively practiced during the cholera epidemic of 1832-33. More recently, this question has received considerable attention, especially by the Germans; and they have proved, by a number of experiments on animals bled to syncope, that life can be restored by injecting saline solutions into their veins, and that they are even to be preferred to blood for that purpose. Ott injected dogs with pure and defibrinated blood, blood-serum, and saline solutions, and found "that the danger from loss of blood, even to two-thirds of its whole volume, lies in the disturbed relationship between the caliber of the vessels and the quantity of blood contained therein, not in the diminished number of red blood-corpuscles; and that this danger concerns the volume of the injected fluids also, it being a matter of indifference whether they be albuminous or contain blood-corpuscles or not, so long as they are not directly injurious." He proves, further, that the hydræmia arising from saline solutions, though greater than that from blood-transfusion, persists for a shorter time; and that the regeneration of the bloodcorpuscles, after transfusion of blood, requires more than double the time required after the saline injection. The soluble or corpuscular elements that may be introduced into the vascular system undergo disintegration and excretion; and, since these processes go on more slowly with all other fluids than with the saltsolution, it follows that the restitutio in integrum, after the injection of the salt-solution, takes place more quickly than after transfusion of blood. Since, moreover, there is no danger of the introduction of fibrin-ferment, the solution is easily prepared, and the technique of the operation is very simple, he recommends it instead of transfusion of blood in the human subject, in whom so great a loss of blood as two-thirds of its quantity is hardly to be observed.1

1 W. T. Bull, "On the Intra-venous Injection of Saline Solutions as a Substitute for Transfusion of Blood." "Med. Record," New York, vol. xxv, p. 6.

Schwarz has also proved, by a series of saline injections into the veins of animals bled to syncope, that the useful element in transfusion is not the blood-corpuscle, which is short-lived and rapidly excreted, but the re-establishment of vascular tension and the resulting energetic contractions of the heart. His observations led him to the conclusion that injections of saline solutions were preferable to blood-transfusion in acute anæmia. Schwarz's solution consists of chloride of sodium, 3 jss.; liq. sodæ, gtt. ij; distilled water, 3 xxxij, warmed to from 100° to 104° F.

Jennings, in his recent essay "On Transfusion," London, 1883, says: "The explanation of the success usually consequent on the intra-venous injection of fluid lies in this, that it is the dynamic, rather than the nutritive, value of transfusion which is serviceable in the class of cases under consideration; and, under conditions which have been indicated, and which embrace most of the instances where transfusion is called for, I unhesitatingly advise the intra-venous injection of fluid as being certain in its action, comparatively free from danger, and not requiring any special skill, if carried out in accordance with the directions which have been given. If, however, a few ounces of human blood can be safely and readily obtained (which is exceptional), it is obvious that the nutritive quality of the saline injection will be much enhanced by the admixture of the blood with it, particularly if that blood can be transfused by an immediate method; but this advantage is generally a secondary consideration, and it is only in some rare cases, such as carbolic-acid poisoning and some of the varieties of chronic anæmia, where, if transfusion be indicated, the transfusion of blood is indispensable." Jennings's solution consists of chloride of sodium, 50 grs.; chloride of potassium, 3 grs.; sulphate of sodium, 2 grs.; carbonate of sodium, 21 grs.; phosphate of sodium (Na,PO,), 2 grs., dissolved in 20 ounces of water at 100° F., with the addition of 2 drachms of absolute alcohol, to be injected by means of a siphon of rubber tubing.

Dr. W. T. Bull, of New York,1 has tabulated nineteen cases

1 Loc. cit.

reported within three years, giving the essential details, in which intra-venous injections of saline solutions were used. Thirteen were cases of acute anæmia; three were cases of collapse from illuminating gas; and one was a case of collapse from iodoform poisoning.

Quite recently, Professor Mikulicz, of Cracow, in the case of a young man whose life was imperiled by loss of blood from a wound of the brachial artery, injected into the median basilic vein twenty ounces of a saline solution composed of one part of carbonate of sodium, six parts of common salt, and one thousand parts of distilled or twice-boiled water, warmed in a bottle to the temperature of 104° F. Dr. Fux, of Laibach, also records the case of a youth who was profoundly anæmic in consequence of repeated hemorrhages from a wound in the hand, but was prepared for successful operation upon the injured member by an intra-venous injection of eight ounces and a half of a saline solution. I have not had the opportunity of reading the original reports of these cases, but they are given on the high authority of the Philadelphia "Medical News" for September 20, 1884.

My personal experience with saline injections is limited to its use in five cases of epidemic cholera in 1854. The good effects were temporary; but it should be stated that all these cases had been for some time in extreme collapse, moribund indeed, so that the value of the treatment was not fairly tested. I was, however, convinced that a treatment which produced such marvelous temporary effects, such as arousing the patient from profound lethargy, restoring the activity of the circulation as well as warmth and color to the skin, and re-establishing intelligence and speech, would yet prove of great value in such cases and in cases of acute anæmia from hæmorrhage.

There are many nice points connected with the operation which can only be settled by experiment; such as the best method of introducing the liquid, the proper composition, temperature, specific gravity, and quantity, and the rapidity with which it should be introduced. In two cases, I injected a fluid