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A NEW APPARATUS FOR TRANSFUSION, WITH REMARKS ON THE INTRA-VASCULAR INJECTION OF BLOOD AND
By JOSEPH C. HUTCHISON, M. D., of Kings County.
Read November 18, 1884.
NOTWITHSTANDING that the operation of transfusion of blood has been practiced for more than five hundred years, and that many brilliant illustrations of its value in saving human life have been noted, it must be reluctantly admitted that it has not fulfilled its early promise and is now resorted to much less frequently than formerly. Within a few months, however, the prevalence of cholera abroad, and the expectation that it will soon revisit this country, have invested the subject of transfusion of blood and other fluids with new interest, especially since many reports of success have been recently recorded in Europe and America.
The writer has for a long time believed that transfusion would be more frequently practiced and take a higher rank as a therapentic expedient, if the measures for performing the operation were simplified, its dangers diminished, and a proper and easily obtainable fluid could be found for the purpose.
The object of this paper is to consider these requirements.
DESCRIPTION OF THE APPARATUS.—The apparatus which I now exhibit consists of a cylindrical glass receiver graduated in cubic inches, with a capacity of twelve ounces. It may be made larger if desirable. A metal cap, containing a perforated female screw, is attached to its lower end, having a perforated, nipple
shaped termination, to which a rubber tube four feet long is connected, in order to convey the liquid from the receiver to the canula which enters the blood vessel. The mouth of the receiver is closed by a rubber stopper, which prevents the escape
of heat, and is perforated in the center to admit a thermometer, which fits the opening tightly. When not in use, the thermometer is pushed well down into the receiver, to prevent it from being broken in handling. The canula has a nipple-shaped end which is to be slipped into the distal end of the rubber tube and is furnished with a stop-cock.
The receiver is surrounded by a double jacket of India-rubber, the walls of which are separated by a half-inch space for holding hot water. The water is introduced into the jacket through a tube projecting from the top, fitted with a nipple-end stop-cock. An opening at the top of the jacket admits the receiver, and a smaller one at the bottom allows the metal cap to protrude. It has a narrow opening extending two thirds of its length, to al
low the operator to see the graduated marks on the receiver, and also a loop on the top for suspending the apparatus when in use.
METHOD OF USING THE APPARATUS.—Drop the end of the rubber tube, to which the male screw belonging to the lower end of the receiver has been attached, into a vessel of hot water
(150° to 200° F.) placed three or four feet above the patient, and attach the other end of the tube to the stop-cock at the top of the jacket, the receiver having been previously put inside the jacket, because it can not be introduced after the jacket has been filled. Now compress the jacket with the hands to expel the air, which will be seen to rise in bubbles through the water; then remove the compression, and, placing the jacket lower than the surface of the water, a siphon is established, which fills it almost immediately. The jacket, when distended, holds ten ounces, and it hugs the receiver closely, so that no air can get between them, which would prevent the heat from being inparted to the receiver. This method of filling the jacket is most convenient and rapid, and a larger amount of water can in this way be introdnced than by pouring it into the opening at the top. In the box containing the apparatus, are three or four bottles filled with the salts which are to be injected, mixed in due proportion, ready for solution, with the formula on the labels.
The rubber tube is now detached from the stop-cock at the top of the jacket and is attached to the canula ; and the other end of the tube is connected with the lower end of the receiver. The apparatus is warmed by filling it with hot water, which is allowed to run off before it is filled with the fluid which is to be injected. The receiver is then closed with the rubber stopper carrying the thermometer, and the apparatus is suspended, or held by an assistant, three or four feet above the vein which is to be opened.
The vein is exposed by lifting a fold of skin transversely across it and dividing it with scissors or a bistoury, making the incision about three-fourths of an inch long. A probe is carried behind the vein, which is then picked up with forceps and opened, by a V-incision, with a delicate pair of scissors. Before doing this, the stop-cock of the canula should be opened and a small quantity of fluid allowed to escape, for the purpose of carrying off the bubbles of air which may have adhered to the walls of the tube. The rapidity with which the fluid is introduced can be regulated by the stop-cock in the canula. After
the canula is introduced, it is fixed in position by the finger laid over the opening in the vein. No ligature is necessary to retain it in position.
A vein at the bend of the arm is usually selected for the operation, a bandage having been previously applied above the elbow, as in phlebotomy, to distend the vessel; but, when there is difficulty in finding a vein in this situation, a saphena near the outer ankle may be selected, or the fluid may be introduced into the radial artery, as was recommended by Hüter and has recently been practiced by Halsted. The central end of the artery should be selected.
A number of appliances have been devised for the purpose of simplifying the operation of transfusion and for preventing the entrance of air into the blood-vessels; but these results can be best obtained by a simple apparatus constructed on the principle of the one I have exhibited. If the operation be managed with ordinary care, it is impossible for air to enter the vein. The special advantage which this apparatus has is in the hotwater jacket. It is a convenient expedient for preventing the fluid to be transfused from becoming cooled, during the operation, below the temperature of the blood. It is important that the injected liquid should not enter the blood at a temperature below 98.5° F., and there is no objection to a temperature of 105° F. The temperature can be accurately ascertained by the thermometer.
TRANSFUSION OF Blood.—It was believed until recently that the reviving power of blood resided in the corpuscles; and that transfusion, when performed with the serum alone or with any other fluid, would prove fruitless. Recently, however, Ott and other observers have demonstrated, by repeated experiments on the lower animals, that the corpuscles of transfused blood, pure or defibrinated, are short-lived and are rapidly excreted; that the blood-corpuscle is not the important element; that the indication is to restore activity to the circulation by restoring the bulk of the vital fluid so as to enable the organs, especially the heart
Halsted, “Refusion in Carbonic-Oxide Poisoning.” “New York Med. Jour.," vol. xxxviii, p. 125.
and brain, to perform their functions duly; and that, for these and other reasons, blood is not so good as saline solutions for transfusion in acute anæmia. Other objections are, the difficulty of obtaining blood at a moment's notice; the danger that minute masses of fibrin, even when defibrinated blood is used, may obstruct the vessels of the brain, lungs, and liver, and cause fatal disorders; the difficulties attending the operation; and the liability of the donor to faint and thus arrest the operation and also to suffer from phlebitis or other serious consequences. These considerations have prevented the frequent use of the operation, although the indications for it are by no means rare. In the only case in which I have practiced blood-transfusion (Aveling's method being used), the donor, a house physician, fainted, the flow of blood was arrested, and the operation was suspended. He developed phlegmonous inflammation and septicæmia and narrowly escaped with his life. During the operation, air entered the vein of the recipient, but no unfavorable symptoms resulted.
TRANSFUSION OF THE BLOOD OF THE LOWER ANIMALS.—Blood of the inferior animals, whose corpuscles are not larger than those of man, has been for a long time used for transfusion when human blood was not available; and several successful cases have been reported. It is said to be free from any special danger to a healthy human life, and that the blood is more easily obtained than that of man. The exact contrary would be nearer the truth; for in cities lambs and calves are much fewer than
Hasse and Ponfick have found, by experiments on the lower animals, that this operation is not infrequently followed by acute nepbritis, suppression of urine, hæmaturia, and uræmic symptoms which, when severe, terminate fatally.
Post-mortem examinations showed that “both kidneys are always greatly swollen ; large portions of the straight and convoluted tubuli are found blocked up by granular and blood-stained casts, a variable number of which may be detected in the scanty
1 Reported in the “Med. and Surg. Reporter,” Philadelphia, March 15, 1878, by A. T. Bristow, M. D.