Transfusion: with special reference to intravenous infusion of saline solution

Abstract

The following may be taken as the most important steps in the development of the procedure:1. Transfusion of dissimilar blood.2. Transfusion of human blood.a. Direct Transfusion.b. Indirect Transfusion.c. Transfusion of defibrinated blood.3. Transfusion of human blood mixed with saline solution.4. Saline Infusion.The use of dissimilar blood is attended with such manifest dangers, that it has been universally condemned, and its discussion need not further detain us.Transfusion of undiluted human blood has more to commend it, but each of the three methods proposed obviously labours under the same defect. The supply is of necessity small, and if the object be to counteract the effects of severe bloodloss, by restoring the original bulk of the vascular contents, the attempt must, in the majority of instances, fall consider¬ ably short of complete success. The procedure is more adapted for the treatment of chronic cases by repeated injections of small quantities of blood. As we shall see, however, there are few occasions on which this treatment can be recommended.While each method has certain merits of its own,perhaps the most generally useful is that of direct arm-to-arm trans¬ fusion. But even this, as already pointed out, has many objectionable features, which outweigh in great measure its undoubted advantages. The necessity for a special instrument, and for previous training and practical skill in its use, is sufficient to preclude the possibility of the operation ever becoming adapted to the needs of the general practitioner.We have therefore to choose between transfusion of blood plus the aqueous solution of a certain salt, and the infusion of a saline fluid without the admixture of blood. The de¬ cision as to which of these is to be used obviously turns on the answer to the question, "is blood necessa_ry". If it can be shown that the injection of blood is not a sine qua non, and that equally good results can be obtained by the intravenous infusion of a neutral fluid, such as a solution of common salt, it will be readily conceded,that the latter method has manifest advantages which cannot be claimed for the former, and possesses a range of applicability beyond that attainable by any method of blood transfusion.It is my purpose in this paper to direct attention more especially to certain acute conditions,in which saline infusion appears to be of value as a curative agent, and in so doing I shall have occasion to enter somewhat fully into the subject of haemorrhage. I shall therefore leave the question as to the necessity or otherwise for the injection of blood in cases of acute anaemia, until that subject is more particularly under consideration. There are, however, certain more chronic conditions, in which the transfusion of blood has been strongly advocated as a means of cure. These may be conveniently considered in the present connection.