IT is not seldom that we read newspaper accounts like the following, which appeared early in the year: "Philadelphia, Feb. 20th.— ' With a subject selected from the score or more volunteers who had offered their blood in response to a want advertisement that appeared in a newspaper here this morning, a remarkable transfusion operation was performed to-night in the Polyclinic Hospital. The patient was David Poloco, a poor tailor suffering from internal hemorrhages, whose family had already given all the blood their physicians would allow, and had advertised to give their savings for a volunteer in a last effort to save the life of their relative. "The subject, who hid hit-; identity under the name of ' Smith,' was a powerful looking man about 2(; years old who came to the hospital in a taxicab and is said to be a member of a prominent family in this city. "The transfusion was permitted to continue for thirty minutes, when the white face of the patient had assumed a rosy hue, while the face of the subject, which at the beginning of the operation was ruddy, had become almost deadly white. An examination of the blood of the two men at the close of CARREL METHOD the operation showed that the coloring matter in Poloco' s blood had risen rom 1 K to 47 per cent, while that of the subject had decreased from 85 to 69 per eent." Dr. Crile of Cleveland, who more than anyone else has developed transfusion (the name of experimenters in the past two hundred years is legion), says that he meets with the warmest enthusiasm in asking relatives to make this sacrifice, while Dr. Carrel describes the moral exaltation of a young man who gave his blood to his aged father. It would thus seem that the victory registered over the material is as blood-stirring as the surgical triumph of transfusion itself. Not that the operation is any longer dangerous. Professional donors of blood have been known to return to. hospitals two and three times to repeat the experience; they are often in condition to work the next day. The ordeal is painless. About half an hour beforehand, each patient is given a hypodermic injection of morphine. Local anaesthesia is used, a small cut being made over the vessels. Reducing the surgical history of transfusion into its elements, it began with one Frenchman and was concluded by another; one in the 17th, the other in the 20th century— Jean Denys, who performed the first real operation of the kind; and Alexis Carrel, who found the way to suture the ends of severed blood vessels. Denys, through animal-experimentation, arrived at conclusions as to choice of blood-vessels in transfusion which are held valid to-day. He showed that the artery (as carrier for the quick-flowing red blood) should furnish the supply, and the vein of the sick man should be selected to re.ceive it, as affording the most direct route back to the right heart and the lungs where the blood becomes re-vitalized. Artery and vein he connected with glass-tube. He was not sustained by the professional opinion of his time, partly because Harvey' s discovery of the circulation, though forty years old, was still ridiculed in Paris, but also in view of the demonstrated negligible quantity of blood capable of being transfused. It had been known for a long time that endotheli um, lining arteries and veins (now known as the intima), has the property, practically peculiar to itself, that blood in contact with it does not clot, while, when brought into contact with any other substance, it soon coagulates and ceases to flow. Denys found that the amount of blood transfused varied according to the size of tube used, and also according to the different size of human and subhuman blood-vessels; though he knew there was no way of satisfactorily gaging the flow save by the pulse of the donor which during the operation must he transmitted from artery to vein. As little as four ounces had brought patients out of syncope, and failure in one case that had promised well, was found on post-mortem to be due to intestinal gangrene. By Genevieve Grandcourt After initiating the work, he got into trouble. In transfusing blood from the femoral artery of a calf into the veins of an insane man, he was twice successful; but the third trial, made at the insistence of the patient' s wife, resulted fatally. Denys was sus- Final suture of artery and vein, showing over-and-over stitches completed between two of the stay-sutures. CARREL METHOD picious and wished to open the body. The widow refused, saying he had “ experimented” on her husband, and demanding a price for her silence. The doctor' s answer was a complaint to the authorities, and in the sequel the French government prohibited the practice. From this time until early in the 19th century, this operation was taken up, dropped and taken up at intervals until the method came into vogue of drawing blood from the subject, whipping out the clots (oJefibrinating it) and injecting it into the patient' s veins. Against this method, the great French physiologist, Magendie, gave early warning. His experiments showed that in this way serious symptoms could be made to develop in perfectly healthy animals; and he suspected that the clotting took place now inside the body instead of out, producing paralysis and death. During the Franco-German war, this method was tried on thirty-seven wounded soldiers with only thirteen successes. A few years later, science began taking those enormous strides which especially in physiology and biochemistry have covered more ground than in all preceding history. It was learned that that microscopic body, the white corpuscle, was back of the blood-clot; that when the ends of blood-vessels were cut, it began A. Vein being drawn through ring. B. Cutting vein over ring, showing hemostats. V ein tied in groove next handle of ring; artery in position to be drawn over vein. I). Complete anastomosis of artery and vein. CRILE METHOD to manufacture fibrin-ferment. Hence, defibrinating the blood did not solve the problem, as only the solid part of the dot was whipped out and the white corpuscle' s fibrin-ferment remained in the blood. And it was only when this clotting inside the blood-vessels did not take place in a vital organ that Magendie' s prognosis was not realized. Thus the only solution was to join the ends of the blood-vessels together so that, as regarded the circulation, they should become one. But stitches seemed out of the question, since, being foreign bodies, they were as objectionable to the. white corpuscle as tubes of glass or paraffine. Yet, if hazardous operations of various kinds ever were to be made safe, to be able to join blood-vessels end-to-end was imperative. Payr answered this call with a magnesium-tube, but the technique was undeveloped and proved clumsy. Meantime, Carrel was investigating with the bloodvessels of dead human bodies; he applied his technique to living animals, and it worked. He had found the way to do that which everyone had said could not be done, to seio the blood-vessels together without clotting or leakage. The principle of the Carrel method consists in “ everting” (turning out) the cut lips of the vessels in such a way that when the openings of the two are brought together, their linings touch. Needle and thread is then drawn through steriliaeoJ vaseline, passed through the outer and upper edge of the artery in its entire thickness, and brought out through the inner and upper surface of the vein. Two similar stitches are made in the blood-vessels (see diagram), in all instances leaving about four inches of thread uncut after tying, to serve as a handle for the assistant surgeon to tilt the blood-vessels in order to join them end to end, as shown in the accompanying illustration. Carrel' s discovery was hailed with thanksgiving, and he made an early application of it in transfusion by saving the life of a four-day-old baby; this as recently as 1908. Dynamics. Before Carrel' s success, Crile was studying to develop transfusion along mechanical lines. He used Payr' s tube, discarded it for Carrel' s stitches; and then deciding that the less skillful surgeon needed an easier method, developed the Payr-tube. The instrument he has evolved is a cannula or ring-with-handle, and is so tiny as scarcely to slip over the point of a pencil. The Crile method is to draw the vein through the ring and cuff its edge back on the ring; there it is (Continued on pa#e 110.) The Editor of Handy Man' s Workshop will be glad to receive any suggestions for this department and will pay for them, promptly, if available.]
This article was originally published with the title "The New Era of Blood-transfusion"