The New York herald., 1922-12-24

OF severely wounded men daily reach
ing the field ambulances and casualty
clearing stations. The direct method
OF blood TRANSMISSION received its frs.
real impetus from the British surgeons
in 1915 when paraffined cannulae and
rubber tubing found their way into the
forward area and some use of the ap-
paratus was made In the casualty
clearing stations. In the latter part of
1916, however. the Canadians began TO
populariZe the indirect method.
Then followed the citrated blood
TRANSMISSION where an interval Of as
much as eighteen hours intervened be-
tween the time the blood was drawn
from the donor and introduced into the
recipients vein. This method, the
forerunner Of the use of preserved
blood. carried the whole principle OF
TRANSMISSION still further forward than
the casualty clearing stations. Resus-
citation teams were trained In trans
fusion methods from among the medi-
cal officers attached to the ambulances
in special shock centers and In certain
casualty clearing stations.
blood TRANSMISSION from the use of cit
rated blood, that Is, blood mixed with,
a solution OF sodium citrate to prevent
coagulation and not conveyed directly
from donor TO recipient. to the use Of
preserved blood, Is observed In the fol-
lowing paragraph on the use OF the
citrated TRANSMISSION.
Although 1t Is better to use blood
freshly withdrawn, It has been found
safe to administer citrated blood taken
as long as eighteen hours previously
from the donors veins. It Is q great
advantage to be able to prepare for
the arrival Of a largo number Of
wounded by drawing off beforehand a
certain quantity OF blood and having
II ready in case Of need. Until the
blood Is actually required the bottles
are kept in as cool a place as possible
in order to diminish the chances Of
hmmolysis dissolution OF the red blood
corpuscles). This plan of preparing
beforehand bottles OF citrated blood
ready for use was carried out with
great success during the heavy fight
ing IN the summer and autumn OF
1918"
"An icebox is necessary for storing
the blood. A suitable one can be i'm
provised out Of two packing cases Of
such dimensions. that when one is
placed within the other an air space
Of two to three inches breadth is left
between the two boxes. The space is
filled with sawdust or some other nom
conductive material. A tight fitting
door or lid Is necessary. 1t is well to
line the inside Of the box with tin and
one end Of this space should be par
titioned' off for the reception of ice. To
insure an equablc temperature, a small
dugout may be excavated for the re-
ception Of the box.
"At the end of flve or six days the
blood. which was previously uniformly
mixed with the preserving fluid. will
be found to have settled to the bottom
Of the bottle. When II Is required for
use the superfiuous supernatant fluid
is syphoned off, leaving the blood
corpuscles and only as much OF the
fluid as will make UP. with them. the
original volume Of the blood.
"In the procedure for TRANSMISSION of
preserved corpuscles the fluid contain
ing the preserved corpuscles is brought
to body temperature by standing the
containing bottle in warm water. 1t
may then be given to the recipient by
means OF bottle similar to that de-
scribed under the heading TRANSMISSION
Of citrated blood, or even more simply.
In the same way as an ordinary saline
infusion, by means of funnel and
tube. Blood preserved in this
manner has been given at any period
up to twenty-six days, and. according
to Capt. Robertson, equally good re-
suits were obtained by this method as
by the use of fresh blood transfusions.
The method was not generally adopted
because of the greater simplicity of
other techniqucs."
Although the results of N'ood trans
fusion in some cases OF penetrating
wounds of the abdomen have borSlered
on the dramatic It Is nevertheless a
fact that TRANSMISSION is relatively Ices
successful In wounds OF that portion
of the body than in the severe and
complicated wounds of the extremities
where damage has been done to the
large blood vessels or In the case OF
severe wounds Of the thorax. Blood
TRANSMISSION was also successfully en-
ployed In cases Of severe carbon mon
oxide poisoning. DR.. Bruce Robertson
cites two cases In which some men as
a result of a shell explosion were
buried In q dugout in which some COM
bustible material caught fire. In spite
of venesection and the withdrawal of
1000 cubic centimeters of blood. only
moderate relief was obtained. the con-
dition of the men remained very grave.
and their color was still BLUSH
gray hue; the blood was almost black
and of n peculiar syrupy consistence.
Blood TRANSMISSION showed no immedi-
ate result, but on the second day a
marked Improvement was evident, and
the cases progressed to recovery.
Major G. Gordon-Taylor. consulting
surgeon of the Fourth Army. assisted
in each TRANSMISSION and his expert