THE VALUE 
OF 
TRANSFUSION OF BLOOD. 
BY 
FREDERIC D. LENTE, M. D., 
COLD SPRING, NEW YORK. 
FROM SEPT. NO RICHMOND AND LOUISVILLE MEDICAL JOURNAL, 1874. 
LOUISVILLE, KY.: 
RICHMOND AND LOUISVILLE MEDICAL JOURNAL PRINT. 
1874. THE VALUE 
OF 
TRANSFUSION OF BLOOD. 
FEEDEBIC D. LENTE, M. D., 
COLD SPRING, NEW YORK. 
In this paper it is my purpose mainly to review the remarks 
of Dr. Fordyce Barker, made at a meeting of the New York 
Academy of Medicine in January last, and reported, with the 
discussion thereon, in the “ Medical Becord ” of April 1, but 
also to refer to the relative value of other methods for saving 
life when rapidly ebbing from exhaustion produced by haem- 
orrhage, shock, etc. 
From the time when Sir Christopher Wren and Dr. Lower 
commenced their experiments, more than two hundred years 
ago, to the present time, the subject has attracted but a mode- 
rate share of attention from the Profession until quite recently; 
and although a variety of ingenious instruments have been con- 
trived, from time to time, and the operation somewhat simpli- 
fied, and some brilliant results obtained, the process has never 
become at all popularized in the Profession, and success certainly, 2 
go far as modern operators are concerned, has not Been commen- 
surate with the expectations of its projectors and cultivators.* 
Dr. Barker relates a successful case occurring in 1666. A 
large number, about seventy, successful cases have been re- 
ported from that time to the present, to which the Doctor al- 
ludes, but a much larger number of unsuccessful cases. Now, 
if we analyze the successful cases, as Dr. Barker presents them, 
we find, in the first place, with a larger experience in the opera- 
tion, and with better apparatus, it has been, if anything, less 
successful latterly than formerly; that, in the unsuccessful 
cases, especially those performed in this city, it has been per- 
formed by, or under the direction of, our most eminent men, as 
Thomas, Van Buren, Flint, Jr. Dr. Braxton Hicks performed 
it in Guy's Hospital six times, all unsuccessful. Six cases in 
Hew York City, all unsuccessful. Hor will it avail to say that 
the fatal result was attributable, in those cases, to thrombosis ; 
as, with such operators, due care would be taken to prevent 
this; and, moreover, in almost every case an improvement, last- 
ing some hours, followed. Again, it will be noted that in almost 
all the successful cases, when the cause of exhaustion is men- 
tioned, it is post par-turn haemorrhage, or that following abor- 
tion, as Belina’s seven successful cases, and ten of Dr. Higgin- 
son’s successful cases. How, all who have had a large obstetric 
experience are aware of what incredible quantities of blood a 
woman may, with impunity, lose under these circumstances, and 
must also have noted the extraordinarily rapid convalescence 
after these losses, provided full nutrition is maintained. I have 
seen these patients again and again lying pulseless, exsanguined, 
blind, respiration irregular and sighing, vomiting the anodynes 
and stimulants vainly given, and yet I never had the ill fortune 
to see one die, though we did not then possess the means which 
*Dr. Jos. W. Howe informs ils that transfusion “ was brought fully into pub- 
lic notice during the latter part of the fifteenth century by the physician of 
Pope Innocence VIII., who sacrificed three young boys in performing the ope- 
ration on his master. The transfusion was made with instruments resembling 
those used at the present day.” 3 
we now do for averting a fatal result; as, for example, hypo- 
dermic injection. 
Then, if we examine Deny’s two cases, occurring in 1666, so 
successful that all France was crazy on the subject, and so many 
fatal results occurred from the operation, as we are informed by 
Dr. Barker, that it was interdicted by law. I say, if we ex- 
amine his cases, we will see that, desperate as they undoubtedly 
appear to have been, they are just such cases as might have been 
relieved by other methods, which will presently be alluded to. 
But I will first relate a case in point. Six years ago I was 
summoned to see a lady of wealth and refinement, young and 
beautiful, married a few years, but separated from her husband 
at the time from some domestic discord. Not appreciating the 
urgency of the call, I delayed perhaps half an hour; and on 
my way met a messenger on horseback, who said the lady was 
dying or dead. On reaching the room, I found the patient 
lying across the foot of the bed, where she had fallen, in a state 
of profound syncope, on endeavoring to get into bed. Her com- 
plexion, usually very brilliant, was blanched; she was com- 
pletely unconscious, and her pulse at the wrist gone. She had 
had repeated attacks of menorrhagia, and had ceased to dread 
them, and so, this time, had allowed herself to go on, day after 
day, losing blood, until a sudden profuse gush induced the alarm- 
ing condition in which I found her. I immediately tamponed 
the vagina to prevent further loss, ordered enemata of brandy 
and Liebig’s extract of beef, and sent a messenger for my friend, 
the late Professor Elliot, who happened in the neighborhood. 
She was, after great exertion, slightly rallied; but we both 
wished for some reliable means of transfusion, but being several 
miles in the country, we had none. However, we sent a tele- 
gram to Professor Flint, Jr., who had just imported an excel- 
lent French instrument. Dr. Flint remained with us all night, 
but the occasion for resorting to the operation did not occur. 
For twenty-four hours, however, it was unsafe to change her 
position across the bed, and her recovery was exceedingly pro- 
tracted. But she did ultimately entirely recover. 4 
Again, in many of the cases reported as successful, only a 
few ounces of blood (in some instances two or three) were used; 
whereas, in some of the unsuccessful cases, a considerable quan- 
tity, thirteen to sixteen ounces, in one case nineteen, were in- 
jected, but introduced slowly and with sufficient care, each fresh 
application producing temporary amendment, Flow, as Austin 
Flint, Jr., remarks : “ formally, the patient should have from 
fourteen to eighteen pounds of blood circulating in the system 
to properly sustain (the italics are mine) the functions of the 
body.” Is it, therefore, reasonable to suppose that from two to 
eight ounces, the amount usually employed in transfusion, should 
do more than temporarily excite the action of the heart ? In 
his remarks before the Academy, on Dr. Barker’s essay, he asks 
the question : “ What seems to be the mechanism of the influ- 
ence by which comparatively small quantities of blood, intro- 
duced into the circulation of a person dying either from hem- 
orrhage or from exhausting disease, produces such restorative 
results ?” But he is not reported as having answered the 
query. 
From the results of injections of solutions of salts in cholera 
and other diseases attended by exhausting discharges, which 
were, at one time, largely and enthusiastically employed, it 
would seem as if the modus operandi is mechanical, as a general 
rule ;■ giving to the heart and large vessels more to take hold of 
and to acton, and thus stimulating them. Wonderful, though 
temporary results have followed these injections, more so, as a 
general rule, than from the use of blood, apparently because of 
the larger quantity. In this connection, I refer to a most 
remarkable paper in the “ Loudon Practitioner ” for January, 
1873, on the injection of pure milk into the veins, by Dr. Ed- 
ward M. Hodder, of Toronto. Basing his action on a knowl- 
edge of the experiments of Donn6, and on the opinions of Wag- 
ner, Gulliver, and others, that the corpuscles of milk are capa- 
ble of alteration into blood corpuscles, he injected fourteen and 
twenty-eight ounces of milk, in a few hours, into the veins of 
two patients moribund from cholera, with immediate relief and 5 
subsequent cure. In a third case, the first injection of fourteen 
ounces produced great relief, but a relapse occurring during his 
absence, he lost his case, as he thinks, from the want of a second 
injection. 
Dr. Anstie adds a note in which he says: “ We scarcely 
know whether it is necessary to add, even for the information 
of English readers, that Dr. Hodder is a very distinguished 
and experienced practitioner, so that his evidence is most valu- 
able and trustworthy.” 
I will only add, in this connection, that, so far as our past 
■experience extends, it appears that, to be really successful in 
any considerable number of cases, and where success would not 
be attained by the vis vitce, or through more acceptable meas- 
ures, the experiments need to be carried further, and the injec- 
tions repeated in regular doses, as the effect of the preceding is 
seen to be passing off, just as we would use any other remedy. 
But, here the difficulty presents itself, the want of material; 
and, on this account, if on no other, the experiments of Dr. 
Hodder deserve a further trial. 
As regards the use of transfusion of blood in blood-poison- 
ing, alluded to by Dr. Lusk in the discussion, further experi- 
ments are also needed to determine whether here the results may 
not be more permanent, as they have been in one or two cases. 
In making the above comments on this discussion, and on 
Dr. Barker’s remarks, it is far from my intention to depreciate 
any of the wonderful triumphs of modern medicine in the alle- 
viation of pain and the saving of life.; no one glories more in 
them. And transfusion may be ranked among the great tri- 
umphs, if it has rescued one life otherwise irrecoverable, and it 
has, without question, rescued many. But the treatment will 
be more successful, if it is placed on its proper basis, .limited to 
its appropriate applications, and assisted by auxiliary measures, 
to which I shall presently allude. Two or three brief cases, in 
addition to the one already adduced, will illustrate the results 
■of the treatment by which we may supplement or assist the 
operation of transfusion of blood. 6 
Case I.—L. S., a man 46 years of age, exhausted by long 
continued strumous suppuration of the ankle joint, and tottering 
on the verge of tire grave, came under my notice in this condi- 
tion, and amputation of the leg was advised as a “forlorn hope.’' 
It was done with the aid of my regular assistant, Dr. Bluxome, 
now of San Francisco, and the late Frederick G. Le Boy, M. 
D., of Tarrytown. He lost a great deal of venous blood, 
and he was pulseless and in artieulo mortis for some time. In- 
jections of brandy with beef-tea per rectum were regularly 
given him by Dr. B. and myself, and it was only by constant 
personal attendance, for forty-eight hours, on our part, that he 
rallied. He is now quite well. 
Case II.—B. S., a girl sixteen years old, lost all the integu- 
ment from arm and forearm from a kerosene burn. Profuse 
haemorrhagic granulations formed, after a time, over these 
parts; and, for months, she continued in this state, suffering 
agony at each dressing, and often requiring anaesthesia to en- 
able her to bear the dressing, but still refusing amputation.. 
Finally, worn out by suffering, she consented, and I removed 
the arm at the shoulder-joint, with the aid of my regular assist- 
ant, Dr. Bichardson, and John F. Hammond, M. D., U. S. 
Army. The arteries were of course much enlarged by long 
continued inflammation and exuberant growths, and also a 
much larger number of smaller vessels than usual required lig- 
ature. Added to this, the pressure on the subclavian seemed 
to exert little or no control over the circulation ; so with scant 
assistance, and under such circumstances, a large amount cf 
blood was necessarily lost, and the girl was completely ex- 
hausted, insensible, and pulseless. The same routine of treat- 
ment as in the last case,, continued for several days, resulted in 
rescuing the patient, and she is now able to support herself. 
My colleague at the Hudson-Biver State Hospital, Dr. Kellogg, 
related a similar case to me to-day, of which he had charge at 
the Utica Asylum. A patient, in the sitting posture, opened 
the veins at the elbows of both sides, and lost an enormous 
amount of blood; she was insensible and pulseless. Dr.Cleave- 7 
land and he worked diligently for twenty-four hours, with 
ordinary remedies, elevation of the foot of the bed, warmth to 
surface, stimulants by mouth and rectum, bandaging the ex- 
tremities, etc., and the patient survived. I will only tax your 
patience with the brief history of one more case of this kind, 
which occurred quite recently, though I might go on multiply- 
ing them almost indefinitely. 
A fortnight ago, while attending a case in Newburgh, in con- 
sultation, it happened that my friend, Dr. S. Ely, of that city, 
was in the midst of a most serious operation, and hearing of 
my propinquity, kindly sent for me. The case was a recurrent 
fibroid tumor of the posterior aspect of thigh, which he had 
twice before extirpated. The condition of the patient, a female, 
was very feeble when he commenced. She refused to entertain 
the idea of amputation. He prepared the limb after the man- 
ner of Esmarch, and with perfect success. For, during the 
extirpation, although as it appeared, on subsequent dissection 
of the limb, all the large vessels, including the femoral, were 
divided, there was absolutely no haemorrhage. My advent on 
the scene was just after the constricting cord had been removed, 
and a furious gush of arterial blood from numerous vessels, 
much enlarged, warned the Doctor to reapply the rubber cord. 
Amputation was now the only hope, and a forlorn one. The pulse 
was flickering at the wrist, and very slow and compressible at 
Poupart’s ligament. At the request of Dr. Ely I compressed 
the artery at this point; and he rapidly removed the limb at its 
upper third by the circular method. Just previous to this, 
however, I suggested the precaution of injecting a stimulant 
per reetum, as she was insensible from exhaustion and the anaes- 
thetic, and Dr. Ely injected half a tumblerful of undiluted 
brandy. Notwithstanding the compressibility of the artery 
and my care in keeping up a steady pressure, for some reason, 
blood poured out freely from numerous vessels, and although 
they were secured with great skill and celerity, a very consid- 
erable loss of blood occurred, and the pulse became quite im- 
perceptible. Within half an hour a tumblerful and a half of 8 
brandy undiluted was given by the rectum and retained. She 
was pulseless at the wrist for half an hour, and considered quite 
hopeless by more than one of the physicians present. I re- 
marked to Dr. Ely, “here is a case for transfusion.” She was 
put to bed, covered -warmly, had bottles and jugs of hot water 
placed about her body and extremities. I saw the patient two 
days afterwards, and she was slowly rallying. Within the last 
few days I received a letter from Dr. Ely, in which he says: 
“ She has been steadily improving in strength, the pulse at first 
imperceptible, gaining in force and frequency. Stump doing 
well. I think, therefore, that a favorable prognosis may be en- 
tertained.” In this case the feeble cardiac action was due 
partly to shock, partly to heemorrhage, as is commonly the case 
in surgical operations. 
There are certain cases undoubtedly, though exceptional, in 
which nothing short of transfusion, and the transfusion of blood 
alone will meet the indications presented. Such a case as this, 
which I saw several years ago in consultation with two surgeons 
of the army. A lady, the wife of an officer had been delivered 
of twins, had lost a large amount of blood post partum, and had 
continued to lose blood for three weeks, up to the date of my 
visit. She was blanched to the last degree; her appearance 
was indeed striking—more ghost-like than anything I had ever 
witnessed. The haemorrhage had ceased just previous to my 
visit, and did not recur. But, although she took a large 
quantity of the most nutritious food and stimulants, she pined 
slowly away and died. It will always be to me a source of 
regret that we did not practice transfusion. 
Dr. Fryer, of the U. S. Army, in an interesting article in 
the last number of the “ Medical Record,” so well describes 
these cases that I quote his words : “ Of the acute cases we 
refer to, those in which natural nutrition is, for the time, sus- 
pended, either from direct lesion of the blood-making system, 
in one or more of its divisions, or is indirectly affected in con- 
sequence of some profound systemic impression ; where, if we 
can bridge over a short period by keeping life’s machinery going. 9 
we may ultimately bring about a restoration of the healthy 
nutritive process and thus save life.” In most of the cases, 
however, which he proceeds to particularize, I can not agree 
that transfusion is necssary, provided we adopt and carry out 
faithfully and systematically the means here proposed, attend- 
ing to the details ourselves as strictly as we should in transfusion, 
or at least superintending them. In some of his gastric cases, 
for instance, the prohibition of all food by the mouth, for days 
together, except small and regular doses of lime-water and 
milk ; sometimes even prohibting this, and making the rectum 
do the duty of the stomach; sometimes the regulated use of 
raiv meat; and latterly, and more important than all, the use of 
induced electricity have enabled me to restore the apparently 
most hopeless of these cases to life and health. 
Among the auxiliary measures to be adopted in aid of trans- 
fusion, or frs a substitute for it, we may enumerate the main- 
tainance of the warmth of the surface, the liberal supply of 
pure air, the elevation of the foot of the bed, the methodical 
bandaging (better with Esmarch’s rubber bandage) of the ex- 
tremities, forcing a large amount of blood from the surface to 
supply the viscera, digitalis to stimulate the heart; but, above 
all, a firm faith in the efficacy of soluble beef with stimulants 
per rectum is requisite, or else its employment, with that su- 
pervision, precision, and perseverance which are absolutely 
essential to success, will not likely be carried out. There is a 
singular distrust in the minds of the laity and of the Profession 
to a very considerable extent regarding the efficacy of beef-tea, 
and especially of Liebig’s extract and similar preparations. I 
say singular, because it is so easy to put the matter, and a very 
important matter it is, to the test. One case, such as I now 
adduce, ought to be sufficient. One of my own children, when 
about five years of age, had scarlatina complicated by diphthe- 
ria, then articular rheumatism, then a low fever allied to ty- 
phus, with a tongue perfectly dry and brown, with complete 
inability to retain anything solid or fluid on the stomach. Sys- 
tematic injections, per rectum, of regulated quantities of beef- 10 
tea and brandy every two Lours, d*»y and night, were resorted 
to and continued for-over two weeks before I could venture to 
rely on the stomach. There were some anomalies in the case, 
and uncertainty as to diagnosis, which induced me to seek 
counsel, and Dr. Alonzo Clark, of New York, kindly saw the 
case with me. 
I will conclude this portion of my paper by a reference to 
one more case occurring in my practice. A maiden lady of 
uncertain age, bed-ridden for ten years from the effects of 
chronic dysentery and dyspepsia, became the subject of femoral 
hernia, which, in time, became strangulated, and -could not be 
reduced by taxis. Operation was strongly urged day after day ; 
but as the symptoms were not felt by herself to be very urgent, 
it was declined. Finally, in the middle of the sixth night, the 
situation became so desperate that I was hurriedly summoned 
to perform the operation. Her almost incessant vomiting and 
her previous bad health had reduced her to a state of alarming 
debility. Assisted by my regular aid, Dr. Richardson, her 
brother, and the apothecary to give the ether, I operated ; but 
owing to the collapse of the brother and the necessity for send- 
ing in next door and rousing up another assistant, the opera- 
tion was protracted, and the quantity of ether used unusually 
large. This did not have a beneficial effect on the stomach, 
and it was very evident that we should have to depend on the 
rectum. I enjoined total abstinence from all ingesta by the 
mouth, and the regular injection of beef-tea and brandy by the 
rectum. 
For eight days this was strictly adhe'rred to, and she 
improved continuously and rapidly; and when I advised the 
disuse of the enemata and a return to the ordinary method of 
feeding, she exclaimed: “Oh! if I could be only fed this way 
all the time. I feel so much better.” For these injections the 
extract or soluble beef is preferable, since, being more fluid it 
is more readily absorbed, and its solubility, without sediment, in 
the smallest quantity of water, renders it possible to give the 
largest quantity of nutriment in the smallest possible bulk; a 11 
matter of no little moment in the case of children and of an 
irritable rectum. 
To show what extraordinary statements are abroad concern- 
ing the action of beef-tea, I extract the following from a popu- 
lar journal in extensive circulation : “ The statement of Liebig 
that the addition of meat extract to vegetable food increases its 
nutritive value, and that the extractive matter of meat, espe- 
cially creatine and creatinine is the material for muscular work, 
has been disproved by Voit and Meissner, and the idea that 
beef-tea and meat extract are beneficial on account of the salts 
they contain is an unlikely one, as these salts are already pres- 
ent in excess in ordinary food. The suggestion, however, that 
they answer the purpose of stimulants, like coffee, tea, and alco- 
hol, seems to be confirmed by experiment. Small doses of meat 
extract quickened the pulse, but large ones produced paralysis 
of the heart and death.” 
Per contra, I may add that, to Professor Scliiff we are in- 
debted for the discovery and demonstration of the fact, that 
broth and beef-tea contain organic materials which need no 
digestion to aid their absorption, “but that they contain a nu- 
triment already formed, and afford to the blood organic elements 
which concur in the formation of the active principles of the 
secretion of the gastric and pancreatic juices.” 
In cases of extreme exhaustion from vomiting during preg- 
nancy, Dr. Barker recommends transfusion of blood as a sub- 
stitute for the induction of labor, or when the latter is consid- 
ered indispensable as a means of restoring sufficient strength to 
enable the patient to withstand the shock of the operation. In 
these cases, I have found that the ordinary Faradaic current, 
passed from over the solar plexus behind, to the epigastrium in 
front, in some cases better from the vertebra prominens, aided 
by general Faradization, after Beard and Idockwell’s plan, will 
generally produce complete relief when it does not depend on 
the irritation of a diseased cervical canal; in which case the 
application of nitrate of silver will have as good an effect. I 
do not give the very interesting cases contained in my note- 12 
book and in that of my assistant, Dr. Murdock, in support of 
my assertion, because they are promised, in another paper, to a 
medical journal. In cases of very sudden and imminent dan- 
ger, when time for transfusion of blood even can not be had, it 
might be well to transfuse brandy directly into the veins, or 
even ammonia slightly diluted, after the method recommended 
by Professor Halford, of Australia. His method has been mis- 
understood frequently, and condemned as producing alarming 
abscesses by those who have injected the fluid into the cellular 
tissue instead of a vein. Both Dr. Murdock and I have used 
brandy undiluted in the cellular tissue, half a drachm every 
half hour, with no unpleasant effect as regards inflammatory 
action, and with a happy effect on the circulation. 
Since this paper was commenced, the most comprehensive 
work yet published on the transfusion of blood was placed in 
my hands by Professor Janeway, to whom I return my thanks. 
It is entitled “Transfusion des Blutes Eine Historische, Krit- 
ische und Physiologische Studie, von Franz Gesellius.” St. Pe- 
tersburg and Leipzig. 1873. 
Not being familiar with the German language, I am indebted, 
for assistance in the translation of such parts as I desire to no- 
tice, to a young lady friend, who was remarkably successful, 
though ignorant, of course, of medical terms. I transcribe 
some of the tables of Gesellius as translated by her; 13 
Quantity of blood taken 
from the person before 
transfusion. 
Quantity in- 
jected—ozs. 
Kind of animal’s blood. 
Manner of 
transfusion. 
Operator. 
Result. 
No depletion 
5 
Vein blood of ram. 
Tube or sy- 
ringe. 
Bliedung, 1839. 
Recovery. 
? ? ... 
6 
Calf’s artery blood. 
Direct. 
Denis u. Emmerez, 1667. 
Died, not from transf’n. 
Depletion of few drops 
8 
Carotids of lamb. 
City Hospital, Wilmington, 
N. C., 1871. 
Recovery. 
Three ounces 
9 
Carotid of lamb. 
“ 
Denis u. Emmerez, 1667. 
Remained perfectly well. 
Seven ounces 
11 
“ “ 
“ 
Lower u. King, 1667. 
Recovery. 
? ? - - - 
12 
“ “ 
“ 
Denis, 1668. 
do. 
No depletion 
14 
Defibrinated calf’s blood. 
Tube. 
Esmarch, 1860. 
Died. 
Thirteen ounces - 
18 
Femoral artery of calf. 
Direct. 
Denis u. Emmerez, 1667. 
Perfectly well. 
Ten ounces 
20 
Femoral artery of lamb. 
“ 
do. 
do. 
Depletion of greater part 
of blood - 
Equally large 
quantity 
transfused. 
Carotid artery of lamb. 
Kaufmann and Burmann, 
1668. 
Recovery. 
? ? - - - 
? 
C( it 
“ 
do. 
do. 
??--- 
? ? - - - 
? 
? 
“ 
(C 
do. 
Riva, 1667. 
Remained a long time in 
a state of melancholy. 
Seemed entirely well. 
No depletion 
Few drops. 
“ “ 
“ 
do. 
Died, not from transf’n. 
? ? - - 
? 
? 
“ “ 
it 
do. 
Recovered. 
? ? - - - 
Much blood 
as desired. 
Carotid artery of ram. 
11 
Baulus Manfredus, 1668. 
Recovered. 
Deplet’n almost to blood- 
lessness 
? 
? 
Blood serum of a calf. 
Syringe. 
Sokolow, in Moscow, 1847. 
Recovered. 
Table of Transfusion of Animal Blood into Men. 14 
History of tlie case operated on by Denis in 1667. The sub* 
ject had a severe and tedious fever in which the physicians had 
bled him twenty times. Before his illness his mind and body 
were in good condition, memory excellent. Afterwards, his 
mind seemed stupid, memory nearly gone, and he was so dull 
and sleepy as to be good for nothing. Denis saw him sitting 
at the breakfast table fast asleep. After sleeping twelve hours, 
he could easily be induced to go to bed and pass the whole day 
in this sort of stupor. 
Quantity and Nature of Bloods—After depletion of three 
ounces of thick, black blood, Denis transfused nine ounces of 
lamb’s blood direct from the carotid artery. 
Manner of Transfusion.—Direct Uberleitung. 
Circumstances after Operation.—Boy appeared exceedingly 
well. After twelve hours, he lost from three to four drops of 
blood from the nose; all dullness of mind and body disappeared. 
He grew visibly fatter, and all who knew him were astonished. 
Complete recovery. 
Instance Ho. 2 : Man, forty-five years of age. Operators, 
Denis and Emmerez, 1667. A robust porter, perfectly healthy; 
willing, for money’s sake, to suffer transfusion. After deple- 
tion of ten ounces, twenty ounces of blood from the femoral 
artery of a lamb were transfused directly. 
After Operation.—Went gaily to an inn to make merry with 
his comrades over his money. Remained perfectly well, grew* 
stronger than ever, and offered himself willingly for a second 
experiment. Satisfactory result. 
Instance Ho. 3 : Case of Baron Bond, who had been reduced 
to extreme debility by a complication of diseases. The trans- 
fusion was fatal. The full histories of many other cases from 
the tables are given. 15 
Quantity bl’d 
injected at 
; each operat’n 
t4H 
O 
CD 03 
,.Q CD 
| 1 
£ 
Quantity bl’d 
altogether, j 
Ozs. 
Ozs. 
1 
1849 Norman and Orrnond, 1852 Luigi Prejalmani, 
1863 Braun (Wien) - - - - 
3 
3 
2 
1828 liictt and Schraegle, 1830 Kiiiau, 1831 Lilian, 
1838 Berg, 1844 Berg, 1863 Greenhaly, 1863 Thorne, 
1865 Thomas 
8 
16 
3 
1828 Klett, 1831 Kalian, 1851 Marmonnier Sen,, 1869 
Buchser, 1870 Antonio Cavaleri and Barbieri. 
5 
15 
3| 
1820 flundell, 1868 Braman -* 
2 
7 
4 
1825 Blundell and Waller, 1826 Ralph, 1826 Jewell 
1827 Douglass Fox, 1829 Savy, 1829 Goudin, 1829 
Bird, 1829 PhiJpott, 1830 ingleby, 1835 lieaiy and 
Frazer, 1842 Blasins, 1845 Brown, 1857 Mastin, 
1860 Michaux, 1866 Gentlehomme, 1868 Rauteru 
burg - 
16 
64 
5 
1827 Barton-Brown, 1834 Kilian, 1835 Turner, 1840 
Lane --------- 
4 
20 
6 
1851 Devav and Desgranges, 1851 Sacristan 
2 
12 
6} 
1866 Martin and Badt, 1870 Beatty - 
2 
13 
7 
1856 Higginson ------- 
i 
7 
71 
1833 Schneemann - 
i 
n- 
3 
1826 Doubleday, 1827 Walker 1829 Blundell and 
Lambert, 1851 Marmonnier Senior 
4 
32 
9 
1826 Waller and Doubleday, 1851 Masfeu, 1861 Mar- 
tin. 
3 
27 
10 
1860 Higginson, 1870 Martin, 1870 von Belina 
3 
30 
11 
1832 Bipxersteth ------- 
1 
11 
12 
1825 Brigham, 1825 Blundell and Urius, 1833 Walton, 
O 
36 
13 
1833 Bauer 
1 
13 
14 
1825 Blundell and Doubleday - - - 
1 
14 
15 
1828 Howell, Ksvis and Doubleday, 1828 Clement, 
1863 von Nussbaum - - - - 
3 
45 
16 
1828 Prichard and Clarke 
1 
16 
17 
1857 Wheatkroft 
1 
17 
22 
1840 Richard Oliver, 1848 Greaves and Waller 
2 
44 
24 
1857 Wheatkroft ----- 
1 
42* 
68 
* Error. 
Thus, for every successful transfusion an average of 6, 9G 
ounces of blood. Besides the above non-fatal cases, there are 
the following entirely of human blood of which the quantity ia 
not mentioned : 1830, Soden’s table, No. 13 ; 1833, Soring ; 
1842, Wolf in St. Petersburg; 1842, Abele; 1852, Schumann; 
1856, Simson; 1859, Higginson; 1858, Dutens. Besides, there 16 
must be counted among the successful, or, to translate literally, 
not fatal transfusions, those two of Dieffenbach in 1830, result- 
ing in melancholy or erotomania; then the number of not fatal 
transfusions with human blood will reach the considerable 
height of seventy-nine cases. 
Gesellius gave three other tables similar to the above, which I 
will not transcribe, but only give the results. The first is a 
table of fatal cases of transfusion with human blood. Entire 
(ganzem), fifty two cases. Aggregate amount of blood, 400J 
ounces. 
The second contains not fatal cases of transfusion with de- 
fibrinated human blood. Thirty-six cases. 258J ounces. 
The third contains fatal cases of transfusion with defibrin- 
ated human blood. Sixty-six cases. 460 ounces. 
Let us criticise these statistics of Gesellius, for they certainly 
place the matter of transfusion of blood in a very different 
light from that in which it must be viewed if we refer to later 
operations only, those performed in the United States especial- 
ly. Though this monograph is comprehensive, and as complete 
as could be expected, with regard to the bibliography of the 
subject, and the reference to cases, it is lacking in the essentials 
for the formation of a judgment concerning the curative value 
of transfusion in those desperate cases where all ordinary means 
are likely to fail, and to which alone it ought to be applied. 
Without the details of the cases, we can not form any opin- 
ion as to their fitness for the operation, and consequently as to 
whether they were cured or simply recovered. The meagre de- 
tails which he does give are not calculated to inspire confidence 
in the accuracy of his tables. For example, case 1: A most 
remarkable case is dismissed, after the operation, with this brief 
and unsatisfactory note: “ The boy appeared excedingly well; 
all dullness of mind and body disappeared. He grew visibly 
fatter, and all who knew him were astounded.” This reads like 
a miracle. We must infer that he grew visibly fatter at once, 
that is, that his friends could see him grow, and were astounded, 
as well they might be. Again, c4se 2: Is that of a healthy 17 
man transfused with animals blood, a most important and in- 
teresting experiment; but out of place in statistics designed to 
show the curative value of transfusion. How many more are 
similar to this we cannot tell. Again, history informs us that, 
within a year after Denis’ successful cases (in 1666), so many 
fatal results followed attempts at transfusion, that it was inter- 
dicted by law unless sanctioned by the “ Faculty ” of Paris; 
yet the cases mentioned in Gesellius’ table as having recovered 
in 1666 and ’67 are all recorded as recoveries, except one, which 
has the significant note: “ Died, but not from transfusion.” It 
may be well, also, to mention the fact that a brother German, 
whose name escapes me, has issued a pamphlet attacking the 
position of Gesellius, and that the latter has rejoined in a sup- 
plementary monograph, and so the contest is going on. 
One fact in his tables, however, is of great importance, and 
will, without doubt, strike most of us with surprise; that is the 
almost perfect impunity with which it was found possible to in- 
ject large quantities of the blood of animals, of different kinds, 
into the human system. It has, it seems, been tried by quite a 
number of experimenters, some in this country, and, according 
to these statistics, with no unfavorable result. It has been con- 
sidered almost, if not quite, a settled question among us, of late 
years, that the practice was a dangerous one, and hardly justi- 
fiable. In illustration of this, allow me to quote the remarks 
of Prof. Flint, Jr., in the discussion, in reply to a suggestion of 
Prof. Peaslee, that experiments should be undertaken to ascer- 
tain the degree of safety with which animal’s blood could be 
transfused. He said “that the subject had already been fully 
investigated by physiologists, and it had been found that the 
introduction of blood of inferior animals into the circulation of 
the human subject is attended by very great risk. * * * 
The introduction of any considerable quantity would, without 
doubt, be an exceedingly dangerous experiment to perform. 
The experiment of introducing the blood of an animal having 
oval corpuscles into the circulation of an animal whose blood 
contained round corpuscles, has already been tried for the pur- 18 
pose of ascertaining, if possible, the length of time occupied by 
the oval bodies in making the round of the circulation. Ex- 
periments of a similar nature have been performed upon sheep, 
dogs, etc. In all these cases, however, death subsequently fol- 
lowed ; which showed that the animal would not tolerate any 
considerable quantity of blood in the system that had been 
taken from one of another species’' (Op. Cit. p 190). Neither 
Prof. Dalto],i nor Prof. Hammond could enlighten me very 
much on this subject, and both seemed to consider that the 
question was practically settled until reopened by the recent 
publication of those experiments recorded in the monograph of 
Gesellius. However, Dr. Hammond himself, in August, 1849, 
performed two of these experiments with the blood of animals, 
but never made them public, because, being then a young as- 
sistant surgeon in the army, he feared to bring down on him- 
self the ire of his superiors for rash experiments. He was in 
camp, en route for New Mexico, when the cholera broke out in 
his command. A Swiss, 22 years old, was in collapse, and 
moribund. With a most imperfect apparatus, he transfused 
from 16 to 18 ounces of bullock’s blood. In the case of a Ger- 
man, 40 years old, in the same desperate strait, he did the 
same. They both revived, and lived about six hours. He con- 
sidered that their life was, without doubt, prolonged. 
Dr. Flint speaks of transfusing blood containing oval cor- 
puscles, and says animals will not tolerate blood in the system 
belonging to another species. He means probably blood con- 
taining corpuscles of a different size and shape. But why re- 
sort to blood of this description, when the blood of all the 
mammalia contains round corpuscles, and, what is remarkable 
and important, smaller corpuscles than the human subject. 
Thus, according to Gulliver and other physiologists, the cor- 
puscles of man measure 1-3200 of an inch ; those of the ox 1- 
4267 ; of the sheep 1-5300 ; and even that of the rhinoceros is 
less than that of man. As Prof. Dalton remarked to me, “His 
(Gesellius’) experiments may be well worth following out.” In 
the “Medical Record” for May 15,1 find a short paragraph from 19 
a Germ on newspaper stating that Dr. Hasse, of Hordhausen, 
has transfused successfully with lamb’s blood in twenty-three 
cases. He does not state if he had any unsuccessful cases. 
These cases date only from May, 1873. He transfused directly 
from the artery of the animal to the vein of the patient. That one 
individual, in less than twelve months, should have had twenty- 
three cases actually requiring transfusion, seemed incredible. 
But, subsequently, on consulting the periodical, from which the 
extract was taken,* I find some explanation in the fact there 
stated that, in at least twelve of these cases, and twelve only 
are referred to at all, they were not such as to involve the issue 
of life and death, but mainly of expediency. “ Five were cases 
of phthisis, two chlorosis, two cachexia after severe illness, one 
cachexia after caries of vertebrse, one carcinoma ventriculi, and 
one severe haemorrhage after placenta prcevici. This last case 
recovered rapidly. The two cases of general cachexia recov- 
ered gradually, and the chlorotic case only very slowly. The 
patient with carcinoma was temporarily benefitted, and the one 
with spinal disease improved in general health and had less 
suppuration. The results in the phthisical patients were won- 
derfully satisfactory.” They would have been more satisfac- 
tory if we knew what the results were, whether they were tem- 
porary or permanent, etc. There is just this indefiniteness 
about almost all these reports of transfusion which prevents 
their being of much practical value to us as statistics. How 
we see in what a different light these statistics appear, with this 
additional history, from that reflected on them by the short 
paragraph in the “Record.” How, as regards the immediate 
effect of the transfusion of animal’s blood, we get some informa- 
tion to which Gesellius’ extensive monograph does not allude. 
It is stated that “the reaction following the operation was very 
violent. There was marked dyspnoea, which even amounted 
nearly to apnoea, and necessitated interruption of the opera- 
tion after sixty or ninety seconds. Half an hour after, there 
*(Tagesblatt du 46 Norsammlung Deutcher Naturfoscher; Wiesbaden ; No. 
7, 1873). London Medical Times and Gazette, May 30, 1874, p 597. 20 
was a violent rigor, and the temperature rose to 40.9 C. (105.6) 
F., and deep sleep followed, and on waking a feeling of comfort 
was experienced. The patients quickly gained several pounds 
in weight (how quickly ?), and their muscular strength and men- 
tal energy rapidly improved. In a few cases there was a slight 
excretion of albumen, and the coloring matter of the blood 
in the urine.” In this connection it is important to quote the 
interesting experiments very lately made by Dr. Landois, of 
Griefswald, “to determine the changes which take place in the 
blood of one animal when transfused into another of a differ- 
ent species.” He was led to investigate the subject in conse- 
quence of the use which has lately been made of animal’s blood 
for transfusion into the human subject; and his results are pub- 
lished in the “ Centralblatt” for Dec. 1873, Nos. 56 and 57.* 
“Dogs were injected with the blood of man, of sheep, cat, 
guinea-pig, calf, pig and pigeon, etc. The frog was especially 
studied as the subject of transfusion of the blood of all the ani- 
mals enumerated, as well as of the pike, and the rana esculenta 
was injected with the blood of the rana temporaria. It was 
found that if from 0.5 to 0.8 cubic centimetres of fresh or de- 
fibrinated mammalia blood were injected into the veins of a 
large frog, changes rapidly occurred in it, the most marked 
being a dissolution of the red corpuscles, so that the frog’s 
serum acquired a deep ruby-red lac color, (Lackfarbe) from the 
haemoglobin set free from the corpuscles. In transfusions with 
rabbit’s blood, the dissolution was nearly completed in from 
three to five minutes, and in other animals generally in from 
twenty to thirty minutes. Dog’s and pigeon’s blood resisted the 
longest.” 
Among a variety of other interesting and ingenious experi- 
ments, which require more space than I have at command, a 
“ frog’s blood (either fresh or defibrinated) was also mixed with 
the blood of other animals, and examined microscopically, or 
else their blood was examined in frog’s serum. It was then 
found that the red corpuscles, often after assuming an irregular 
* London Medical Times and Gazetta, May 30, 1874. 21 
outline, and exhibiting lively molecular movements, became 
pefectly globular, and so appear smaller than before; they then 
become paler and paler, till at last only the "stroma”* remains 
visible, and this at last also disappears. The stromata often 
aggregate into masses, and thus can give rise to embolisms, and 
consecutive inflammatory phenomena in the circulation.” The 
blood of one mammal dissolved the corpuscles of another, but 
in very varying degrees, according to the animal. The corpus- 
cles of one being much more resisting than those of another, 
while the serum of one has also much more solvent power than 
that of another. It wmuld seem as if we should be influenced 
by this fact, if it is established by other observers, in our choice 
of animals for transfusion. " The dissolved constituents of the 
blood are disposed of in two ways; they are partly ex'creted 
principally by the urine, but in smaller and uncertain quantities 
by the bowels, uterus, bronchi, and into the serous cavities. 
The other part probably goes to the nutrition of the receiver.” 
Dr. Landois “ believes that transfusion may benefit the re- 
ceiver in three ways—1. By bringing nutritive material into 
his body. 2. By the oxygen which is derived from the dis- 
solved blood-cells, and in its serum. 3. By possibly, in cer- 
tain circumstances, improving the mechanical conditions of the 
circulation. He does not think that there isrmuch probability 
of the foreign blood-cells ever taking on themselves the physi- 
ological functions of those of their receiver.” 
" In consequence of the partial destruction of the cells of the 
receiver’s blood by the foreign serum in some animals (e. g. 
the rabbit), symptoms of great severity and danger may occur 
after the operation, such as immensely quickened respiration, 
dyspnoea, convulsions, and even death, or asphyxia may follow it.” 
Symptoms of this kind actually, as we have seen, did follow it 
in Dr. Hasses cases. " If life is sufficiently prolonged, the 
urine becomes bloody and albuminous.” "Death may occur, 
after copious transfusions from the rapid massing together of 
* The term “ stroma” applied by Rollet to the blanched, pale, globular resi- 
due of the red corpuscle after removal of the coloring matter. 22 
the foreign (or the animal’s own) blood-cells, which leads to ex- 
tensive coagulations of fibrin in the vessels; and many kinds 
of blood exhibit the phenomenon that, when mixed with other 
blood, their corpuscles aggregate into masses, which may give 
rise to capillary embolisms in the lungs. The danger of the 
transfusion, then, into the blood of different animals, depends 
on the relation of the species employed.” 
Since commencing this paper, some additional cases have 
occurred, or have fallen under my notice, to which it is neces- 
sary to refer; but first I desire to review briefly a case mentioned 
by Dr. Barker, that occurring at Bellevue Hospital, and con- 
cerning which some additional particulars have come to my 
knowledge within a few days. The subject of this case, report- 
ed by Dr. F. J. Metcalfe, I happened to see and examine the 
day previous to the operation. There was a sudden loss of 
a very large quantity of blood some hours after the operation. 
The patient was not pulseless at any time. My friend, Dr. B. 
D. Taylor, now of Highland Falls, near West Point, who per- 
formed the operation, informs me that he furnished sixteen 
ounces of blood from his own arm, and another member of the 
house-staff furnished three ounces, the largest amount of human 
blood which I have known to have been used in any case. This 
was aided by nutritious and stimulating enemata, digitalis to 
stimulate the heart’s action, hypodermic injections of strychnia, 
and the patient survived, according to Dr. Taylor’s recollec- 
tion, twenty-four hours; according to Dr. Metcalfe’s report, 
“ forty-eight to sixty hours,” and yet she succumbed at last. 
This is, therefore, a very discouraging case, and should stimu- 
late a further inquiry into one mooted point; whether it is not 
proper, in all cases, to keep the vessels filled) if not with blood, 
with a proper saline solution, added to it, or injected in the 
intervals of the sanguineous injections, pro re nata, or with the 
blood of animals. Two cases, which will now be mentioned, 
seem to render it still more difficult to generalize, or to draw 
definite conclusions as to the proper method of transfusion, 
especially as to the amount of blood necessary, or even safe. 23 
It has been stated, in the discussion before the Academy of 
Medicine, that six cases Lave occurred in this city, all fatal. In 
1869, one of the most interesting cases on record occurred, and 
a successful one. Dr. Buchser, of this city, was the operator, 
assisted by Dr. Guleke. It is reported in the “ Medical Record ” 
for October, 1869, and referred to by Gesellius as having occur- 
red in 1868. In this case it certainly appears that no remedy 
short of transfusion of blood would have availed; and, strange 
to say, only three ounces of blood (not defibrinated) were used. 
The following significant fact is noted: “July 1. Patient 
received ferri corbonat. alcohol, and drank daily two quart- 
bottles of claret. Previous to his illness was never used to wine, 
and now states that he could drink a quart at once without any 
ill effects.” In the very number of the (April 1, 1874), 
containing the report of Dr. Barker’s paper is a report by 
Dr. Joseph W. Howe, surgeon to the Charity Hospital, of a very 
successful case; with the recommendation also of perhaps the 
simplest and best method of performing the operation. Here, 
also, only a small quantity of blood was injected (four ounces). 
In only two of the cases alluded to by Dr. Barker, in his paper, 
is the quantity of blood mentioned, a very unfortunate circum- 
stance, but for which he is not, of course, responsible. But, in 
both of them, the amount is comparatively large; eight ounces 
and thirteen, or, according to Dr. Taylor, nineteen ounces. 
During the discussion, Dr. Peaslee remarked that he “ had 
been struck with the fact that the use of so small a quantity of 
blood had caused the recovery of the patient in many reported 
cases ” ; that is, from two to four ounces. “ He had been in- 
clined,” he says, “ to reject these individual cases as not being 
very reliable.” 
Within the pasl few days, my medical friends have furnished 
me two other cases never published. The first occurred some 
eighteen months ago at Bellevue Plospital, for the account of 
which I am indebted to J. C. Young, M. D., of the resident 
medical staff. The second occurred a few days ago at the New 
York State Woman’s Hospital, for the histoiy of which I 24 
am indebted to the operator, Professor T. Gaillard Thomas. 
Case I.—John Dauphy, aged twenty-two, was run over by a 
railroad car and sustained a compound comminuted fracture of 
left humerus, complicated by an opening into the shoulder- 
joint. Sent to Centre-street Reception Hospital, where the 
brachial and other arteries were found bleeding, and tied, but 
not until a large amount of blood had been lost. Received into 
Bellevue Hospital the following day at 1:15 P. M. Dr. Wood 
immediately performed amputation at shoulder-joint. Five 
hours after, the pulse rose to 160, and became very weak and 
gaseous. He continued to lose some blood after both opera- 
tions. Stimulants and food were given him by every channel. 
At 2 o’clock A. M. the patient sank so low that transfusion was 
decided upon. Five ounces of blood were taken from the arm 
of Dr. Terriberry; it was surrounded by warm water and defib- 
rinated, and, by means of a syringe enveloped in warm cloths, 
was injected into the median basilic vein of the patient. Force 
of the heart and pulse a little increased, and the frequency 
diminished ten beats. One hour later six additional ounces 
were injected with about the same result. But shortly after 
this the patient became delirous, and continued in this state 
until 6 A. M., when he died. 
Case II.—In reply to your letter of the 11th, I state that I 
transfused blood into the vein of a patient from whom I had 
removed, by gastrotomy, a fibrous tumor of the uterus weighing 
fifty pounds. The transfusion was performed about seventeen 
hours after the operation, and at the time the patient was pulse- 
less at the wrist. About four ounces of defibrinated blood were 
introduced into the patient's arm. In a short time a flickering 
pulse was perceptible in the radial artery, and the patient, who 
was, at the time, apparently in articulo mortis, rallied and sur- 
vived about twenty-four hours. I repeated the operation in 
about eighteen hours after this time (forty-two hours after re- 
moval of tumor), and injected about six ounces more of defib- 
rinated blood. But this seemed to have no marked effect, and 
the patient died. The blood was obtained from strong and 25 
healthy men. I commenced the operation with Aveling’s ap- 
paratus, which I found impracticable, and resorted to an instru- 
ment made by Tiemann, on the principle of the stomach-pump. 
I think life was prolonged for twenty-four hours by the opera- 
tion. 
These two histories of operations performed in two of our 
great hospitals, by men well accustomed to surgical manipula- 
tions, only emphasize more strongly the remarks already made. 
It is well to note the failure of Aveling’s instrument, in Prof, 
Thomas’ hands, so highly commended lately. 
Just at the last moment, I have received a letter from Dr. 
Joseph W. Howe, furnishing the notes of another case of trans- 
fusion performed by him at Charity Hospital a few days ago. 
They are as follows : 
“The patient was very much reduced by excessive discharge 
from a large ulcer of the leg and necrosed bone. I first placed 
in the aspirator (this is the instrument recommended by Dr. 
Howe for transfusion) a solution containing ten grains of car- 
bonate of ammonia, which became mixed with the blood as it 
entered the instrument (this is to prevent coagulation); I in- 
jected about six ounces altogether. The patient’s appetite and 
strength improved for about a week, and then began to fail. 
He left the hospital in about the same condition as when the 
transfusion was made.” 
I am aware that the foregoing observations have somewhat 
of a desultory and disconnected character, due partly to the 
fact that an important portion of the information which they 
involve fell under my notice after the greater part of my paper 
had been prepared. It was not intended, by any means, to be 
exhaustive of the subject, or to present any novel facts or theo- 
ries ; nor does it even seek to establish any point of practice, 
but simply to bring this question before the Profession in all its 
bearings, which has never yet been done. As has been stated, 
there have been periods in medical history when a sort of fashion 
for experiments in transfusion has arisen; and, for a few years, 
quite enthusiastic efforts have been made by distinguished men 26 
in different countries to establish the practice; but a reaction 
has, each time, led to its almost total abandonment for a long 
period. One of these revivals occurred in 1819 through the 
experiments of Dr. Blundell, of London. Quite recently symp- 
toms of another revival have manifested themselves, and now 
appears to be an auspicious period for such a thorough scien- 
tific investigation of the whole subject, as the exacting spirit of 
the age demands, as has been accorded to other mooted ques- 
tions of professional importance, and such as may effect the 
establishment of some principles by which we maybe guided in 
forming an opinion as to the propriety of the operation, and as 
to the details of its execution. 
At present we are, to employ an expressive, if not scientific 
phrase, all at sea on this subject; as to what conditions of acci- 
dent or disease it is applicable ; whether blood or some other 
fluid should be employed, alone or mixed, or interchangeably; 
if blood is necessary, whether animal or human; whether ani- 
mal’s blood is even safe in a healthy subject, whether it should 
be defibrinated; how much is necessary or safe; how often a 
repetition is called for; what apparatus shall be preferred; 
what auxiliary means are proper or essential. Can any one 
answer any of these questions satisfactorily to any person but 
himself? Or can we consider any one of these important points 
established ? 
N. B.—Since this paper was read, I find in the July number 
of this Journal an article on transfusion by Dr. Morton, of the 
Pennsylvania Hospital, in which he gives the histories of three 
successful cases of his own and four of Dr. J. G. Allen, two of 
which may be called successful. Defibrinated blood was used. 
In some of the cases the amount is not given. The smallest 
amount was two ounces (successful), the largest eleven ounces. 
In the same number is a short paragraph extracted from the 
“ British Medical Journal,” giving the experience of several 
distinguished German experimenters with animal’s blood, be- 
sides those mentioned in this paper. Ivtister mentions serious 
symptoms supervening upon the injections, as dyspnoea, cyano- 27 
sis, pains, shivering, rise of temperature, etc. These symptoms, 
as usual, disappeared after the lapse of a few hours. Sander, 
of Barmen, also warns against the indiscriminate use of ani- 
mal’s blood. One of his patients had symptoms of uraemia, 
which lasted four days. It is very evident that further experi- 
ments with animal’s blood should be made; and that, if possi- 
ble, some measures should be devised for obviating these un- 
pleasant symptoms. It might be well to try the effect of dilut- 
ing the blood with proper saline solutions, such as have been 
often resorted to successfully, and to which allusion has been 
made in this paper. 
I deem it my duty to state that, within a day or two, I have 
seen Dr. Ely, who informs me that his patient gradually sank 
and died, after his letter was written, with symptoms of rapid 
phthisis pulmonalis, constant cough, and abundant purulent ex- 
pectoration. She had never enjoyed good health, and such a 
development, under the circumstances, is not at all surprising.