Wednesday, March 11, 2015

Two Cases of Civil War Blood Transfusion: Treatment of Haemorrhage

From: Medical/Surgical History--Part III, Volume II; Chapter XII.--Wounds And Complications.

Two cases of transfusion of blood are found on the records; one, a successful operation, was performed by Surgeon E. Bentley, U. S. V.; the other, a fatal case, by Assistant Surgeon B. E. Fryer, U.S.A. Both are here detailed:

CASE 1186.--Private G. P. Cross, Co. F, 1st Massachusetts Heavy Artillery, aged 19 years, was wounded in the right leg, before Petersburg, June 16, 1864, and entered the Grosvenor Branch Hospital, Alexandria, two weeks afterwards. Surgeon E. Bentley, U. S. V., who operated in the case, made the following report:' "The injury consisted of a flesh wound on the posterior aspect of the leg. At the date of the patient's admission he was exsanguineous from previous loss of blood. Owing to his condition no operative measures were adopted, but his languishing vital powers were sustained by stimulating treatment combined with highly nutritious diet. Under this method he slightly improved in strength, but the circulating fluid was so impoverished in quality and reduced in quantity that the face of the wound looked pale and bad, and ultimately, on August 12th, it assumed a gangrenous aspect. Local applications, such as creasote, charcoal poultices, nitric acid, etc., were applied to combat this condition. These means failed to arrest its onward progress, the leg presenting in a short space of time a mass of gangrenous sloughs, horribly fetid. Haemorrhage from the posterior tibial artery again commenced on the afternoon of August 15th, when it was deemed advisable to amputate to prevent further loss of blood. The operation was accordingly performed just at the tubercle of the tibia, the condition of the parts not allowing a flap to be made below that point. Not more than two tablespoonsful of blood was lost; but the patient not seeming to rally, it was determined to test the method of transfusion of blood as recommended by Brown-Séquard. Blood having been obtained from the temporal artery of a strong healthy German, an attempt was made to penetrate the internal saphenous vein, but was unsuccessful on account of its small size; after which an <ms_p3v2_812>opening was made into the median basilic, and about two ounces were transfused by means of a Tiemann's syringe. Immediately after the injection a marked difference was noticed in the patient's pulse, which became stronger and firmer. He was then removed to his bed and generous diet was administered, together with stimulants and tonics, under which treatment he gradually improved, his appetite became better, his strength increased, and the stump assumed a healthy aspect. On October 20th the stump had healed and the patient had so far improved as to be able to be furloughed. At its expiration he returned, and, finally, he was transferred to Webster Hospital, Manchester, January 13, 1865, cured." The patient was ultimately discharged from Central Park Hospital at New York City, June 9, 1865, and pensioned, and afterwards he was supplied with a "Hudson" artificial limb. This pensioner died August 24, 1867.

CASE 1187.--Private J. Mort, Co. E, 105th Illinois, aged 37 years, received a flesh wound in the upper third of the left leg, at Keneeaw Mountain, June 26, 1864, by a musket ball, which lodged between the tibia and fibula. He entered Brown Hospital, at Louisville, nine days after receiving the injury, the missile having been extracted and the wound looking unhealthy and sloughing. During.the night of July 24th the patient had a copious haemorrhage from what was supposed to be the anterior tibial artery, which was arrested. On July 26th bleeding again commenced, the blood welling up from between the bones and from the tissues posterior to them. It was then deemed necessary, in order to save life, to amputate, which was done through the upper third of the leg by the circular method, by Assistant Surgeon B. E. Fryer, U.S.A. Ether was used as an anaesthetic, and three ligatures were applied, the patient reacting very slowly. On the following day it was determined to transfuse some blood into the patient, for which purpose, in the absence of any other suitable apparatus, an ordinary gutta-percha syringe was used, the nozzle of which was filed to fit a small tube having a stop-cock through its centre. The right cephalic vein having been selected, an opening was made carefully into it, and the syringe having been warmed and filled with blood from a healthy man, a little of which was allowed to flow from the syringe before forcing its nozzle tightly into the tube in order that any air might be driven out, the tube was introduced and the stream of blood was slowly and carefully forced in. About sixteen ounces were thus transfused. The first effect upon the patient was to increase respiration from about fifteen to twenty-eight per minute, though it soon returned to its normal number of about sixteen. The pulse ran up from one hundred to one hundred and thirty, which, however, also soon returned to what it had been. The man's general condition was greatly improved. His pulse became fuller and slower; he slept well; his stomach retained food, and altogether the prognosis became more favorable. On August 4th haemorrhage commenced from the face of the stump, the whole surface of which appeared to be involved. From the effects of this, and from chronic dysentery, the patient died on the following day, August 5, 1864; although his condition, from the effects of chronic dysentery and of the haemorrhage at the time of the transfusion, was such as hardly to expect his recovery, the improvement was such as to show that the operation was not only justifiable, but that it was to all intents a success. The history of the case was reported by the operator.


Image: An Antique 19th Century Blood Transfusion Pump


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