40 TuDzcJoL JOUA ACUTE GENERAL HAEMORRHAGIC PERITONITIS. LJULY 8, I9id blood was transfused. Following this he slhowed improvement , and for the next week his progress was fair, but he seemed to have lost heart, anid it was thouglht that a second tranlsfusion would give hiw the desired stimulus. On December 28thi (red blood co'ls 2,330,000, haemloglobin 60 per cent.) 450 c.cm. of whole blood was transfusedl with the two-way stop-cock from a second donior. More than this quantity was not used, as towards the end of the proce(lure the patienlt complained of gelneral discomfort, and withini ten miniutes after the operation the pulse became weak an(d rapid, respirations shallow and hurried, and he was only partly colnscious. StimLulants were administered, anld four lhours later lhe was sitting up in bed smoking a cigarette. The followiing day intenise jaundice was present, anid he had passed a smiiall quantity of very dark red urine. The pulse was weaker and there had beeti con-si(lerable bloody oozinig from the stump. Twenty-four hours after this (the second) transfusion he became unconscious and died. At autopsy only a few petechiiae were founld benieath the serous coat of the small intestine, the liver was fatty, the kidneys and spleen dark red. No signi of pulmonary embolus or infarct could be found. Death was due, apparently, to acute haemolysis. CASE Iv.-Rfm. M., under the care of Major T. 1R. Elliott, R.A.M.C., who was kinid enough to furnish mne witlh progress niotes, sustained multiple shrapniel wound(ls oni December 14tl, 1915. Three days later he was a(dmitted to base hospital in very bad condition, with septic wvouii(s of the left kniee, right ankle, and left lunig. Oni the twelftlh day after tlhe inijury trismus appeared simultaneously with the expectorationi of gangrenous pus from the lungs. Tetanius developed rapidly on the next day, causing rigid trismus aln(d board-like abdomen, but no spasms nor difficulty of respiration. The con(lition of the patient was very pitiable, since he could niot void from his mouth the fetid material that contiinued to come up from the lung abscess on the left side. Antitetanius serum was giveni ulltil January 6th (a total of about 60,000 units). Oin the twenty-seventh day after the injury secondary haemorrhage occurred twice from the septic wound of the left knee. The vessel was ligatured. The blood lost was estimated as being rather less than a quart; the patienit was much blaniched. For the next week the general conditioni became 'worse, and there were signs of consolidation at the base of the left chest. No pus was found oni exploration. On JaInuary 17th, before transfusion, the red blood cells were 2,832,000, an(lhaeino-globin 45 per cent. By syringe-caninula iietlIod 860 c.cm.. of blood was transfused; a rigor followed at once, and lasted fifteen minutes. On January 18th the red blood cells were 4,600,000, and haemoglobin 60 per cent. Following this the conidition improved, and on February 1st a small localized empyema was opened, and the right ankle thoroughly cle...
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