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Dilution with physiologic saline solution and other fluids accelerates the coagulation of properly collected normal and hemophilic blood and plasma in silicone coated vessels, with or without the aid of activating agents such as platelets, thromboplastin, cephalin, glass particles or plasma euglobulin fractions. When normal plasma is diluted under a concentration of about 20 per cent, its rate of clotting is prolonged, principally because of diminution in prothrombin. Regardless of the activating agent used, the rate of coagulation of hemophilic plasma can be made equal to that of normal plasma by appropriate dilution. These findings speak against the existence in hemophilic blood or plasma of a deficiency in any procoagulant factor, and support the concept of the presence in excess of a stabilizing inhibitor which slows the conversion of prothrombin to thrombin by one or both of the following mechanisms: (1) reducing or inactivating the effect of released coagulants (antithromboplastin activity) (2) conjugation with a procoagulant thereby maintaining it in an inactive form (anti Ac-globulin activity).

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IN I940, WHEN the technic for infusing blood or other fluids into the circulation via the bone marrow was discussed, the following points were stressed: (a) The method is indicated only when intravenous injections or infusions are needed and the peripheral veins are not available for one reason or another (poor development; delirious or uncooperative patients; extensive burns; shock). (b) The operator should familiarize himself with the anatomic landmarks in adults (sternum) and infants (tibia and femur), and practice the technical steps on the cadaver before attempting to carry out the procedure in a patient . (c) No irritating substances should be introduced by this route. (d) In the presence of extensive infection, with or without bacteriemia, the use of this route is not advisable except for the introduction of bacteriostatic drugs (sulfonamides, penicillin) .1 2 3There has been wide application of this method and the reports thus far pabhlished have, on the whole, been favorable.4-19 The feeling may grow, however, that infusion by this method may be undertaken by any one, without previous training and in disregard of the points enumerated above. Lest this happen, attention is hereby drawn to certain serious complications which have resulted from trials at the performiaice of this technic.The outstanding example of the consequences of flagrant disregard of simple precautions is that reported by Ravitch,20 in September, I943: Seventy-five cubic centimeters of sevent-day-old blood, removed from a flask opened two days previously, were given in the sterintun of an eight-month-old infanit. The child developed a mediastinal abscess requiring drainage, which was followed by recovery. In October, 1941, the anatomic features of the b)one marrow in the sternum, femur and tibia of infants were reviewed, and attention was dIrawn to the fact that in inifants unider three vears of age. the sternuimi shoul(d not be use(d for this purpose because of its small size alndl somiewhat irregular distribution of its marrow deposits.3 Use of either femur or tibia was recommended in such patients.Papper7 has recorded a death presumably resulting from the administration of 5 per cent glucose solution via the marrow of the corpus sterni in a 20-year-old woman, with acute thrombopenic purpura. The infusion needle was inserted into the sternum while a splenectomy was in progress and, because of the necessity of not interfering with the operative field, the needle was pointed caudad. A small amount of nmarrow was obtained before the 266

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