Some success was attained
by Oswald Robertson in treating cases of hæmorrhage by the method of
“forced fluids,” large quantities being given by the mouth and by
the rectum (245). In many serious cases, however, this treatment is
inapplicable, and it is clear that transfusion is more rapid and more
certain in its effect. Isotonic saline having been found ineffectual,
it was suggested that a hypertonic solution (2 per cent. sodium
chloride) might be of more value. This was tested clinically and in
the laboratory, and was found to have no advantage over the isotonic
solution (11).
When the association of increased hydrogen-ion concentration with
shock was demonstrated, it was at first supposed to be one of the
factors producing the condition. It was therefore natural that the
effect of a solution of sodium bicarbonate (4 per cent.) should
be tried. The effect upon certain cases suffering from extreme
“acidosis” and air hunger was very striking, but in general the
alkaline solution was no more effective than the ordinary isotonic
saline. I soon abandoned its use for intravenous infusion, but it was
of service in serious cases when given by the rectum.
During the war the necessity for the conservation of time--and
of blood--was evident. The search for a satisfactory substitute
for blood was therefore prosecuted with great energy, most of the
research being done by, or under the direction of, Professor W. M.
Bayliss. The object of the research was to discover a non-toxic
solution which possessed the same “viscosity” as the blood, and the
same osmotic pressure due to contained colloid. It was believed that
such a solution would not tend to exude so rapidly into the tissues
and would therefore augment the blood volume more effectively than
the fluids previously used. After many experiments it was claimed
in 1916 that a blood substitute had been found in a 6 per cent.
solution of gum acacia with ·9 per cent. sodium chloride. It was
even stated on the evidence of laboratory experiments that the gum
solution was as effective as blood in the treatment of shock and
hæmorrhage. It was therefore used very extensively among the wounded,
and favourable reports upon its value were made by various workers.
It is difficult, however, to control the results in giving treatment
of this kind. If a patient dies after being given a gum infusion,
no one can state definitely that he would have lived had he been
given a blood transfusion instead. If a patient lived after having a
blood transfusion, it would be equally rash to state that he would
have died had he been given gum. Nevertheless, after giving the gum
solution a number of trials, I formed the opinion that the results
were inferior to those obtained with blood. Patients did not recover
whom from previous experience with blood transfusion I should have
expected to do so. I accordingly continued to use blood in preference
to gum whenever it was available, although justice must be done to
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