The hazards of blood transfusion in historical perspective

The genetic and antigenic basis of tumour transplantation

The role of iso-immunization in the pathogenesis of erythroblastosis fetalis

A number of transfusion accidents in pregnancy have been reported in the literature, even though the donor, frequently the husband, was in the same blood group as the patient.1In one instance analyzed by Levine and Stetson2it was assumed that the accident could be attributed to an agglutinin resulting from immunization of the mother by factors in the fetus inherited from the father. Analysis of a series of 12 cases in which atypical agglutinins could be demonstrated revealed the significant fact that these patients presented obstetric histories characterized by a number of complications such as toxemia, macerated fetus, repeated abortions, miscarriages or stillbirths.3 Recently 5 additional patients with atypical agglutinins were observed, 3 of whom gave birth to infants suffering from erythroblastosis foetalis. The obstetric histories of these cases are so striking as to merit brief mention. One patient, J. L. (decigravida, sextipara), now pregnant and

Isoimmunization in pregnancy: its possible bearing on the etiology of erythroblastosis foetalis

Fetomaternal hemorrhage: incidence, risk factors, time of occurrence, and clinical effects

The recent important contribution of McQuarrie 1 on the toxemia of pregnancy suggested, as an explanation of this condition, the accidental transfusion of incompatible blood between mother and child as the result of a fortuitous opening in the placenta between the two circulations. Examining 180 women and their new-born infants, McQuarrie found that toxemia occurred sixteen and one-half times more frequently when the maternal and fetal bloods were incompatible than when they were in the same iso-agglutination group. More than 70 per cent. of the cases of toxemia (all forms included) occurred in the small group in which there was interagglutination between maternal and fetal blood. The work was of particular interest to me, because in 1911 I worked on the same idea, and was about to publish a preliminary communication on it (my article having already been approved by Professor Gies and Dr. Mandelbaum, in whose laboratories I was

The etiology of eclampsia: historical and critical notes

Accidents following transfusion have been sufficiently frequent to make many medical men hesitate to advise transfusion, except in desperate cases. It has been our opinion since we began making observations on this question in 1908 that such accidents could be prevented by careful preliminary tests, leading to the exclusion of agglutinative or hemolytic donors. Our observations on over 125 cases have confirmed this view and we believe that untoward symptoms can be prevented with absolute certainty. It has been the general impression that preliminary blood-tests ought to be done to determine the compatability of the donor's with the patient's blood, but there has been little direct observation as to the correspondence between the test-tube phenomena of agglutination and hemolysis and symptoms arising after transfusion. Scattered reference to the hemoglobinuria following transfusion have made it clear that the occurrence of hemolysis between the donor's and patient's blood is a real danger.

Accidents in transfusion: their prevention by preliminary blood examination: based on an experience of one hundred twenty-eight transfusions

Experimental agglutinative and hemolytic Transfusions.

In 1919, L. and H. Hirshfeld 1 showed that agglutinogen A (characteristic of Group II, red blood cells) predominates greatly over B in the population of northern Europe, and that agglutinogen B (characteristic of Group III, red blood cells) predominates in Asia and Africa. The two are about equal in certain intermediate races. They classified the races examined on the basis of the "racial index"—the ratio of the percentage of A to the percentage of B in the population. Those races having an index of more than 2 were assigned to the European type, those with an index of less than 1 to the Asia-African type, and those with an index between 1 and 2 to the intermediate type. This classification (which disregarded entirely Group I) was sufficient so long as only those races had been examined whose proportion of Group I was at about the same level. Since the

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A classification of human races based on geographic distribution of the blood groups

Suppurative pylephlebitis with multiple liver abscesses is an extremely grave disease. It most commonly follows acute appendicitis but also may complicate a great variety of intra-abdominal and rectal infections. The diagnosis may be difficult, and in many more cases the disease is recognized on the postmortem table rather than during life. The incidence of the condition has been appreciably smaller in recent times, owing to earlier operative intervention for acute appendicitis. In the older statistics necropsy reports of patients dead of acute appendicitis revealed pylephlebitis and liver abscesses in 4.7 per cent (Fitz),15 per cent (Armstrong)2and 5 per cent (Petren).3More recent analyses showed 0.4 per cent (Gatch and Durman)4and 0.3 per cent (Hawkes).5Colp,6in analyzing 2,841 cases of acute appendicitis, noted an incidence of 6.8 per cent of preoperative chills; in only a small fraction of these cases did

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Reuben Ottenberg

Papers

The etiology of eclampsia: historical and critical notes

Accidents in transfusion: their prevention by preliminary blood examination: based on an experience of one hundred twenty-eight transfusions

Experimental agglutinative and hemolytic Transfusions.

A classification of human races based on geographic distribution of the blood groups

Sulfanilamide therapy for suppurative pylephlebitis and liver abscesses