The use of replacement transfusion in diseases other than hemolytic disease of the newborn.

transfusions in the seventeenth century began by doing replacement transfusions. Eutyphronus remarked, ‘ ‘It is foolish to transfuse a patient without previous blood letting, because this would not reduce the strain on the body.” This operation, although it had a few successes, caused quite a few deaths. This is easily understood since the transfusions were usually done with animal blood. After the report of Claude Perrault to the Academy of Science in Paris in 1664, this body declared the transfusion ‘ ‘a dangerous method. ‘ ‘ In 1675, Parliament passed a law prohibiting its use. Since the discovery of blood groups by Landsteiner, the use of transfusion has increased greatly, but replacement transfusion was almost completely abandoned. At most, it was used in a few cases of carbon monoxide poisoning, mushroom poisoning, and intensive burns. Even in those cases, only one blood letting and a transfusion of oo to iooo cc. was performed. The purpose of this article is to discuss not replacement transfusion as it was used then, but the replacement of the total blood volume of a patient by the blood of many donors and the repetition of that technic many times in the same patient. The progressive realization of a complete blood replacement in man was achieved in 1946. We had thought for some time that such an operation would be of great value if it was well tolerated by the patient. In 1939-1940 we studied with our director, A. Tzanck, and our associate, M. Burstein, a technic for rapid replacement transfusion in the dog. We showed that in that animal the total blood volume could be replaced by a mixture of fresh blood of other dogs without any serious reaction. We achieved thus not a simple blood letting followed by transfusion, but a true “washing out” of the organism. At the same time, we attempted similar results in man, but did not succeed completely. After the war, in 1945-1946, studies on the Rh factor and hemolytic disease of the newborn gave a new impetus to this problem. It is known that in hemolytic disease of the newborn the infant has in his body both Rh positive blood cells and anti-Rh serum. A few persons thought that the most rational treatment would be replacement transfusion of the newborn. That