| Reprinted from the American Gynaecological and Obstetrical Journal 
for January, 1895.] 
SUBCUTANEOUS INJECTIONS OF LIQUIDS IN ACUTE 
HAEMORRHAGE* 
T. J. Crofford, M. D., Memphis, Tenn. 
Having recently read the report of a series of cases from Guy’s 
Hospital, London, and another from the Johns Hopkins Hospital of 
this country, in which intravascular injections of a saline solution 
were practiced in acute haemorrhage, causes me to report some expe- 
riences which I have been having for the past few years and to put 
forward the advocacy of a method simpler than intravascular transfu- 
sion for supplying the system with fluid to take the place of the blood 
which has been lost. I refer to the subcutaneous injection of fluids 
in quantities sufficient to supply the deficiencies or sufficient to tide 
the patient over the crisis. The method I have adopted has served 
the purpose well, and is briefly described as follows : 
Make a saline solution of two, four, or six per cent, of common 
salt in an ordinary water pitcher, pour this into an ordinary fountain 
syringe, into the end of the tube of which an aspirator needle has 
been inserted. While the water is running out through this needle 
thrust it through the skin into the cellular tissue of the flank or back 
of the patient. It will be observed that several ounces or a pint of 
fluid will have been deposited under the skin in quite a short while. 
The position of the needle can now be shifted to another location 
without fully withdrawing it and another quantity of fluid deposited. 
This can be done several times, till a quart or more of the fluid has 
been injected without withdrawing the point of the needle from the 
original puncture made in the skin. 
It will be argued that the intravascular injection is directly into 
the circulation, and is consequently, on account of its immediate 
* Read before the Mississippi Valley Medical Association, Hot Springs, Ark., 
November 20, 1894. T. J. Crafford, M. D. 
effect, the better applicable to the crises of the acute haemorrhages 
which need transfusion most. This may be the case where the neces- 
sary apparatus and an experienced operator is at hand and ready to 
do the operation of transfusion. In other words where you are 
looking for a haemorrhage and have prepared for it beforehand, it 
may be best in certain cases, but this has not been the case in any of 
the cases of haemorrhage with which it has been my misfortune to 
deal. 
When we consider the simplicity of the method which I have 
above described, that no instruments beyond a fountain syringe and 
an aspirator needle are required, no operation beyond passing this 
needle through the skin into the cellular tissue ; then when we con- 
sider the rapidity with which the fluid is absorbed after haemorrhage, 
it is very evident that this method is the most feasible and therefore 
the most applicable, in by far the greater number of cases encoun- 
tered, whether surgical, obstetrical or medical varieties of haemorrhage 
be met with. 
I have put the method to test in quite a number of cases, but to 
avoid tediousness I shall report only three, these being quite suffi- 
cient to show its efficiency as well as the ease and certainty with 
which it can be got to work in emergencies. 
Case I.—Mrs. V., aged thirty-five, was operated upon May 19, 
1893, for huge pus-tubes, likely of long standing, firm and universal 
adhesions. Upon enucleation the haemorrhage was very great, in spite 
of my best efforts to control it. By the time the haemorrhage was 
under control, the incision stitched up, and the patient placed in 
bed, it was found that the pulse had failed at the wrist. Considerable 
quantities of a saline solution were thrown under the skin. In a short 
while she rallied and made ultimately a good recovery. 
Case II.—Mrs. L., aged thirty, had a tedious delivery on the 
morning of June 5, 1894. After the child and placenta were expelled 
she was found to be flowing profusely. A very few moments later she 
was quite blanched and the pulse had failed at the wrist. The clots 
were quickly turned out of the uterus and it was irrigated with hot 
bichloride apple vinegar. With the same syringe a large quantity of 
mildly saline fluid was injected into the cellular tissue of the back 
and flank. She rallied nicely and before twenty-four hours was up 
her pulse was 84 beats per minute and of fairly good volume. Re- 
covery perfect. 
Case III.—Mrs. M., aged forty, was delivered on September 25, 
1894. A terrific haemorrhage immediately followed. The uterus was Subcutaneous Injections of Liquids in Acute Hcc7norrhage. 
3 
emptied and she was at once irrigated with a hot bichloride solution. 
No abatement of the haemorrhage followed. The uterus was then ir- 
rigated with hot bichloride apple vinegar, with still no abatement of 
the haemorrhage. The patient was now very much exhausted. The 
circulation was very feeble. The pulse was 140 at the wrist. The 
uterus was again quickly emptied and thoroughly packed with iodo- 
form gauze, which controlled the perfectly. A large 
quantity of saline Solution was injected into the flanks and back and 
in a very short while the circulation was restored. Her successful 
progress was uninterrupted from this time on. 
In all probability the first two would have died without the 
transfusion. The third case would likely have recovered without it, 
but she rallied much more quickly and progressed much more satisfac- 
torily with it. It will be remembered that a large percentage of the 
patients who die from haemorrhage rally somewhat and then die some 
hours or even a day or two later from cardiac exhaustion, incident to 
the lessened blood pressure. 
The operation as above described, if it can be called an operation, 
is so simple that any assistant or nurse can attend to it, while the 
surgeon or obstetrician is completing his work. No patient who has 
lost any considerable quantity of blood should be allowed to go 
without it, especially if the stomach is not in a condition to absorb 
fluid. 
When death takes place on account of the sudden withdrawal of a 
large quantity of blood from the circulation, it is because the heart 
fails to act. The heart fails to act because there is a sudden fall in 
the blood pressure, which is its continuous direct stimulus. 
The diminished blood pressure is relieved within certain limits by 
the vaso-motor system of nerves stimulating the blood-vessels to con- 
tract, thereby adapting the vascular apparatus to the lessened volume 
of blood. 
If the haemorrhage is sufficiently slow for the vaso-motor contrac- 
tion of the blood-vessels to keep pace with it, then life can be sus- 
tained with a proportionately small quantity of blood. 
From the foregoing the interdependence between the blood, the 
vascular apparatus and nervous system is apparent. The indications, 
then, are first, to stop the haemorrhage; second, to increase the vol- 
ume of the circulating medium; third, to sustain the heart and nerv- 
ous system during the crisis. 
It will be remembered that the middle coat of the blood-vessels 
contains both non-striated muscular fibers and yellow elastic tissue, T. J. Crofford, M. D. 
the former predominating in the small and the latter in the large ves- 
sels. In algid congestions there is a recession of the blood into the 
large vessels in the interior of the body, leaving a diminished quantity 
in circulation. It is possible for one to die with all the symptoms of 
haemorrhage, the blood being poured into the large vessels instead of 
upon the ground. The remedy for present relief of the two condi- 
tions would, theoretically, be the same.