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 those who so strongly advocated gum by saying that there can be no doubt that it is very much more effective than other solutions previously used. The same opinion was formed by many other surgeons, although it was natural to feel a bias in favour of gum which could be given with much greater economy of time and effort than blood. Up to the present time I have seen no reason for altering this opinion, and should always prefer to treat hæmorrhage and shock with a blood transfusion if possible.