The medical value of red cell suspension could be evaluated by the kind of solution which was used as a suspension of red cells.
The authors have investigated the proprieties of several solutions for suspending the red cells, especially the preservability of these cells in them.
It has been found that Pereston N, a saline solution of low molecule P. V. P., was the best for this purpose and 6% Dextran was next. It was also possible to use the solution of aminoacid crystals. These red cell suspensions were used in 130 cases of chronic anemia with excellent results.
So far, it has been practically contraindicated in patients with anemia with hypoproteinemia and for operation or hemorrhage. However, we have had 22 clinical cases receiving massive transfusions of red cell suspensions in several kind of major surgical operations with good results without causing edema or tendency of bleeding.
Warnings have been given repeatedly against massive and frequent administration of high molecule colloid solution because there was the possibility of its deposit in tissues. Thday we believe Pereston N is the most suitable solution for massive and frequent transfusions of red cell suspension.

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In order to clarify the influence of hemorrhage associated with hemothorax on the circulatory system, 58 mongrel dogs were bled by bleeding bottle method until blood pressure fell to 50mmHg and oleothorax with liquid paraffin was created, simulating acute hemothorax.
Analysis was made on the relation between circulatory failure and the amount of injected paraffin which parallel the severity of hemothorax.
1) The oleothorax with the paraffin injection in amonnts of 20cc/kg and 40cc/kg did not overload the circulatory system, while the injection of 80cc/kg was followed by irreversible circulatory failure.
2) The most effective treatment for the oleothorax associated with hemorrhage was blood transfusion, supplemented by O₂ inhalation and removal of paraffin.

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In order to investigate the influence of postoperative hemothorax in the field of thoracic surgery, the author performed experiments on 73 normal hybrid dogs in which liquid paraffin was poured into the left thoracic cavity, thus intrathoracic condition simulating hemothorax being produced, and hypotension averaging 50mmHg was maintained by means of massive hemorrhage.
Influence of the stated condition with the pulmonary compression and hemorrhagic stress, influence of removing the condition, and effect of oxygen inhalation and blood transfusion were scrutinized from the standpoint of blood gas volume, amino N and fluctuation of the acid-base balance.
1. Fluctuations in chemical composition of the blood were slight in degree when only liquid paraffin was present in the thoracic cavity, while, when hemorrhagic stress was added to the condition, fluctuations in the form of decrease of blood gas volume, decline of pH and increase of amino N were all more prominent than in simple bleeding. The group with massive paraffin injection showed particularly rapid changes and died in a short period of time.
2. The acid-base balance tended to develop compensatory respiratory alkalosis by the intrathoracic injection of liquid paraffin and it shifted to the side of compensatory acidosis after hemorrhage occurred.
3. Improvement in the composition of blood chemistry was induced by removal of intrathoracic liquid paraffin, oxygen inhalation and blood transfusion. Combined administration of removal and oxygen inhalation showed a prominent effect on the survival time, and combination of removal and blood transfusion showed more remarkable results in these respects.

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Postoperative jaundice was noted early, especially after surgery in which large amounts of banked-blood were used.
This fact was analysed from clinical and laboratory points of view and experiments were performed pertaining to toxicity of hemolobin to the liver cell.
1. Postoperative jaundice appeared in 41 of 380 cases who had blood transfusions at some stage of surgical operation, rather early, in 21 of 41 cases.
2. This early jaundice developed within one week in 21 cases.
3. Early jaundice tended to develop in cases receiving transfusions of banked blood in large amounts.
4. This type of jaundice was differentiated from serum hepatitis clinically by rapid onset and disappearance.
5. Early jaundice and serum hepatitis could not be differentiated by means of liver function tests.
6. This post-operative early jaundice was not a simple manifestation of hemolytic jaundice, but hemolytic jaundice may lead to hepatocellular jaundice.
7. Hepatocellular damage could be induced by repeated injections of hemoglobin solution.
8. From these results, it may be concluded that the blood should be as fresh as possible and hemolysis should be minimal in transfusing large amounts of banked-blood.

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The author made experimental studies on dogs concerning the circulatory influence of hypotension of 80mm.Hg induced by repeated massive hemorrhages and transfusion by means of blood reservoir technique, and simultaneously he observed the influence of administration of norepinephrine, hydrocortisone and chlorpromazine.
1) Repeated massive hemorrhages and intermittent severe hypotension cause a grudual exhaustion of compensatory mechanism of the circulatory system. The process is clearly illustrated by fluctuations of the blood loss curve, which can be divided into three stages, i. e., bleeding stage, balanced stage and stage of back flow as is exactly the case of non-repetitive hemorrhage. The circulatory influence of massive hemorrhages persists for fairly long time regardless of restitution of normal blood volume by transfusion.
2) There is individual difference in the time of shift of the stages, and it is not always proportional to the time of repetition of hemorrhage.
3) Repeated massive hemorrhages and transfusions cause such a great influence upon the circulation that they shorten the course of exhaustion
4) In the course of breakdown, norepinephrine, hydrocortisone and chlorpromazine show prolonging effects on the process, while ACTH is ineffective.

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This is a report of a case which developed acute hemolytic reaction due to incompatible blood transfusion of anti-D and anti-C Rh antibody.
1) The case had received massive blood transfusion in the previous gastrectomy which, it is construed, probably gave rise to production of anti-Rh antibody and induced an antigen-antibody reaction in the concurrent blood transfusion. In order to prevent such complications it is advisable to test anti-D and anti-E antibody on those patients with histories of blood transfusion, stillbirth or abortion and if it is negative Coomb's test should be performed.
2) Shock due to incompatible blood transfusion under general anesthesia is evasive to detection, and so need of its careful detection cannot be over-emphasized.
3) As for the treatment plasma, plasma expander, massive administration of hydrocortisone and transfusion of Rh negative blood showed remarkable effects.

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