SERUM TEST FOR PAROXYSMAL' ttEMtfGrOBINURlA IOI 



The patient's and the control individual's 'sertfni are eUtfe tftixed with 

 washed human erythrocytes in various proportions. It does not matter 

 whether the red blood cells are obtained from the patient or normal individ- 

 ual. The mixtures are allowed to remain for one-half to one hour in the 

 ice box and then from one to three hours at a temperature of 37 C. The 

 serum from the paroxysmal hemoglobinuria patient shows hemolysis. 



A control tube containing the same ingredients, in the same proportions 

 and maintained at either cold or warm temperatures, but not at both in 

 succession as above, exhibits "no hemolysis. 



The hemolytic process in this disease is of a complex nature. In the 

 cold, one element combines with the erythrocytes, and at high temperature 

 another unfolds hemolytic tendencies. Some sera lacking entirely or not 

 having enough of the second element in the serum, demonstrate no hemoly- 

 sis. But on addition of some normal serum hemolysis occurs. It can there- 

 fore be concluded that the second factor which acts in the heat is present 

 within normal serum, while the first substance, the specific one, is found 

 only in the blood of those suffering from paroxysmal hemoglobinuria; 

 (and according to Donath and Lands teiner in 10 per cent, of cases of general 

 paralysis). It is, in addition, the author's opinion, that similar toxic 

 substances exist in the blood of epileptics and idiots. 



Not all cases of paroxysmal hemoglobinuria possess this characteristic 

 hemotoxin. In some it is only found periodically. 



No explanation has as yet been offered for these varying phenomena. 

 Attempts have been made to ascertain whether the hemotoxin is stimu- 

 lated by an external agent or by infection (lues, malaria, trypanosomiasis) 

 or whether it is of endogenous origin. The answer is still for the future to 

 disclose. 



The Antiferments. 



Ferments are very closely allied to toxins in their biological structure. 

 By the immunization of animals with ferments in as pure a form as possible, 

 antiferments can be demonstrated. Just like antitoxins, antiferments can 

 neutralize their respective ferments in vitro. As to their presence, it is 

 quite important to know that they are found in normal serum in certain 

 small quantities (together with antitoxins). The difference in their pres- 

 ence in a normal serum and that in an immune, is purely a quantitative 

 one. 



The antiferments thus far demonstrated are 



Antilabferment. Antipepsin. 



Antitrypsin. Antisteapsin. 



Antifibrinferment. 

 // is difficult to obtain by immunization an antiferment serum of very high 



