PAROXYSMAL HEMOGLOBINURIA. 



93 



According to Calmette one can approximate the efficiency of an immune 

 serum by its antihemolytic power inasmuch as the hemotoxic and neurotoxic 

 actions run parallel. This is denied by Noguchi. 



The scorpion and bee poisons display properties similar to those of the 

 cobra poison. They also combine with lecithin to produce hemolysis. 



Thus far, it has been shown that the lipoids, especially lecithin are 

 actively associated in the hemolysis of erythrocytes; whether the toxin com- 

 bines with the lipoids and forms a toxolipoid (toxolecithid) which is hemo- 

 toxic, or whether as v. Dengen believes, the hemolytic action is due to the 

 fatty acid derived from the lecithin by the ferment action of substances 

 contained in the poison, has not been definitely proven. 



Quite recently it has been thought that pernicious anemia and parox- 

 ysmal hemoglobinuria are closely associated with such toxolipoids. 



Tallquist obtained from a Bothriocephalus latus, a hemotoxic 

 Pernicious poison of a lipoid nature which experimentally produced a 



Anemia. blood picture characteristic of pernicious anemia. But it 

 would be incorrect to associate all forms of pernicious anemia 

 with tape worm poison; more probable is it that hemotoxins are formed 

 within the organism itself. 



In paroxysmal hemoglobinuria a hemotoxin of very peculiar 

 Paroxysmal properties is found circulating in the blood. 

 Hemoglobi- It can be demonstrated as follows. 



miria. Im EhrlicWs method. One of the patient's fingers is ligatured 

 by means of a small tourniquet and kept immersed in ice-cold 

 water for a half hour. Some blood is then collected into a capillary pipette 

 from the finger thus tied, and as a control, blood from a finger of the other 

 hand is drawn off. This is allowed to clot and then centrifugalized. The 

 results are that the serum from the finger held in the ice water is tinged red 

 from dissolved hemoglobin while the control serum is normally pale. 



2. Donath-Landsteiner's method repeats Ehrlich's experiment in vitro. 

 The patient's and the control individual's serum are each mixed 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 or not having 

 enough of the second element in the serum, demonstrate no hemolysis. 



