PAROXYSMAL HEMOGLOBINURIA 227 



lating phagocytosis or by so altering the red cells that they are 

 particularly susceptible to phagocytosis. This idea is not substanti- 

 ated by the work of Pearce,^^ who found the anemia of splenectomy 

 accompanied by an increased resistance of the corpuscles to hemolysis, 

 and no hemolytic agent was present in the blood. There also occurs 

 the group of anemias associated with great enlargement of the spleen, 

 and in which removal of the spleen may result in a return to nofmal 

 blood conditions; a fact suggesting, among other possibilities, that 

 there may be poisons which stimulate directly the hemolytic action 

 of the spleen independent of the natural stimulation of splenic hemoly- 

 sis which comes from the presence in the splenic blood of injured red 

 corpuscles. ^- 



Resistance to hemolysis varies greatly in disease conditions'^ and often specific- 

 ally, — i.e., resistance may be increased to one agent, decreased for another, and 

 normal with a third. Attempts have been made to use this resistance as a diag- 

 nostic or prognostic index, but not with great success in most cases. Apparently 

 changes in the plasma lead to alterations in the permeability of the corpuscles, 

 which determines their behavior with hemolytic agents; also changes in the pro- 

 portion of lipoids and hemoglobin may modify hemolysis. As an example of 

 this condition may be cited observations on hemolysis by cobra venom, the cor- 

 puscles having been found less resistant in dementia precox, more resistant in 

 carcinoma and syphilis. Butler" states that fragility of the corpuscles is abnor- 

 mally high in exophthalmic goiter, cancer, syphilis, tabes, anemia and malaria. 

 In obstructive jaundice the corpuscles show an increased resistance to hemolysis 

 by hypotonic salt solution, but in congenital hemolytic jaundice the resistance is 

 decreased.'^ Using saponin hemolysis, Bigland'^ found the resistance greatly 

 decreased in icterus, although the serum had an increased protective action because 

 of antagonism between the saponin and the bile salts; in all anemias resistance 

 was found increased, except pernicious anemia, which showed normal or slightly 

 subnormal resistance; high temperature decreases resistance. As will be seen from 

 the few examples cited, the resistance to different hemolj'tic agents may vary with 

 the same corpuscles.'^ 



Paroxysmal Hemoglobiniiria.^^ — This condition seems to depend 

 upon the presence in the serum of a hemolytic amboceptor (an auto- 

 hemolysin) , which will combine with the corpuscles of the same indi- 

 vidual and sensitize them for his own complement (Donath and 

 Landsteiner, Eason) . This au^ ohemolysin can react with the corpuscles 

 only at low temperature, such as may be furnished in the peripheral 

 vessels by exposure to cold, and the complement unites when the tem- 

 perature of these corpuscles again reaches 37° in other parts of the 



'^ Pearce ct al, Jour. Exp. Med., 1912, ^'ol. 16. See also Roccavilla, Arch. 

 Med. Exp., 1915 (26). 508. 



" See Banti. Semain Med., 1913 (33), 313. 



'3 Keview bv Paltauf, Krehl and Marchand's Handb. allg. Pathol., 1912 (II 

 (1),) 83. 



'* Quarterly Jour. Med., 1913 (6), 145. 



" See Richards and Johnson, Jour. Amer. Med. Assoc, 1913 (51), 1586 Giffin 

 and Sanford. Jour. Lab. Clin. Med., 1919 (4), 465. 



'6 Quart. Jour. Med., 1914 (7), 370. 



" Bibliography by Krasny, Folia Hematol., 1913 (16), 353. 



'' Landsteiner, Handbuch d. Biochem., Vol. 2 (1), p. 492; Meyer and Emmerich, 

 Deut. Arch. klin. Med., 1909 (96), 287. 



