228 CHEMISTRY OF THE IMMVXITY REACTIOXS 



body. In susceptible persons attacks of hemoglobinuria may be 

 brought on merely by holding the hands in cold water, and their blood 

 serum will sensitize to hemolysis human corpuscles (even of normal 

 individuals),^^ m vitro at low temperatures.""* Certain infections, es- 

 pecially syphilis, ^^ predispose to paroxysmal hemoglobinuria. Not 

 only the hemolytic amboceptors, but also an auto-opsonin is present 

 (Eason) and the resistance of the red corpuscles is decreased to various 

 harmful agencies, including COo and other weak acids.*- The cor- 

 puscles of three cases studied by Moss'*^ showed an increased resistance 

 to hypotonic NaCl solutions. Just before the rigor, hemolysins may 

 be found in the blood, disappearing after the hemoglobinuria (Rob- 

 erts).** In a case studied by Dennie and Robertson,*^ hematuria 

 resulted from destruction of only 6.3 c.c. of the patient's blood, and 

 90 per cent, of the liberated hemoglobin was excreted within two hours. 

 There also occur conditions in which aiito-aggluti7iati on occurs without 

 hemolysis when the blood is cooled.*'' 



Pathological Anatomy in Hemolysis. — The lesions produced in the organs of 

 animals poisoned with hemolytic agents are usually pronounced and quite char- 

 acteristic. There is often a subcutaneous edema, which is usually- blood-stained, 

 and similar fluid may be present in the serous cavities. The fat is yellowish, and 

 the muscles are darker in color than is normal. The spleen is usually much 

 swollen, soft, friable, and very dark in color. The liver is usually swollen and 

 mottled with red areas in a yellow background. The renal cortex is dark in 

 color, even chocolate-colored, and the pyramids are comparatively light; hemo- 

 globin is frequentlj'^ present in the urine. In the lungs are often found hemor- 

 rhages or areas resembling small infarcts. The blood may be thin and even 

 distinctly transparent. Microscopically the red corpuscles are found in all condi- 

 tions of degeneration, and often fused together. In the liver, besides patches of 

 congestion, fatty changes are present if the animal lives long enough. Large 

 phagocytic cells packed with red corpuscles are abundant in the spleen and lymph- 

 glands, as well as diffuse accumulations of the blood-cells, which are often fused; 

 and much pigment is also present, both free and in the cells. Pigment also accum- 

 ulates in the renal epithelium, which often shows much disintegration; congestion 

 is prominent, and hemorrhages into both interstitial tissue and glomerules are 

 frequent. Some of the lesions are due to the hemolysis, and some to the associated 

 agglutination of corpuscles, which form hyaline thrombi. Pearce"" lias found that 

 agglutinative serum when injected into dogs causes widespread necrosis in the 

 liver, which is followed by proliferation of connective tissue and the production 

 of changes re.seml)ling cirrhosis. There is a marked decrease in the glycogen 

 content of the liver, and of its lipolytic activity' (Andrea).'" 



39 See Lorant, Deut. Arch. klin. Med., 1918 (126), 148. 



*" Widal looks upon paro.\ysmal hemoglobinuria as an autoanajjliviaxis (Semain 

 M6d., 1913 (33), 013). 



*' Matsuo, Arch. f. klin. Med., 1912 (107) 335. 



« lierghausen, Arch. Int. Med., 1912 (9), 137. 



" Folia Serologica, 1911 (7), 1117. 



** Brit. Med. Jour., 1915 (2), 398. 



*' Arch. Int. Med., 1915 (lb), 205. 



'"' See Rous and Robertson, Jour. Exp. Med., 191N (27^, .")()3; C'lough and 

 Richter, Hull. Johns Hop. Hosp., 191S (29), 80. 



"".Jour. Kx]). Med., 1900 (8), 04; Jour. Med. IJesearcli. 1900 (14). 541. 



*' Arch, internal. i)harmacodyn., 1905 (14), 177. 



