230 CHEMISTRY OF THE IMMUMTY h'EACTIOXS 



(See ' ' Pigineutation, " Chap, xvi.) Wlioiievor during disease red cor- 

 puscles are more rapidly injured than they are under normal condi- 

 tions, these processes of normal hemolysis are exaggerated and we not 

 only find the phagoc.vtic cells of tlie spleen and glands packed with 

 corpuscles, but endothelial cells elsewhere, and also leucocytes, take 

 on the hemolytic function. At the same time there results an exces- 

 sive production of bile-pigment from the destroyed red corpuscles, 

 which has an etiological relation to the so-called " hemato-hepatogen- 

 ous" jaundice. If hemolysis is very excessive, the blood pigment ac- 

 cumulates in other organs than the liver and spleen. According to 

 Pearce *^ and his associates, when the blood contains at one time more 

 than 0.06 gm. of free hemoglobin per kilo of body weight, it begins to 

 be excreted by the kidneys ; smaller amounts are cared for chiefly 

 by the liver, and even when much larger amounts of hemoglobin are 

 present in the blood the liver takes care of most of it, only a rela- 

 tively small proportion, 17 to 36%, being excreted in the urine. 

 Hence it is possible to have hemolytic jaundice without hemoglobin- 

 uria. Part of the pigment is converted into urobilin, and the amount 

 of this pigment in the stool is an index of the amount of hemolysis.^^* 

 In persons with hemolytic hemoglobinemia, intravenous injection of 

 hemoglobin will produce hemoglobinuria with snuiller dosage than in 

 normal persons, who require at least 17 c.c. of laked corpuscles to pro- 

 duce hemoglobinuria.^^'' 



It is possible that the globin, which is quite toxic when f ree,^- may 

 play a part in the symptomatology of hemolytic poisons. The stroma 

 of the erythrocytes also seems to be toxic. ^-^ 



The resistance of erythrocytes to hemolytic agents varies greatly 

 in disease conditions ^^ and often specifically, — 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 diagnostic 

 or prognostic index, but not with great success in most cases. A])- 

 parently changes in the plasma lead to alterations in the permea- 

 bility of the corpuscles, which determines their behavior with hemo- 

 lytic agents ; also changes in the proportion of lipoids and hemo- 

 globin may modify hemolysis. As an example of this condition may 

 be cited observations on hemolysis by cobra venom, the corpuscles hav- 

 ing been found less resistant in dementia precox, more resistant in 

 carcinoma and sy])hilis. Hutler®* states that fragility of the cor- 



acute li(»ni()l\iic niicTiiia in raliliils llio oxooss iron stored in tlic oryans has liccii 

 nearly all alisorbod by tlie time re<i'oneratioii of tlio blood is coniplcU'. 



81 .lour. Kxp. !\Iod.,"ini2 (10), several articles. 



siaSco llobeitsoii. Areh. Int. IMed., 101.') (If.), 1072. 



«ib Sellards and Minot, Jour. Mod. Res., 1010 (.34). 400. 



f<2 Reliittoiditdm and Woiohardt. ISliincli. mod. Wooli., 1012 (.")0). lOSO. 



82aBarratt and Yorko, Brit. Mod. .Tour., Jan. .31. 1014. 



83 Review by Paltanf. Krolil and :\lareliaiurs Handb. all-r. rath(d.. l'.)12 (11 

 ( 1 ) 1 , 8.3. 



S'J Quarterly Jour. Mod., 1013 (0), 14."). 



