II i:\lOLYSlH J\ DISEA.Sl-J 231 



puscles is abnorinally liigh in exophthalmic f^oiter, 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 de- 

 creased 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 ex- 

 amples cited, the resistance to different hemolytic agents may vary 

 with the same corpuscles.**'' 



The hemolysis of the acute febrile diseases is readily explained by the 

 demonstrable hemolytic property of the products of the organisms 

 that cause them, such as streptocolysin, staphylolysin, etc. Perhaps 

 at the same time products of altered metabolism may also play a 

 part, but it does not seem probable from experimental results that 

 the thermic condition per se has much effect. In malaria, although 

 the parasites enter and destroy the corpuscles in which they live, yet 

 this alone does not account for all the blood destruction of the dis- 

 ease, for the amount of anemia is quite without relation to the num- 

 ber of parasites to be found. There is good reason to believe that the 

 Plasmodia produce hemolytic substances that are discharged into the 

 serum. In the primaiy anemias hemolysis seems to be the essential 

 process, although the agents involved are at present unknown. Ab- 

 sorption of hemolytic products of intestinal putrefaction or infection 

 has always come in for much suspicion, without ever becoming com- 

 pletely established. Here also the hemolysis seems to take place in 

 the endothelial cells rather than in the vessels. In such a disease as 

 pernicious anemia there is much reason to assume that defective or 

 abnormal hematogenesis is an important factor. Probably the 

 anemia of nephritis is the result of hemolytic action of the retained 

 products of metabolism, in which connection the hemolytic properties 

 of ammonium compounds may be recalled. In some diseases asso- 

 ciated with anemia it has been found that the blood-serum of the 

 patient is distinctly isohemolytic, although isoagglutination seems to 

 be more frequent. The fluids that can be obtained from cancers have 

 been found to be hemolytic, while antihemolysin has been found in 

 ascitic and pleural effusions. Autolytic disintegration of liver, and 

 presumabl}' other tissues, may also cause the presence of hemolytic 

 substances in the blood. ®^ Arseniuretted hydrogen may produce 



84a See Richards and Johnson, Jour. Amor. Med. Assoc, 1913 (01). 15S0. 



84b Quart. .Tour. Med.. 1914 (7), .370. 



84c Bihliofrrapliy by Krasny. Folia Ilcmatol., 1913 (16). 353. 



85 Maidorn, Bioehem. Zeit., 1912 (4.5), 328. Hemolytic lipoids are believt-d by 

 some to )ie liberated from injured tissues (see Kirsche. Bioehem. Zeit., 1913 (ol). 

 169), but McPhedran (Jour. Exp. Med., 1913 (18), 527) could find no evidence 



