232 CHEMISTRY OF THE liJilUMTY h'EACTIOXS 



hemolysis in some such way, since it causes no hemolysis in the test 

 tube (Ileffter). The very great hemolytic action of soaps and free 

 fatty acids, which varies directly with the number of unsaturated 

 carbon atoms they contain (Moore **"), makes it possible that these sub- 

 stances play a part in the hemolysis of disease, especially since the 

 fatt}' acids of the liver are characterized by their high content of free 

 fatty acids. Bile is strongly hemolytic, and in icterus this is an im- 

 portant consideration. 



In many forms of poisoning hemolysis is a prominent feature ; in 

 some it seems to be the chief effect of the poison, e. g., potassium 

 chlorate and arseniuretted hydrogen. In severe extensive burns there 

 may occur hemolysis, and hemoglobinuria may also result. The hemo- 

 globinuria of "blackwater fever" has been the cause of much discus- 

 sion as to whether the malarial parasite or the quinine is the cause, 

 with a divided opinion resulting, although, undoubtedl}', cases do occur 

 in malaria without administration of quinine. The studies of Brem *■ 

 indicate that the hemolysis is produced by a hemolysin coming from 

 the Plasmodium, and that the quinine influences the condition by pre- 

 venting the action of an antihemolytic substance present in the blood. 



After removal of the spleen, hemolysis by the hemolymph glands ex- 

 ceeds that of the primitive spleen, causing an excessive destruction of 

 red corpuscles (Warthin ***). This suggests that the spleen may nor- 

 mally dispose of some hemolytic agent which acts either by stimu- 

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

 ticularly susceptible to phagocytosis. This idea is not substantiated 

 by the work of Pearce,^** who found the anemia of splenectomy ac- 

 companied 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 ma}' result in a return to normal 

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

 there may be poisons which stimulate directly the hemolj'tic action of 

 the spleen independent of the natural stimulation of splenic hemolysis, 

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

 corpuscles.*'"^ 



Paroxysmal Hemoglobinuria.'"' — This condition seems to depend 

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



that any particularly licmolytic fatty afid, more active (lian oleic acid, can be 

 isolated from either normal or diseased tissues. 



s« Brit. Med. Jour., 1909 (ii), 0S4; see also Lamar. Jour. Kxper. Med., 1911 

 (13), 380. 



STArcli. Int. Med., 1912 (9), 129. 



88 Jour. Med. Researcii, 1902 (7), 4.'{.'). 



89 Pearce ct at., Jour. Kxp. Med., 1912, \'ol. IG. Sec also Roccavilla, Arch. Mtnl. 

 Exp., 191.5 (26), 508. 



*<»aSee Ranti, Semain Med., 1913 (33), 3i:?. 



'•'O T.andsteiner, IIandl)Uch d. Riochem., \'ol. 2 ( 1 ) . ]). 492; Me\(M- and iMniiiericli. 

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



