HEMOLYSIS I\ IHSEASE 233 



hemolysin), which Avill eunibine with tlic corpuscles of the same indi- 

 vi(hial and sensitize them for his own complement (Donath and Land- 

 steiner, Eason). This antohemolysin can react w^th the corpuscles 

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

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

 temperature of these corpuscles again reaches 37° in other parts- 

 of the body. In susceptible persons attacks of hemoglobinuria may be 

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

 senim will sensitize to hemolysis human corpuscles (even of normal 

 individuals) in 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 CO, and otiier weak acicls.^- The cor- 

 puscles of three cases studied by jMoss '^^ 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. 

 Pathological Anatomy. — The lesions produced in the organs of 

 animals injected with hemolytic agents are usually pronounced and 

 quite characteristic. 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, fria- 

 ble, and very dark in color. The liver is usually sw^ollen 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; hemoglobin is freqiiently present in the urine. In the lungs 

 are often found hemorrhages or areas resembling small infarcts. The 

 blood may be thin and even distinctly transparent. Microscopically 

 the red corpuscles are found in all conditions 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 cori3uscles 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 accumulates in the renal epithelium, 

 which often shows much disintegration ; congestion is prominent, 



90a Widal looks upon paroxysmal hemoglobinuria as an autoanaplivlaxis- 

 {Semain Med., 1913 (.3.3), 613). 



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



92 Berghausen, Arch. Int. Med., 1912 (9), 137. 



93 Folia Serologica, 1911 (7). 1117. 

 93a Brit. Med. Jour., 1915 (2), 398. 

 93b Arch. Int. Med., 1915 (16), 205. 



