566 SAMUEL H. HUKWITZ 



bility that it exists and that hemolysis is active in some diseased con- 

 ditions of the organ. But the evidence thus far obtained does not 

 support such a contention. Thus Antonelli, Kahn, and Robertson (a) have 

 not been able to demonstrate that the extracts obtained by them from 

 the spleens of patients with hemolytic anemias possessed any hemolytic 

 activity in vitro. 



Again it has been held by some investigators that in the anemias 

 characterized by hemolysis, there is at large in the blood a powerful 

 hemolytic agent which is soluble in alcohol and ether, and which has 

 been shown to diminish in amount following removal of the spleen. As a re- 

 sult of the work of Joannovics and Pick, of Eppinger(&) (c), and of King, 

 attention has been more especially directed to the unsaturated fatty acids. 

 Both Eppinger and King studied the fat content of the blood of normal 

 and splenectomized animals and of a number of patients suffering from 

 diseases characterized by hemolysis. According to their results, the blood 

 of the dog after splenectomy shows an increase of the total fats and a 

 decrease of the unsaturated fatty acids (lowering of the iodin figure). 

 These results naturally raise the question of the possible influence of 

 the unsaturated fatty acids in affecting the conditions of hemolysis after 

 splenectomy and give significance to the observation of Eppinger that in a 

 variety of clinical conditions characterized by excessive hemolysis, there 

 occurs an increase in the unsaturated fatty acids of the blood, which 

 after splenectomy sinks to normal. Such findings, if substantiated, might 

 explain the increased resistance of the red blood-cells and the lessened 

 tendency to hemolysis which often attends splenectomy in the hemolytic 

 anemias. Dubin and Pearce, however, conclude from their careful experi- 

 ments that splenectomy has no influence on the blood fat, but they feel, 

 nevertheless, that this hypothesis is sufficiently attractive to justify, in 

 view of the contradictions between their work and that of Eppinger and of 

 King, a delayed opinion in the hope that further experiments may throw 

 more light on this complex problem. 



Some confusion concerning the regulatory function of the spleen 

 has arisen because of the divergent results following the removal of the 

 normal and abnormal spleen. Thus, both the blood crisis and the rise in 

 the red blood-cell count which so frequently follows splenectomy for 

 splenic disease, has been shown to be practically absent after removal of 

 the normal spleen. Such a discrepancy may be due to a difference in 

 the conditions which prevail. In one instance an abnormal spleen is 

 removed under abnormal conditions of the blood, whereas in the other a 

 normal spleen under normal conditions. 



Many reasons for this paradox have been given. One probable and 

 very attractive explanation is that in disease the improvement is due to 

 the removal of an agent which both causes hemolysis and depresses bone- 

 marrow function, whereas the anemia following normal splenectomy is 



