HEMOLYSIS IN DISEASE 201 



essential process, although the agents involved are at present 

 unknown. Absorption of hemolytic products of intestinal 

 putrefaction or infection has always come in for much suspicion, 

 without ever becoming completely 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 associated 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. 



In many forms of poisoning hemolysis is a prominent feature ; 

 in some it seems to be the chief effect of the poison, e. g., potas- 

 sium chlorate and arseniuretted hydrogen. In severe extensive 

 burns there may occur hemolysis, and hemoglobinuria may also 

 result. The remarkable "paroxysmal hemoglobinuria" is at 

 present without satisfactory explanation as to the cause of the 

 hemolysis except that during the paroxysm the blood is hemo- 

 lytic. The hemoglobinemia of " blackwater fever " has been 

 the cause of much discussion as to whether the malarial parasite 

 or the quinine is the cause, with a divided opinion resulting, 

 although, undoubtedly, cases do occur in malaria without adminis- 

 tration of quinine. After removal of the spleen hemolysis by 

 the hemolymph glands exceeds that of the primitive spleen, 

 causing an excessive destruction of red corpuscles (Warthin l ). 

 This suggests that the spleen may normally dispose of some 

 hemolytic agent which acts either by stimulating phagocytosis 

 or by so altering the red cells that they are particularly suscep- 

 tible to phagocytosis. 



Pathological Anatomy. The lesions produced in the 

 organs of animals injected with hemolytic agents are usually 

 pronounced and quite characteristic. There is often a sub- 

 cutaneous 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, friable, and very dark in color. 

 The liver is usually swollen and mottled with red areas in a 

 yellow background. The renal cortex is dark in color, even 

 1 Jour. Med. Kesearch, 1902 (7), 435. 



