105 



followed by excretion of a part of them through the kidneys. (Choluria, 

 bilirubinuria.) 



If the destruction of blood corpuscles proceeds or increases the 

 liver is unable to decompose the entire quantity of haemoglobin which 

 it receives, and so the surplus of this latter goes, as it is, into the bile 

 and is mixed with the faeces. Then a further increase of the haemolysis 

 emphasises itself by haemoglohinuria followed by renal symptoms." 



In cases of (haemolytic) icterus, simultaneously with the bile 

 pigments, salts of the bile acids— especially sodium glycocholicum and 

 tauro-cholicum are also in the blood. 



As the latter salt itself is able to destroy blood corpuscles, icterus as a 

 symptom is at the same time a pathogenic factor of haemolysis, under 

 the supposition that the concentration of these salts in the blood is high 

 enough, which is perhaps seldom the case. IN^ore important, however, 

 is the influence of taurocholic salts on the heart and on the kidnevs, 

 a protraction of frequency being one of the effects on the former. 

 After all, the icterus influences the liver itself, and haemolytic sera are 

 also able to affect liver cells.* As the "internal" function of 'this organ is 

 enormously important, specially for the nitrogen and hydrocarbonate 

 nietabolism and the destruction of poisons, interruption or disturbance 

 of the normal liver action influences the health of the entire organism. 



Haemoglobin which is not retained in the liver, bile pigments and 

 salts of bile acids circulating in the blood, have to be eliminated by the 

 kidneys and thus give rise to a complex or symptoms due to afEections 

 of the kidneys : (1) haemoglolunuria, (2) albuminuria, (3) choluria, 

 (4) haematuria. ^ 



(1) Albuminuria was found in slight cases of haemolysis as a 

 consequence of the increased blood destruction. The most striking 

 and common symptom of haemolysis (besides jaundice) is the appearance 

 of haemoglobin in the urine. Subsequently the latter l)ecomes stained 

 from a slight to a deep dark red colour. 



If the inflammation of the kidneys is acute, epithelial cells may be 

 found in the urine, and a more intense destruction of them in situ is 

 followed by the escape of blood cells into the tubuli (haematuria). In 

 such cases the quantity of urine is very small (anuria, uraemia), and 

 death is the general exitus. (Compare the following examples.) 



Clinical symptoms resulting from the affection of spleen and bone 

 marrow have not yet been recorded. 



The leading idea for the above classification of the sjanptoms of 

 haemolysis is the physiological course of life, function, and death of a 

 red blood corpuscle. It enables us to derive the following symptoms 

 of intensity and chronological succession of the clinical symptoms of 

 haemolysis, which are in accordance with the recorded facts : — 



1. Very slight destruction of erythrocytes. Very small decrease 

 of their number and volume is the only symptom. (Eventually 

 slight albuminuria). 



* Kretz, Lubarsoh-Ostertag, Ergebu. 8, tl, 495, 1902. 



