Paroxysmal Hemoglobinuria 



279 



to be negative in four congenital syphilitics without paroxysmal 

 hemoglobinuria, all of whom had strong Wasserman reactions. 



If the serum of the hemoglobinuric is exposed to an equal 

 volume of a 100 per cent, suspension of his own erythrocytes at 

 0° C, and the mixture is centrigugalized cold, the supernatant 

 serum is found to have lost the Landsteiner auto-hemolysin. 

 It has been completely absorbed at the low temperature. Wasser- 

 man reactions done on absorbed and unabsorbed serum show an 

 almost identical titre. It is, therefore, clear that the Landsteiner 

 auto-hemolysin and the Wasserman reacting substance are dis- 

 tinct serological entities. The former may be removed without 

 weakening the latter. This result harmonizes with the observa- 

 tion that of our three cases, the one having the highest titre of 

 Landsteiner auto-hemolysin had the weakest Wasserman re- 

 action. 



Since the serum of the hemoglobinuric, in addition to the 

 auto-hemolysin, contains a similar hemolysin for the erythro- 

 cytes of other individuals even of the same blood group, an 

 attempt was made by absorption experiments to separate the 

 auto-hemolysin from the iso-hemolysin. It was found that the 

 red blood cells of other individuals, as well as the patient's own 

 erythrocytes, absorbed out both the auto- and the iso-hemo- 

 lysin. Presumably, therefore, they are inseparable and possibly 

 identical. 



It appears, therefore, that in this disease we are dealing 

 with a thermolabile hemolysin which unites with its antigen only 

 at a low temperature, that the union is more effective with chill- 

 ing for only 5 to 10 minutes than with longer exposure to the 

 low temperature ; that complement is necessary for consummation 

 of the reaction, that there is an intimate relation between this 

 disease and syphilis, but that the substance upon which the 

 diagnostic test tube reactions depend are not identical. 



