Chicago School of Medicine and Surgery - Medicos Yearbook (Chicago, IL)

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l i , i E 1 3 l l . 1 . . 1 i i -r-as-an-.-,.,-Y., I ,aa LITERATURE confirmation of this latter observation in our work in the original statement of Nlaragliano, that the serums of pathologic cases are hemolytic for the corpuscles of diseased individuals as well as for the corpuscles of normals. In regard to the nature of the isolytic substance. Ascoli was able to show that its activity was destroyed by heat, but that it could be reactivated by the addition of a fresh serum. This would seem to indicate that it was an amboceptor that depended on the presence of complement for exerting its hemolytic influence on blood corpuscles, and that it was not due to the action of any toxin produced by an infectious agent. . A On the other hand, holding in mind the experiments of von Dungern, Ehrlich and Morgenroth, Ascoli, etc., it would seem that this hemolytic property of pathologic serums was associated in some way with cell destruction, and that, as Ascoli suggests, a reaction of the organism against the absorbed products of cell destruction results in the formation of antibodies which are hemolytic. YVe examined several weeks ago, among others, a student's blood which was taken as normal. At that time his serum, which agglutinated the corpuscles of Groups 2 and 3, did not show any hemolytic action on human corpuscles. VVe examined his blood a few days ago and found that his serum hemolyzed corpuscles which it agglutinated to about the same extent as had a cancer serum in the same series of examinations. On inquiring into the history of the student during the interim of examinations, we found that he had lost about seventeen pounds in weight. I-Ie denied any infection and said that he felt well, but tired. I-Ie attributed his loss of weight to increase of work and loss of sleep in preparing for state examinations. The circumstances in this instance, in which a normal-acting serum was converted into a pathologic- acting serum, would seem to support the theory that the isohemolytic property of serum is dependent on absorption products orvantibodies of absorption products of abnormal cell degeneration. In reviewing the literature of this subject and in analyzing our own work, which we find to conform to the earliest observations on this subject, we can see no reason for bringing this isohemolytic action of serums into specific relation with any one disease or condition. On the other hand, we can confirm Maragliano's original observation, that the serums of many pathologic cases may exert an hemolytic infiuence on the blood corpuscles of normal and diseased individuals. Tho faided haunts beguile my soul In high esteem I hold that goal W hich leads me on from day to day To prove myself, that those may say To whom was given Just iaith s reward In truth thy words and deeds accord E I-I K Page 195 rn' EL'21'L's2 - M- -1'-Nw ' - -f-vff ' W Q x:---Q --- .wwf-:aa-1-A----W 4... ...J ,.....-A ---K --,f-J,Q.4-,.f.u..s.-w.w9:.u..zru-- tweak- 11 ug-1 my-:..a..:,rz-.ux1,m..-..4..r..' '- f....x.4 nuaaummauz. u.-v.z4..muvmm.1 -manga 3 5 i 1 B l F I f I i I P l 5 rl l ,. l l l 9 l 1 l. l l' 5 ' ll I Q l Ii I I i I l i il 1 if 1 1 i ' ' 1 l , l - -' ij a. i v . gl - j ., 1' i , ' f 1 Y i , 5 . ?l 1 ' ' I , li , if i 2 I I 1 I - 9 4 ,l , . I . I L: 1 ' , . 2 g V 5 . . ,- . , 5 . ' y ': -4 yi ll i ' 1 u ' 2 My . . . , ' l:- W 5 f Q, li , 'i , if '7 - I- i v l f f : ll H l 5 l. f , fl 5 l ,f i 1 ' . Z L I, l , K ' J n I 5 I l 5 E 2 l 1 E fl s 3 e f 1 P I T f 1 i 1 l , fi ' i 5 ' El 1 s 1 . fl , , 5 : I f ' , 52 3 . . rf 1 ' 2 4 1 I it l , V

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I f l l l i ll , l I l l I E 1 b 1 lr 'l l v Il .I H Ir I. 1 s , r I I I . ll li li r 1 I x. , v l I. l I 'I ll' ll. up-A . Mmm ,-,Ju MWA.. ,um-JM-U glut, .,-- LH, nav: VA-WW lrlt if JL. V J, , y :M Li. g V: , , -, ., M: A M, ..., .,,, .gm ,, Q, New .'., .,. fc.. ,t4.,.-.:.,...... .,-.... .... V-, .I-..,t......,. .4 .. . . .1 A. .. ... l LITERATURE Blumgarten, as had been recommended by Landsteiner, used the washed corpuscles without salt solution, ' as Nlaragliano had stated in his communication that among other. factors the decrease of sodium chlorid in the serum of diseased patients had something to do with their dissolving red blood corpuscles. In order to determine whether or not the hemolytic reaction had any specific value in the diagnosis of disease, we examined the bloods of a number of individuals .Some of these were healthy adults, others were suffering from cancer typhoid, pneumonia, gastric ulcer, etc. We found on completion of our work that our observations coincided in many points with those of Ascoli. We had not made any effort to estimate quantitively the agglutinin content of serums: we did, however, observe a definite relation to exist between isolysins and isoagglutinins to which Land- steinerw had referred conjecturally in his first communication on isoagglutinins. Among the seventy cases examined, we tried nine normal persons against each other for isoagglutinins and isohemolyslns. A Landsteineru divides individuals into three main groups by means of isoagglutination, namely: CID those whose corpuscles are not agglutinated by the serums of Groups 2 and 3, but whose serums agglutinate the corpuscles of these groups, Czj those whose corpuscles are agglutinated by the serums of Group 3 and whose serums agglutinate the corpuscles of Group 3, Q35 those whose corpuscles are agglutinated by the serums of Group 3 and whose serums agglutinate the corpuscles of Group 2. According to this classification for agglutination, 4. of the normal persons belonged to Group I, 4 to Group 2, and I to Group 3. In 4 the supernatant fluid showed a faint pinlcish tinge, one tube showing a considerable trace of solution. In these tubes agglutination of corpuscles had occurred. We did not notice isoagglutination of the strictly homologous corpuscles. In none of the tubes in which isoag- glutination had not occurred was any trace of hemolysis present. Among the pathologic cases examined by us were 22 of cancer, mostly of the stomach, uterus and breast. In I3 of these, or SQ per cent, we found isohemolytic serums, some hemolyzi.ng the corpuscles of cancer patients. Of 8 cases of tuberculosis, 3 showed the hemolytic reaction, I hemolyzing the corpuscles of another tuberculous patient. We did not observe the reverse hemolysis in tuberculosis referred to by Crile. I Of 5 typhoid patients, 2 gave a strong hemolytic reaction, I of these hemolyzing the corpuscles of another typhoid patient as well as of a normal person. Qf .5 pneumonia patients, of whom I was convalescent, the serums of 2 showed a strong isolytic action. Ascoli found in I case of pneumonia a decrease in the hemolytic action of the serum from week to week untilit disappeared In 2 cases of ga-stric ulcer, I of convalescent malaria, I of perniciouis anemia, I of postdiphtheric I paralysis, I of salpingitis and I of pregnancy, the serums were found to be isohemolytic. Two cases of pleurisy with effusion gave a negative result. The degree of isolysis observed in the hlaragliano reactionin diseased conditions is quite variable, some red cells showing apparently a greater degree of resistance than others, and some a complete resistance to the action of isolysins. According to Landsteiner, Ascoli, Hektoen,uAetc.,the isoagglu- tinins are considerably increased in some diseased conditions over that found in normal individuals. Landsteiner, who first thought a relation existed between isoagglutination and isohemolysis, stated in a subsequent communication that an essential difference existed between the phenomena of isoag- glutination and of isohemolysis, in that in the Maragliano reaction the serum acts on the corpuscles of the same individual. In the pathologic serums examined by us we observed the hemolytic action of the serum on the corpuscles of the same individual in two cases of cancer and one of convalescent malaria. On the other hand, we observed a close relation to exist between isohemolysis and isoagglutination in the examination of bloods of pathologic cases. This association was so frequently observed that we could apprehend with considerable certainty before examining the corpuscles that they had been agglu- tinated from the pinkish color of the supernatant fluid. While this observation is not constant, it is sufficiently frequent to influence greatly the results obtained with the hemolytic reaction. ' It would appear from our observations that the frequency of what is commonly termed a positive isohemolytic reaction will depend usually on two factors: CID to what group with regard to isoagglutinins the suspected blood belongs, and Czj whether there are bloods among those against which it is tested whose corpuscles will be agglutinated by the serum of the suspected blood, and it is immaterial appar- ently whether the corpuscles are from another case of cancer, tuberculosis, etc., or a normal. We find 7 Crile, George: Hemolytic Tests for Malignancy Cabstrj THE JOURNAL A. M. A., June 27, 1908, 1, 2150. Alsog Jour. Am. Surg. Assn., 1908, xxvi, 619. 8 Blumgarten: Bled. Record, 1909, lxxv, 61 9 Whittemore: Boston med. and Surg. Jour. 1909, elx, 77. 10 Landsteiner: Wien. klin. Wehnschr., 1901, xiv, x1132. 11 Hektoen: Jour. Infec. Dis., 1907, iv, 297. 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