THE ICTERUS INDEX (A QUANTITATIVE ESTIMATION OF BILIRUBINEMIA)

Abstract

In 1847, Virchow observed in old, shed blood the presence of a substance, crystalline in form, much like bilirubin, which, like bilirubin, gave the Gmelin reaction. He called this substance hematoidin. Subsequent investigations (Jaffe, Hoppe-Seyler, Salkowsky, Eppinger) have shown the relationship between the pigments of the blood and the bile. Tarchanoff, in 1874, was the first to show, in dogs with bile fistulas, a rapid and marked increase in bile pigments in the bile after the intravenous injection of hemoglobin. Stadelmann,¹and Brugsch and Yoshimoto,²repeated these experiments with similar results. Since these observations were made, it has been the generally accepted opinion that hemoglobin is the mother substance of the biliary pigments. In 1917, Whipple and Hooper,³repeating these experiments, found that in bile fistula dogs the bile pigment output was generally, but not always, increased after intravenous injection of hemoglobin, but observed a far greater