362 DOES A H^EMATOGENIC JAUNDICE EXIST ? [BOOK II. 



verted into bile pigments 1 . French's observation was, however, cor- 

 rect that in certain cases of jaundice in which no obstruction can, 

 prima facie, be detected, the bile secretion is at first increased. The 

 polycholia, which he described as resulting from certain icterogenic 

 agents, is a precursory, or concomitant, phenomenon, but not the 

 efficient cause, of the jaundice. 



'Does a Hcematogenic, as distinguished from a Hepatogenic, 

 Jaundice exist?' 



Icterogenic Poisonous Agents. 



Theobserva- We have stated that Frerichs, from the experi- 

 tionsofKtthne. ments which he had made with Stadeler, was led to 

 conclude that the bile acids could be converted into bile colouring 

 matters by the action of chemical agents, and that a similar con- 

 version occurred in the economy ; the latter conclusion was drawn 

 from the fact that when decolourized bile was injected into the 

 circulation, the urine, subsequently excreted, contained bilirubin. 

 In a remarkably interesting paper, published in 1858, Klihne 2 , whilst 

 confirming the accuracy of the last experiment, pointed out that 

 the salts of the bile acids act in the same way as decolourized bile, 

 and, further, that they possess the power of dissolving the coloured 

 blood corpuscles. He was led to conclude that the bilirubin ex- 

 creted in the urine was derived not from bile acids, as Frerichs 

 had supposed, but from the haemoglobin thus set free in the blood, 

 an explanation which appeared plausible enough when we consider 

 that the researches of Virchow and others (see p. 316) had already 

 established that bilirubin (haematoidin) can be, and actually is 

 formed from the blood colouring matter when this is locally 

 extravasated. In pursuance of his researches, Kiihne injected a 

 solution of the blood colouring matter into the circulation of dogs, 

 but found that the urine excreted contained haemoglobin or its 

 derivatives, but no bile colouring matter. If, however, a very small 

 quantity of the salt of a bile acid were injected together with the 

 solution of oxy-haemoglobin, bilirubin was excreted in the urine. 



The observations of Kiihne seemed to afford a new explanation for 

 one group of cases of jaundice which had been, until then, explained 

 by the old theory of non-elimination or by the more recent hypothesis 

 of Frerichs. The cases to which we refer are particularly those in 

 which jaundice, or at least the elimination of bilirubin, occurs as a 

 consequence of the action of medicinal or poisonous agents, as when 

 chloroform or ether are introduced into the blood, or when an animal 

 is poisoned with phosphorus or arseniuretted hydrogen. In some 



1 Frerichs u. Stadeler, ' Ueber die Umwandlung der Gallensauren in Farbestoff,' 

 Mailer's Archiv, 1856, pp. 5661. 



2 Kiihne, 'Beitrage zur Lehre von Icterus, eine physiologisch-chemische Unter- 

 suchung.' Virchow's Archiv, Vol. xiv. (1858), pp. 310356. 



