366 NON-EXISTENCE OF A * UROBILIN JAUNDICE.' [BOOK II. 



pyaemic jaundice in which no obstacle to the flow of bile into the 

 intestine existed, and in which the liver was not more deeply bile 

 stained than the other organs. 



Does a ' Urobilin Jaundice ' exist ? 



It has long been known 1 that cases of jaundice occasionally occur 

 in which the urine, though of dark colour, does not exhibit Gmelin's 

 reaction. Some of these cases are to be explained by the fact that 

 when stained with bile colouring matter, the skin retains its jaundiced 

 tint for some time ; in transitory cases of jaundice it does so for a 

 considerable time after the liquor sanguinis and urine have become 

 free from bilirubin. There are, however, some cases of slight and per- 

 sistent jaundice in which the urine does not exhibit Gmelin's reac- 

 tion, but contains abnormal quantities of urobilinoid bodies 2 . These 

 have been called cases of ' Urobilin icterus ' (Ictere hemapheique of 

 Gubler and Dreyfuss-Brissac). Quincke 3 , who has investigated this 

 subject carefully, concludes that the jaundiced colour of the skin 

 never depends upon urobilin (a self-evident proposition, seeing that 

 urobilin possesses no such tinctorial power as would enable it to stain 

 the tissues), but that the urobilin found in the urine in these cases is 

 due to a transformation in the urine of normal bile colouring matter. 

 On examining the blood serum he always found it to contain bilirubin. 

 According to Frerichs, jaundiced urine occasionally does not exhibit 

 Gmelin's reaction when first passed, but does so after exposure to 

 air (?). Hence he surmised the existence of certain chromogens, con- 

 vertible by oxidation into normal bile colouring matters. 



SECT. 2. THE MODIFICATIONS IN CHEMICAL COMPOSITION WHICH 

 THE BlLE EXHIBITS IN DISEASE. 



Our knowledge of the changes which the bile undergoes in disease 

 is remarkably scanty ; this necessarily follows from the fact that we 

 have, in the human subject, no means of obtaining the secretion 

 during life, and that such data as we possess are almost entirely 

 derived from analyses of bile obtained post mortem. 



The presence In discussing the action of icterogenic poisonous 



in the bile of a g en t s we have referred to the fact that, in the first 

 t>jn~airi8 g de- mst ance, these agents lead to the setting free of the 

 rivatives: oxy-hsemoglobin which the red blood corpuscles con- 



4 haemogiobi- tain. It has been found that under these circumstances 

 nochoiia'. haemoglobin finds its way into the bile. Filehne 4 , 



1 Frerichs, Klinik d. Leberkrankheiten, Vol. i. p. 106. 



2 C. Gerhardt, ' Ueber Urobilinurie.' Wiener med. Wochenschrift, 1877, no. 24. 



3 H. Quincke, Beitrage zur Lehre vom Icterus. 4 'Ueber den sogenannten Urobilin - 

 icterus.' Virchow's Archiv, Vol. xcv. (125 140). 



4 W. Filehne, ' Der Uebergang von Blutfarbstoff in die Galle bei gewissen Vergift- 



