486 PATHOLOGICAL PIGMEXTATION 



bile pigment can be formed from hemoglobin. Several authors have 

 found bilirubin produced in hemorrhagic elfusions located where the 

 liver could have had no influence.®^'' We also recognize types of hemo- 

 lytic icterus in which the liver does not seem to be concerned, and 

 with bile pigments present in the blood and urine unaccompanied by 

 bile salts (dissociated icterus), so that the old dictum of the essential" 

 implication of the liver in icterus seems to be incorrect.^*'' Joanno- 

 vics " gives, as a result of a comparative study of icterus from bile 

 obstruction and icterus from hemolysis, the following chief differ- 

 ences: Icterus due to hemolysis appears sooner than icterus from 

 bile-duct occlusion, and reaches a much higher degree ; the obstruction 

 in hemolytic icterus, Avhen present, is intra-acinous ; in stasis it is 

 cliiefly inter-acinous ; in hemolytic icterus there is a large splenic 

 tumor due to accumulation of degenerated red cells in the spleen, 

 where they become disintegrated preliminary to the formation of bile- 

 pigment. If the spleen is removed, hemolytic agents may not cause 

 icterus, because the corpuscles are not then prepared for pigment 

 formation. ^^-'^ 



Toxicity of Bile. — In any event, we must appreciate that in icterus 

 not only are abnormally large quantities of bile-pigment present in 

 the blood, but also the other less conspicuous constituents of the bile. 

 Whole bile of rabbits is fatal to rabbits in doses of 0.25 to 0.5 cc. per 

 kilo, by intraperitoneal injection, and about half as much intraven- 

 ously (Bunting and Brown ^'^). Death is the result of changes in the 

 myocardium, where necrosis is produced ; and severe degenerative 

 changes are also found in the kidneys and liver; when the bile is in- 

 jected into the peritoneum, pancreatitis and fat necrosis result. The 

 relative toxicity of the bile-pigments and the bile salts is not as yet uni- 

 formly agreed upon. 



Bile-pigments. — Bouchard *^ and others have claimed that the bile- 

 pigments are far more toxic than the bile salts, which is contradicted 

 by Rywosch and others. A series of analyses by Gilbert '^'"^ and others 

 gave the following results : Normal blood-serum contains 0.027-0.08 

 gram bilirubin per liter; in obstructive ictenis they found 0.7 to 1.0 

 gram of bilirubin per liter, in biliary cirrhosis 0.33 gram per liter, in 

 icterus neonatorum 0.2 to 0.5 gram ; in pneumonia 0.068 gram was 

 found. King and Stewart -^ state that the amount of pigment in a 



s<4aTIoop(M- and ^^■llippl(>, Jour. Exp. Mod., inifi (2:1), 137. 



S4b Att('iiij)ts to produce hile pifjments from liemojiloliin by bacterial action 

 have been un.successful. (Quadri, Fol. Clin. C'liim.. 1914, Xo. 10). 



ssZeit. f. Hellk., Path. Al)t.. l')()4 (25), 25. 



S5a 'I'lic etiology of icterus neonatorum (when not obstructive) has not been 

 ascertained, but a nalurai tendency towards icterus is said to exist in tiie new- 

 l)orn, llieir l)b>od containin<r much more bile ]u<jment tlien than later, (llirsch. 

 Zeit. Kinderheilk., ]it]3 (0), 10(1; Ylppo, Miinch. med. Woch., 101,3 (39), 2161.) 



^«.7our. Kxper. Med., mil (14), 445. 



f+T Literature and discussion by StadelTiiaiui. Zeit. f. V,\o\., 1806 (34), 57. 



«7aC"ompt. Rend. Soe. Biol., 1005 and 1006. 



xs.Tour. Exper. ISled., 1000 (11), 673. 



