168 



LOUIS BAUMAN 



increased excretion of urobilin in the stool of some cirrhosis patients was 

 pointed out by Mueller (a) (1892). 



A disease or condition causing an increased destruction of red cells 

 is usually if not always accompanied by an increased elimination of 

 urobilin in the bile, in the stool and sometimes in the urine as well. In 

 secondary anemia the excretion of urobilin remains normal or subnormal 

 while in pernicious anemia it may rise to 15 times the normal amount, 

 hence urobilin estimations may serve to differentiate the two conditions. 



Schneider (a) (1916) studied the urobilin in the duodenal contents of 

 pernicious anemia patients. He found over 2,000 dilutions in pernicious 

 anemia while in secondary anemia little or no increase could be detected. 

 Aftef splenectomy a decrease of the urobilin occurred. These results have 

 been confirmed by Giffin, Sandford and Szlapka. Robertson (b) (1915) 

 and McCrudden emphasize the diagnostic value of urobilin estimations of 

 the stool, thus confirming the work of Wilbur and Addis. Most recently 

 Howard and Hansmann, working in the writer's laboratory, studied the 

 excretion of urobilin in the feces, urine and bile of a number of pernicious 

 anemia patients. They conclude that the estimation of the stool is more 

 reliable than that of the bile. Attempts to demarcate the 24-hour quantity 

 of feces were unsuccessful. In pernicious anemia a marked increase of 

 urobilin in the stool occurred even when the blood examination showed no 

 abnormality. The urobilin was occasionally diminished during the re- 

 missions so frequently encountered in this disease. 



Although obviously inaccurate the "quantitative" estimation of uro- 

 bilin in the stool yields information which possesses considerable clinical 

 value. On a priori grounds it would appear preferable to approximately 

 determine the total daily excretion than that contained in a casual sample 

 of bile; furthermore, it obviates the passage of the duodenal tube, a pro- 

 cedure which is sometimes disagreeable to the patient. 



The diagnostic value of urobilin estimations is illustrated by the fol- 

 lowing case report: 



An Italian, J. G. (history number 44,031), entered the Presbyterian 

 Hospital in November, 1919, complaining of gastric distress and constipa- 

 tion which had lasted for 2 years but which was never accompanied by 

 real pain, vomiting or diarrhea. During the 2 weeks prior to admission 

 he had experienced a sudden attack of weakness and dizziness followed 

 by the appearance of tarry stools and shortness of breath. During the 

 period of illness he had lost approximately 25 pounds. 



Physical examination showed evidences of neuroretinitis in both eyes 

 occurring in an anemic man measuring about 5y 2 feet and weighing 143 

 pounds. The remainder of the examination was irrelevant. Eadiographic 

 examination and sigmoidoscopy were also negative. 



The red cells numbered 2,000,000; hemoglobin was 40 per cent; white 

 blo<xl cells 6,800, of which 58 per cent were polymorphonuclear. The 



