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March 30, 1929, Vol 92, No. 13 >
ARTICLE | March 30, 1929

BILE FORMATION AND ITS DISTURBANCES

JAMA. 1929;92(13):1129-1130. doi:10.1001/jama.1929.02700390099008.
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Since van den Bergh1 described his direct and indirect tests for bilirubin in the blood in 1918, considerable speculation has developed concerning the formation of the two types of bilirubin thus demonstrated. That either can produce jaundice is not seriously questioned. It has been generally assumed that the type demonstrated by the direct reaction is that which occurs in obstructive jaundice. The type of bilirubin shown by the indirect reaction is present in hemolytic jaundice. The theory thus elaborated has been convenient in describing the type of dyscholia (defined as disturbance in the formation and elimination of the bile forming substance), but its inadequacy is open to severe criticism.

Aschoff2 in a recent paper has admirably summed up the available knowledge of dyscholia. He considers that there are three main types of icterus into which, or into combinations of which, all forms can be placed. These three are

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