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January 1921


Arch Intern Med (Chic). 1921;27(1):131-134. doi:10.1001/archinte.1921.00100070134009

Acholuric jaundice has long been recognized and frequently seen in many conditions with various clinical designations. Most commonly it is ascribed to some disorder of the liver or to anemia, but because no bile appears in the urine little investigation has been made of such jaundice. In 19171 I reported an investigation of the blood in pernicious anemia and found that fifteen out of twenty patients had bilirubin in the plasma and none had it in the urine. I concluded from these findings that bile pigment was in some way fixed to the blood plasma and could not be excreted by the kidney. Previously Dr. Hoover and I reported2 a series of observations under the title of "Dissociated Jaundice," in which it was pointed out that biliary elements occur in the blood in varying amounts; that there is a fairly constant "threshold" for these substances above which they appear in

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