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May 26, 1923


Author Affiliations

From the Medical Division of the Montefiore Hospital.

JAMA. 1923;80(21):1516-1519. doi:10.1001/jama.1923.02640480020007

The occurrence of outspoken jaundice with yellow sclerae and bile pigments in the urine as an incident in myocardial insufficiency was long ago observed, but is not common. Very frequent, on the contrary, is the development of a faint yellow or brownish-yellow pigmentation of the skin without the presence of bile pigments in the sclerae or urine. Determination of the exact shade of the coloration is made more difficult by the usual accompaniment of cyanosis, a condition that makes the jaundice more readily perceptible on the skin of the abdomen than on that of the extremities or face. This frequent combination of slight ochrodermia with the dusky tinge of cyanosis has resulted in the application of the term cyanotic icterus to the condition. Recent investigations have shown, in fact, that many patients with myocardial insufficiency have an increased amount of bilirubin in the blood. Bilirubin in the urine is rare,