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January 9, 1926


JAMA. 1926;86(2):119-120. doi:10.1001/jama.1926.02670280039016

After the decades during which it was firmly believed that the bile pigments are formed in the liver alone, the proof that bilirubin accumulates progressively in the body when this organ has been excluded came as a contribution of unexpected importance to physiology.1 The occurrence of jaundice has taken on a new meaning; it has become necessary to modify some of our inherited conceptions regarding hepatic function. There are, for example, types of hemolytic icterus in which the liver does not seem to be concerned. In such instances bile pigments may be present in the blood and urine, unaccompanied by bile salts—so-called dissociated icterus. Hence, the old dictum of the essential implication of the liver in jaundice can no longer be upheld.2

The conception of the extrahepatic formation of bile pigments has received further corroboration in the demonstration by Mann, Bollman and Magath3 that bilirubin is formed