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October 24, 1959


JAMA. 1959;171(8):1110. doi:10.1001/jama.1959.03010260066014

INCE the discovery by Ehrlich in 1883 of a color reaction which permits the estimation of bilirubin, quantitation of this substance has played an important role in diagnosis and treatment of numerous diseases. The usefulness of this method was increased by the development of the van den Bergh method for quantitative estimation of bilirubin and for qualitative discrimination of the etiology of jaundice. Obstructive jaundice is accompanied by an increase in "direct bilirubin" while hemolytic jaundice is characterized by an elevation of "indirect bilirubin." Direct bilirubin refers to the prompt reaction in serum after addition of appropriate reagents while indirect bilirubin signifies the reaction dependent on the additional presence of alcohol.

Although this empirical distinction has been of great value in clinical medicine, understanding of these phenomena eluded investigators until recently. The discovery of the nature of direct and indirect bilirubin coupled with the elucidation of the mechanism of uronide