A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
History
A system of practical medicine. By American authors. Vol. 1 : $b Pathology and general diseases
Medicine -- Practice
It is well known that a yellowish discoloration of the general surface
frequently takes place when extensive internal hemorrhages have
occurred, constituting a form of jaundice (hæmatogenous) attributed to
the presence of the coloring matter of the blood. As yet there has
been no satisfactory chemical analysis of this diffused pigment, which
if not hæmatin must be regarded as its derivative, although a
coexistent increase of the urobilin in the urine has been observed.
The association of the stained skin and urine, {91} in the absence of
causes favoring an absorption of bile-pigment, leads to the inference
that the abnormal discoloration is due to the absorption into the
circulating fluids of the body of a pigment dissolved out of the
extravasated red blood-corpuscles. This view is confirmed by the
microscopic examination of the latter, which discloses the presence of
pale, shadowy, round outlines enclosing faintly granular material,
which are regarded as decolorized red corpuscles. In the course of a
few days glistening crystals and granules of a yellowish-red color
make their appearance in the midst of the unabsorbed blood. The
crystals are usually oblique rhombic prisms, varying in size from the
larger symmetrical shapes to the more minute, apparently granular,
forms. Acicular crystals are also to be met with, more yellow than red
in color, and are sometimes present in great abundance, although they
may be wholly absent. Virchow has applied the term hæmatoidin to these
crystals. Owing to the resemblance in the chemical reactions of
solutions of hæmatoidin and of the biliary coloring matter, bilirubin,
and to the similar crystalline forms of the latter, it has been
maintained that the two are identical. Late investigations indicate
that solutions of crystals with the appearances of hæmatoidin are not
invariably alike in their reaction. A solution of these in chloroform
may become decolorized when acted upon by a dilute alkali, or it may
not be thus altered. Bilirubin presents the former relation, while
chloroform solutions of the coloring matter of the yelk of egg and of
the corpus luteum, called lutein or hæmolutein, are not decolorized by
an alkali. Although the crystalline forms of hæmatoidin and bilirubin
are not to be distinguished, it is not to be conceded that the two
substances are identical. As Maly,[41] the latest writer on this
subject, states, the term hæmatoidin is merely indicative of a
microscopical picture. Although the identity of the coloring matter of
the blood and of the bile is not admitted, the intimate relation of
the two is not only suggested by the similarity of crystalline form,
but by the relation determined between urobilin, bilirubin, and
hæmoglobin. Urobilin is the coloring matter extracted from the urine
in fever by Jaffé, and it has since been obtained from bilirubin by
Maly,[42] who has given it the name of hydrobilirubin. This
hydrobilirubin has also been derived from hæmoglobin. According to
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