BLOOD PHOSPHATASE AND THE VAN DEN BERGH REACTION IN THE DIFFERENTIATION OF THE SEVERAL TYPES OF JAUNDICE

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Abstract
The current description of the direct and biphasic van den Bergh reactions is criticized and suggestions made for its improvement. A series of cases of jaundice is reported which indicates that the reaction fails to differentiate obstructive from toxic and catarrhal jaundice. The obstructive nature of a jaundice can be recognized by the increased phosphatase activity of the blood, which occurs strikingly in this type alone. The procedure adopted to recognize this increase is described, and the results obtained in 52 consecutive cases reported, which show that by this method toxic, infective, and catarrhal jaundice may be distinguished from jaundice of the obstructive type. The relation between the bilirubin content of the blood and its phosphatase activity is discussed, and a modification of the existing theory of jaundice proposed, which appears to explain the facts better than the present view, and to allow also of an explanation of the above relationship.

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