1. That we have in the Icterus Index a delicate
clinical test for hyperbilirubinaemia, which, if
used in correlation with the clinical findings,
will in certain diseases be of value in diagnosis,
treatment, and prognosis.
2. That the technique is a simple one, requiring
no specialized laboratory experience. Some of
the more recent modifications of the technique
are especially simple, and while not so accurate
as Bernheim's method, are perhaps sufficiently
so for general purposes.
3. That normal persons show an Icterus Index which
lies between 3.0 and 8.0
4. That an Icterus Index of over 8.0 may be considered
as denoting a pathological hyperbili_
5. That with an Icterus Index of 15.0 or over there
is almost invariably clinical jaundice present.
6. That the Icterus Index varies directly in proportion
to the degree of jaundice. In this
connection it has been found that the Icterus
Index follows very closely any variations in the
jaundice, and may be taken as a means of recording
recording increase or decrease of the latter,
It is as a means of following up cases of jaundice
that the Index has been found especially useful.
7. That in cases of cholecystitis and cholelithiasi
by means of variations in the Icterus Index,
taken in conjunction with the clinical findings,
the former are of value in the placing of operative indications.
8. That the Icterus Index is of value in the post
operative prognosis in cases of gallbladder
9. That the mere presence of gallstones, without
obstructive symptoms or associated cholecystitis
will not cause a hyperbilirubinaemia with a
resultant raised Icterus Index.
10. That the mere height to which the Icterus Index
is raised in a case of jaundice is not evidence
for or against malignancy, but a steadily rising
Index points to malignant obstruction of the
common bile duct. In this connection the possibility of a simple tightly impacted stone, completely
occluding the duct, must not be forgotten.
11. That the Icterus Index may be used to differentiate between renal and biliary conditions,
the former giving normal figures.
12. That while a raised Index may be caused either
by effects on the liver or by haemolytic processes,
the figures obtained are usually higher in
13. That the Icterus Index is of no value in the
diagnosis of early secondary malignant deposits
in the liver.
14. That as duodenal ulcer commonly causes a raised
Index, while gastric ulcer gives normal figures,
the Icterus Index may be of use in the differential
diagnosis of these conditions.
15. That confusion may arise owing to the fact that
both biliary dysfunction and duodenal ulcer caus
a raised Icterus Index. It is sometimes difficult
to make a positive diagnosis between then
two conditions, but the clinical findings and
the fact that biliary disorders almost invariabl
give higher figures than duodenal ulcer should
enable one to decide the diagnosis in the
majority of cases.
16. That though a raised Icterus Index is sometimes
obtained in cases of acute appendicitis, this is
uncertain, and cannot be considered as of value
17. That cases of chronic appendicitis do not raise
the Icterus Index.
18. That the Icterus Index is raised in pernicious
anaemia, and that variations in the Index are of
prognostic value in that disease.
19. That the Icterus Index is of value in the differential
diagnosis between pernicious anaemia and
carcinoma of the stomach, the latter giving a
20. That cases of secondary anaemia show a subnormal
Icterus Index, and that therefore this test may
be used to differentiate primary and secondary
21. That there seems to be small ground for supposing
that the Icterus Index may be used ás a means
of deciding for or against splenectomy in Banti'
22. That the low Icterus Index caused by secondary
anaemia may mask a raised Index due to disease.
This fallacy must be kept in mind when interpret
ing results of Icterus Index readings in anaemic
23. That the Icterus Index is raised in cases showing
cardiac decompensation, and that this rise is
directly proportional to the degree of decompensation.
24. That repeated Icterus Index readings in cardiac
cases are of value in following the progress of
the case, and in forming one's prognosis.
25. That mere valvular disease or any other cardiac
disease without decompensation will not raise
the Icterus Index.
26. That cases of arsenical hepatitis and dermatitis
cause a raised Icterus Index.
27. That venereal disease in general, and syphilis
in particular, does not raise the Icterus Index,
but the intravenous administration of arsenic
for syphilis often causes a preliminary rise in
the Index at the start of treatment. This rise
disappears as treatment is continued and does
not contraindicate further arsenical medication.
28. That in a case receiving arsenical treatment an
Icterus Index rising steadily through the period
of latent jaundice is a danger signal of oncoming
29. That until the Icterus Index has returned to
normal in a case of arsenical hepatitis, further
arsenical treatment is contraindicated.
30. That we have in the Icterus Index a convenient
'tolerance' test for patients receiving intra_
venous arsenic, which, if performed at regular
intervals, should prove of great value in the
anticipation and prevention of such complication
as hepatitis and dermatitis.
31. That any rise in the Icterus Index in cases
receiving arsenic is not in any way proportional
to the amount of arsenic given.
32. That a high Icterus Index in pneumonia is a bad
33. That in the majority of cases of diabetes, the
Icterus Index is not raised, and that the high
figures obtained in some cases is probably due
34. That the Icterus Index is raised in cases of
hyperemesis gravidarum. Opportunities for
investigating the possible prognostic value of
this rise have not, however, presented themselve ,
and no definite statement ca n at present be made.