Current concepts concerning the formation and metabolism of bile pigments hold that bilirubin is formed from the catabolism of hemoglobin by the reticuloendothelial system, mainly in bone marrow and spleen, and that the bilirubin is then transported to the liver where it is modified and excreted. via the biliary system. These concepts are based largely on the studies by Mann, Magath and Bollman (1, 2) of the effect of total hepatectomy on mammals which show that after complete extirpation of the liver, indirect-reacting bile pigment was formed and accumulated in the serum progressively during the survival period of the animal. Bollman and Mann (3) noted that as the amount of bilirubin in the blood increased after hepatectomy, the van den Bergh reaction changed from an indirect to a direct reaction and bilirubin began to appear in the urine.Since the original work of van den Bergh, Snapper and Muller (4, 5) on the application of the Ehrlich diazo reaction to the quantitative measurement of the serum bilirubin and their observation of the differing character of the reaction in various types of jaundice, many investigators have sought to determine the fundamental basis for these differences. Despite a voluminous literature on the subject which has accumulated for more than 40 years, disagreement and lack of exact knowledge are still evident. In this paper we can cite only recent surveys encompassing the many concepts which have been proposed (6-9).

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