Alterations in Liver Function as an Index of Toxemia in Pneumococcus Lobar Pneumonia.

Jaundice, varying from a slight icteric tinting of the sclerae to a pronounced generalized pigmentation of the skin and mucous membranes is not infrequently encountered during the course of lobar pneumonia. Further, if examined for carefully, the presence of urobilin and urobilinogen in the urine is found to be practically constant during the acute febrile period of the disease. Both jaundice and urobilinuria may be considered as probable indicators of liver damage, yet despite the fact their occurrence has long been appreciated, with the exception of the icterus index studies of Bernheim (1), the work of Kahler (2), and a few isolated case reports in the recent literature, there has been no detailed study of liver function in pneumonia. Bernheim, in a study of the icterus index in various conditions, found it to be greater than normal in most of the cases of pneumonia studied. Kahler, working with phenoltetrachlorphthalein, commented on the frequency with which high degrees of retention were observed in pneumonia. The lack of a detailed study of the liver function in pneumonia may probably be attributed in part to the lack of trustworthy methods for the clinical determination of liver function. The comparatively recent introduction of the dye elimination tests and of the improved methods for the quantitative determination of circulating bile pigments has made it possible to carry on such a study. Accordingly an investigation was undertaken in a series of cases of pneumococcus lobar pneumonia to determine (1) if pneumonia is uniformly attended with alterations in liver function; (2) if the various types of infecting pneumococci produce characteristic degrees of hepatic dysfunction, and (3) if there is any parallelism between the 211