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By M.D. G. Fulton Roberts

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He carefully distinguished between a uniform surface impregnation of the brain by bile pigment, a condition generally considered nowadays to result most commonly from a postmortem change, and the staining of the basal ganglia alone, which he described in six cases. Several more accounts soon followed, notably those of Beneke (1907) and Pfannenstiel (1908) until von Gierke (1921) noticed that the erythroblastosis that he observed in cases of kernicterus was akin to that found in hydrops foetalis; he proposed a common origin, and, at the same time that the Rh blood groups were being studied in the 1940's, it seemed to be universally held that kernicterus was a complication of haemolytic disease of the newborn, and hence of maternal blood-group iso-immunization.

The nature of this reaction was not at first at all clear. g. the properties of rheumatoid arthritis sera) and appeared to be an in vitro peculiarity, for spontaneous clumping of cells from human infants with haemolytic disease is not usually seen (though the phenomenon is common in foals and piglets with the same disease).

Schmorl, they believe, was comparing the properties of the kernicteric pigment with directreacting bilirubin, which does not turn green, and which is the pigment concerned in other conditions of neo-natal jaundice, such as biliary obstruction, when there is no kernicterus. Their extracts from kernicteric brains reacted not as pure indirect bilirubin, as those of Waters, Richert and Rawson (1954) did, but as a mixture of indirect bilirubin with normal brain tissue. Hence, they too believe that the indirect-reacting bilirubin has an affinity for brain tissue.

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