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The clearance of bilirubin from the plasma following intravenous injection was first used to measure the excretory function of the liver by have established the value of the test. Aside from the theoretical desirability of using a physiologic material (bili-rubin) rather than a dye (bromsulphalein or rose bengal) to assess hepatic excretory function, it is generally agreed that the bilirubin test is unusually sensitive in demonstrating disturbed function when the degree of liver damage is relatively slight. The usefulness of the test and a desire to extend the range of clinical disorders to which it can be applied have prompted the present study. As now used, the test involves determination of the percentage of injected bilirubin remaining in the circulation after a standard time period, usually 4 hours. Three samples of plasma are required. An initial sample a is obtained to determine the natural level of bilirubin in the patient's plasma. Pure bilirubin-1 mgm. per kilogram of body weight dissolved in a small volume of 0.1 M sodium carbonate solution-is injected intravenously. After allowing 4 to 5 minutes for mixing in the blood stream, a second sample of plasma b is secured. The final sample c is collected 4 hours later. If Ba, Bb and Bo represent the bilirubin concentrations in each of the three plasma samples, the percentage retention equals 100 (Bc-Ba) (Bb-Ba). Reported results indicate that in many normal subjects there is no retention of pigment at the end of the 4-hour period. Soffer (7) considers retention in excess of 5 per cent to be evidence of impaired liver function. It will be observed that the above method which utilizes percentage retention as the measure of hepatic function is based on the assumption that rate of excretion is not influenced by the basal level of bilirubin in the plasma. The value for this level is simply subtracted from each of the other levels before the retention is computed. It will appear presently that the assumption is not justified. However, since most authors state that the test should not be applied when the basal level is above 1 mgm. per cent, and since the result is usually interpreted simply as normal or abnormal, and not as a quantitative measure of excretory function, it has in general served its purpose satisfactorily. Occasional attempts (13, 14 1) to utilize the test when the basal concentration was elevated have yielded results which …

THE CLEARANCE OF BILIRUBIN FROM THE PLASMA. A MEASURE OF THE EXCRETING POWER OF THE LIVER