Pioneers in the scientific study of neonatal jaundice and kernicterus

Neonatal jaundice must have been noticed by caregivers through the centurie s, but the scientific description and study of this phenomenon seem to have started in the last half of the 18th century. In 1785 Jean Baptiste Thimot ee Baumes was awarded a prize from the University of Paris for his work des cribing the clinical course in 10 jaundiced infants. The work by Jaques Hervieux, which he defended for his doctor of medicine d egree in 1847, was, in many respects, a landmark. He had autopsied 44 jaund iced infants and apparently had clinical observations on many others. His d escriptions of pathoanatomical findings were very detailed and systematic. A number of his clinical observations are still thought to be accurate toda y, such as the essentially benign nature of neonatal jaundice in most cases , the appearance of neonatal jaundice during the first 2 to 4 days of life as well as its disappearance within 1 to 2 weeks, and the cephalocaudal pro gression of jaundice. He described jaundice of the brain in 31 of his 44 au topsied cases, with variable intensity of staining. Johannes Orth was an assistant to the famous Virchow in Berlin, when in 187 5 he published the results of an autopsy of a jaundiced term infant. The br ain was notable for an intense yellow staining of the basal ganglia, the wa ll of the third ventricle, the hippocampus, and the central parts of the ce rebellum. While the contribution of Orth was limited to this single case re port, in 1903 Christian Schmorl presented the results of his autopsies of 1 20 jaundiced infants to the German Society for Pathology. All of these infa nts' brains were jaundiced, but only 6 cases demonstrated a staining phenom enon similar to that previously described by Orth. Schmorl coined the term kernicterus (jaundice of the basal ganglia) for this staining pattern. Although the following century of scientific study has added an enormous am ount of information about the epidemiology and pathophysiology of neonatal jaundice and kernicterus, the contributions of Hervieux, Orth, and Schmorl will undoubtedly continue to be seen as historical landmarks in our quest f or understanding of these phenomena.