I found it!  Now that my sleuthing is done I can get back to my real work,
but this was fun to look for.

The citation:
McDonagh AF. Phototherapy: from ancient Egypt to the new millennium. J
Perinatol. 2001 Dec; 21 Suppl 1:S7-S12.

I found this, by the way, by doing a subset search on PubMed in History of
Medicine.  You can do this search by clicking on "Limits" under the search
field and then scrolling to "History of Medicine" in "Subsets".

I could only access it in pdf format, so following is the pertinent part
from the article.  Please email me personally if you would like the pdf of
the entire article, which really is interesting.  Incidentally, the entire
December 2001 supplement of the Journal of Perinatology is dedicated to
jaundice.  Why am I not surprised the observation from the nurse gets only
passing mention, and is not supported by any documentation?  I would
venture, by the way, that she was not necessarily a nun - my mother was a
nurse during the same era, and she was always referred to as Sister and she
was not and is not a nun.

"Phototherapy for unconjugated hyperbilirubinemia

This form of phototherapy was introduced by Cremer et al. in 1958, but it
was not widely adopted until further studies by Lucey et al. nearly a decade
later proved its safety and efficacy.  Originally introduced to reduce the
need for exchange transfusions, it is now used both therapeutically and
prophylactically in neonates and has been a lifesaver for people with severe
forms of Crigler-Najjar syndrome, a rare metabolic disease.  Its discovery
was not based on sound scientific principles, but was largely serendipitous.
It stemmed from the careless accidental exposure of some blood to sunlight,
an astute incidental observation by a nurse, and an unwarranted
extrapolation from in vitro to in vivo data.  The accidental exposure of the
blood sample led to the finding that bilirubin in serum undergoes oxidation
to biliverdin and degradation to colorless compounds when exposed to light
in vitro.  The observation by the nurse, Sister J. Ward, was that the skin
of jaundiced infants becomes bleached on exposure to sunlight, whereas
unexposed skin does not.

Putting these two observations together and oblivious of the danger in
extrapolating from in vitro to in vivo photochemistry, the investigators
then tested whether exposure to sunlight would oxidize or degrade bilirubin
in vivo in a jaundiced infant.  They found that sunlight exposure did indeed
lower the serum bilirubin concentration of icteric newborns and, further,
that the same effect could be achieved using blue fluorescent lights in lieu
of sunlight.  They observed, reasonably enough, that the process leading to
bilirubin disappearance in the in vitro and in vivo experiments were the
same.  However, consistency between experimental data and a mechanistic
hypothesis is never adequate proof of the latter.  Nonetheless, for years
thereafter (and even today) it was generally accepted that photodegradation
of bilirubin (and/or photooxidation to biliverdin) is responsible for the
effectiveness of phototherapy..."

References cited in this portion of the article:

Cremer RJ, Perryman PW, Richards DH. Influence of light on the
hyperbilirubinaemia of infants. Lancet 1958;1:1094.

Lucey J, Ferreiro M, Hewitt J. Prevention of hyperbilirubinemia of
prematurity by phototherapy. Pediatrics 1968;41:1047.

Broughton PMG, Rissiter EJR, Warren CBM, et al. Effect of blue light on
hyperbilirubinaemia. Arch Dis Child 1965;40:666.


Katherine Shealy
Atlanta, GA USA



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