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March 4, 1950


JAMA. 1950;142(9):670. doi:10.1001/jama.1950.02910270060019

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To the Editor:—  In response to the communication of Dr. Irving Brick of Washington, D. C., which appeared in The Journal (142:198 [Jan. 21] 1950), I should like to state that it is unfortunate that Dr. Brick did not correctly evaluate the part of my article which pertained to pruritus and jaundice. It is difficult to understand why Dr. Brick stated that I "claimed" that pruritus is "pathognomonic" of extrahepatic obstruction. Nowhere in my article does the word "pathognomonic" appear, and nowhere was such a "claim" made. I stated that when the pruritus was the primary complaint I felt quite positive that there was an obstruction in the extrahepatic passages. This does not imply that pruritus of a lesser degree cannot be associated with another type of jaundice, nor does it imply that quite positive is synonymous with pathognomonic.Dr. Brick quoted Rothman and Shapiro (in MacBryde, C. M.:

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