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October 28, 1933


JAMA. 1933;101(18):1365-1371. doi:10.1001/jama.1933.02740430011004

The internist confronted with chronic jaundice in a young patient usually diagnoses it as catarrhal jaundice. If he encounters it in an older patient, he is likely to consider it as due to carcinoma of the head of the pancreas. The surgeon, on exploring, may find no carcinoma at the head of the pancreas and no stones in the common duct. He then usually performs a cholecystectomy, or a cholecystectomy and drainage of the common duct, or he decides that he is dealing with intrahepatic cirrhosis with jaundice and closes the abdomen without further intervention. We believe that in such cases the condition is due to an infection which begins as duodenitis and ascends the pancreatic and common ducts. This triangular infection produces inflammation and hypertrophy of the ampulla of Vater, which in turn give rise to spasm and obstruction of the common duct, biliary stasis and ultimately a breaking

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