Man ordinarily tolerates mechanical obstruction of the common bile duct fairly well. Death from obstructive jaundice in the first few weeks of its course is quite rare and is only occasionally observed. After a period varying from four to six months, however, patients suffering from occlusion of the common bile duct usually deteriorate rapidly and die. During the greater portion of this time, save for the loss of weight and accompanying loss of strength incident to the altered digestion and assimilation of the ingested food, the patient remains ordinarily wholly free from any threatening symptoms. Then suddenly the picture of a rapidly progressive intoxication is superimposed on the silent jaundice; ascites, coma and spontaneous hemorrhages may supervene, and death quickly follows.
Somewhat more than a year ago, a patient was admitted to the surgical service of the University Hospital with a profound icterus of more than three and one-half years'