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March 6, 1943


JAMA. 1943;121(10):736-738. doi:10.1001/jama.1943.02840100022006

In 1922 following a rather prolonged period of clinical observation it became evident that there were certain types of mortality that followed operations on the external biliary system.1 There were three types of death that followed gallbladder surgery. Later these findings were more formally presented as follows:

Group 1.—  Liver deaths associated with hyperpyrexia and coma. Death ensues in eighteen to thirty-six hours.The first group is composed of patients who have had a comparatively simple gallbladder operation. The patients were usually obese and gave a history of chronic gallbladder disease. Preoperative study did not reveal any contraindication to surgical intervention. Following cholecystectomy the recovery from the anesthesia was slow; in fact, the patient never did emerge fully from the anesthesia. In four to six hours after the return to the ward the patient was in a semicomatose state that passed rapidly into stupor and coma, with a rapidly