THE CONCEPT OF LIVER DEATHS

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