Dr. Rodolfo N. Perez, Jr., Senior Assistant Resident in Medicine, the Jewish Hospital of St. Louis, and Assistant in Medicine, Washington University School of Medicine: A 50-year-old black woman was admitted to Jewish Hospital for the first time in October 1968 with a history of jaundice and anorexia. The patient was not aware of exposure to infectious hepatitis, and denied intravenous injections or transfusions, recent surgery, exposure to hepatotoxic agents, or ingestion of any medication. On physical examination, she had scleral icterus and a soft abdomen without palpable organomegaly; Murphy's sign was not elicited. The remainder of her physical examination was within normal limits.
The hematocrit reading was 39% and the white blood cell count (WBC), 4,500/cu mm with a normal differential cell count; the urine was positive for bile but was otherwise unremarkable. The total circulating alkaline phosphatase level was 307 international units (IU; normal, < 100 IU); lactic