The direct surgical attack upon biliary tract disease began less than a century ago, when Bobbs, in 1867, performed the first cholecystostomy. 1 Langenbuch reported the first recorded cholecystectomy in 1883. 1 Exploration of the common duct for removal of calculi was accomplished by Kummell in 1890. 2 By 1900, these three procedures had become established, and, while indications for their employment were well described, there was a general belief among the medical profession in the United States that the late stages and the complications of diseases of the biliary tract provided the most fertile field for operative intervention. Many believed that biliary tract disease could be tolerated well by most patients, and that the risk of surgery was greater than that arising from the disease. Medical management was by far the most frequent therapy accorded to patients. From 1900 until 1923, when cholecystography was introduced by Graham, Cole, and