The problem of the safe and certain removal of calculi from the common bile duct and of the restoration of its permeability is often a pressing one in the course of operation for cholelithiasis. Its solution must be by simple mechanical methods which should occur to any resourceful surgeon even though the exact problem has never presented itself before. The frequency, however, with which patients apply for the relief of symptoms due to calculi in the common duct overlooked at a previous operation leads to the conclusion that the methods in general use by surgeons are not efficient. This impression is strengthened by observations recently in twelve European clinics, in not one of which were satisfactory measures to explore the common duct apparently in routine use, and by a nearly similar experience in this country.
Calculi in the common duct offer three avenues of approach, according to the part of