The hemorrhagic tendency associated with obstructive jaundice, with prolonged biliary fistula and with certain types of hepatic damage has been a well recognized clinical entity for many years. However, elucidation of the underlying cause of the bleeding has been accomplished only recently. There have been many experimental studies of the various components of the blood which play a role in the process of coagulation, and until lately the cause of the clotting defect had not been found. Moss1 in 1933 demonstrated that the concentration of plasma fibrinogen is normal in dogs with obstructive jaundice. Carr and Foote2 in 1934 confirmed the results of Moss and showed that massive parenchymatous hemorrhage occurred in dogs with obstructive jaundice if life was prolonged to fifteen weeks.
In 1935 and 1936 Hawkins and Whipple3 and Hawkins and Brinkhous4 demonstrated the hemorrhagic tendency in dogs with biliary fistulas and showed that