Malvinder Parmar's Clinical Vistas article1 illustrates a Courvoisier gallbladder handsomely. Parmar aptly and carefully notes the occurrence of exceptions, whereby nothing more ominous than cholelithiasis and chronic cholecystitis underlie painless jaundice with a palpable gallbladder. Thus, for clarity, we should stop calling the sign of Courvoisier a “law,” which by definition must apply to all. This point is made in a wonderful short review of the phenomenon, and of Courvoisier's important place in the history of medicine, which was published 17 years ago by Verghese and associates.2
Henry Schneiderman Hebrew Health Care University of Connecticut School of Medicine West Hartford, Conn.