Medical Officers o/ the-Army-of India.
of which the nuclei only were distinguishable. The ducts were most numerous
in the fibrous tissue of the portal sheaths, a few were found in the larger inter-
- l o b u l a r t r a c t s a n d i n t h e f i b r o u s t i s s u e b e t w e e n t h e g r o u p s o f h e p a t i c c e l l s a t
the periphery of the lobules.
From the foregoing description of the morbid anatomy of the form of cir-
-
rhosis found in children in this part of India, it is evident that the disease pre
- s e n t s s e v e r a l p e c u l i a r f e a t u r e s . I t a t t a c k s y o u n g c h i l d r e n , u s u a l l y u n d e r o n e
year old. The liver primarily enlarges with comparative rapidity and reaches an
enormous size, and subsequently contraction takes place. The disease is almost
invariably fatal. The appearances presented by the liver of case 5 show that
the formation of fibrous tissue begins within the lobules and occurs indepen-
- d e n t l y o f t h e p o r t a l s h e a t h s w h i c h u n d e r g o p r o l i f e r a t i o n a t a l a t e r p e r i o d . T h e
presence of abundant loosely arranged fibres between the liver cells explains the
large size of the organ. The cirrhosis is primarily intercellular. In most
cases the portal sheaths proliferate and each lobule becomes encircled by a
band of fibrous tissue. The diminution in the size of the liver follows, as in the
ordinary form of cirrhosis, from the contraction of the interlobular bands. Re
- c e n t l y I h a v e h a d t h e o p p o r t u n i t y o f e x a m i n i n g t w o c a s e s ( k n o w n a s c a s e s 6
and 7) which were treated in the Medical College Hospital. In case 6 the inter-
- c e l l u l a r f i b r e s a r e v e r y a b u n d a n t ; t h e g r o u p s o f l i v e r c e l l s a r e s e p a r a t e d b y w i d e r
intervals, but the portal sheaths are only slightly affected and the interlobular
tracts are narrow and inconspicuous. This seems to show that the intercellular
formation of fibres is the primary and essential feature of the disease, and that
the proliferation of the portal sheaths and interlobular tracts, though generally
present, is secondary and may be altogether absent. In the later stage of the
disease jaundice is present. It comes on gradually, and in most cases consti
- t u t e s t h e m o s t p r o m i n e n t s y m p t o m . I t w a s a b s e n t i n c a s e s 5 , 6 , a n d 7 . I n
these three cases, although many of the liver cells are destroyed, a large number
appear healthy, or but slightly affected. In my first four cases t he liver cells
are almost completely destroyed and jaundice of a most marked character was
present. It seems that jaundice, in this disease, depends upon the amount of
liver cells destroyed, and that so long as a sufficient number of healthy cells
remain, this symptom is absent. The destruction of the liver cells can hardly
be altogether due to pressure; it has begun in case 5 in which the fibrous tissue
is composed of loosely arranged fibres, and is not greater in cases 6 and 7,
although in these the quantity of intercellular tissue is much more and the fibres
are compactly arranged. It may be due to the direct action of an irritant on
the liver cells.
The multiplication of the bilducts appears to be connected with the de
-
struction of the liver cells. They are most numerous in those parts of the sec
- t i o n s o f t h e f i r s t f o u r c a s e s i n w h i c h t h e l i v e r c e l l s a r e c o m p l e t e l y d e s t r o y e d .
Comparatively few are found in the three last cases.
57