108 T. GlLLMAN 



then, was a selected population of people that we biopsied in 

 one ward in the hospital over a period of only two months. 

 In these biopsies, the incidence of cirrhosis, defined on the 

 most stringent histological criteria, was 46 per cent. Severe 

 siderosis occurred in 88 per cent of these cirrhotics, only 12 

 per cent being non-siderotic cirrhosis (Fig. 1). We did not 

 diagnose cirrhosis on the basis of the deposition of moderate 

 amount of fibrous tissue in the portal tracts, i.e. portal 

 fibrosis, but only when gross architectural distortion of the 

 liver was detected in association with such fibrous tissue 

 accumulation such as I will show in a moment. These sidero- 

 tic livers had iron contents which were found, in previous 

 studies (Gillman, Mandelstam and Gillman, 1945), to range 

 from 0-2 to as high as 5 • per cent of the dry weight of the 

 liver. Primary carcinoma of the liver occurred in 4 • per cent, 

 i.e. in three cases. Secondary tumours are rarely seen in the 

 African liver, and we found only one such case. We classified 

 as relatively normal only 10 per cent of the livers seen in 

 these cases. This is more or less the inverse of what one finds 

 in Europeans, in whom the incidence of cirrhosis, varying in 

 different populations, ranges from 1-5 to 4-2 per cent. 



Apart from reporting this high incidence of severe liver 

 disease, I would like to indicate the kind of reactions which we 

 found associated with it. We have now got to the stage where, 

 having correlated clinical and histopathological examinations 

 and laboratory investigations in one series of cases, we can 

 now diagnose this hepatic siderosis with reasonable precision, 

 solely on clinical criteria. 



Fig. 2 typifies the kind of patient with whom we have 

 constantly to deal. The distended abdomen, due to ascites, is 

 frequently associated with palpable hepatic enlargement. 

 Gynaecomastia, varying from nipple enlargement (Fig. 3) to 

 frank enlargement of the entire breast (Fig. 4) is common and 

 is often associated with axillary and also with pubic alopecia 

 (Fig. 5). In Fig. 4 the enlargement of the breasts is more 

 obvious, both the areola and nipple being enlarged, while the 

 underlying breast tissue was also palpably hyperplastic. The 



