110 T. GlLLMAN 



as in the portal tracts (Fig. 10). During an even later stage in 

 this disease, when the accumulation of iron in liver cells may 

 diminish temporarily, the amount of siderin within the liver 

 cells themselves may be relatively small while quite consider- 

 able amounts may be found in the Kupffer cells and in the 

 portal phagocytes. Now, this kind of picture seems to have led 

 people to believe that we are dealing with some form of 

 primary reticuloendothelial siderosis, whereas my brother and 

 I have maintained (and all the studies which we have con- 

 ducted more recently in Durban confirm the original conten- 

 tion) that this seems to be primarily an intracellular lesion and 

 only secondarily a reticuloendothelial one. We still maintain 

 this view despite the opinions of some South African workers 

 (Higginson, Gerritsen and Walker, 1953). It is apparent from 

 Fig. 10 that iron accumulates in massive clumps in the portal 

 tracts, and even the collagen in the associated fibrous tissue 

 may take up iron. 



A serial section of this same liver, but stained for connective 

 tissue, revealed the considerable amount of connective tissue 

 present although it may be partially obscured by the large 

 amounts of portal iron shown in the previous slide. In such 

 sections iron-containing pigment appears as coarse brown 

 granules. However, it is misleading to attempt to assess the 



PLATE I 



Fig. 2. Characteristic clinical picture of advanced nutritional siderosis with 

 cirrhosis in an African. Note gross ascites, loss of hair of outer third of eye- 

 brows, skin changes and emaciation. 



Fig. 3. One form of gynaecomastia producing elongated, "top hat" type of 



nipple enlargement. 



Fig. 4. Grosser degree of gynaecomastia with nipple and areolar enlargement, 

 as well as hyperplasia of breast tissue. Note labial and angular stomatitis. 



Fig. 5. Axillary alopecia, frequently observed in advanced nutritional 

 siderosis with cirrhosis. 



Fig. 6. Classical European type arcus senilis in an African, with opaque, 

 pearly- white limbic ring and minimal conjunctival pigmentation. 



Fig. 7. Golden brown transparent limbic ring (medial part of limbus), 

 gross conjunctival pigmentation and Bitot-like spot medial to cornea. The 

 limbic ring resembles the classical Keiser-Fleischer ring of hepatolenticular 



degeneration. 



