CHAPTER LXXXin 



DISEASES OF THE LIVER AND PANCREAS 



General remarks — Tropical liver — Amoebic abscess of the liver — 

 Opisthorchiosis — Clonorchiosis — References. 



GENERAL REMARKS. 



Diseases of the liver and pancreas are of common occurrence in 

 the tropics. The liver may be affected in the course of tropical 

 fevers, especially in malaria and kala-azar, in the latter of which 

 Rogers has described a special form of cirrhosis. The disease 

 called ' infantile biliary cirrhosis of the liver,' described by Ghose 

 and Mackenzie as occurring in Calcutta and other parts of India 

 in Hindu and Mohammedan children, appears to us to require 

 reinvestigation, with a view to deciding whether it also is a variety 

 of kala-azar. It is said to attack children under one year of age, 

 and to be characterized by a low type of fever, associated with 

 enlargement of the liver and spleen, jaundice, pale motions, dark 

 urine, and sometimes vomiting of blood, oedema, and ascites, and 

 ends fatally in three to eight months. 



Acute yellow atrophy of the liver is not as uncommon in Ceylon 

 as in Europe, for, on an average, we have met with one or two cases 

 per annum. It occurs in Ceylon more commonly in men than in 

 women, but the cause appears to be quite obscure. 



An extraordinary case of acute severe hepatitis and gastritis, 

 which caused a considerable haemorrhage to take place, filling all 

 the small biliary ducts, the gall-bladder, the common bile-duct, 

 the duodenum, jejunum, and ileum with blood, has been recorded 

 by one of us in Ceylon. The inflammation occurred in a stomach 

 which was altered by chronic atrophic gastritis. The haemorrhage 

 was caused by the blood passing from the damaged hepatic capil- 

 laries into the minute bile channels, and was due to the destruction 

 of the walls of these capillaries and the liver cells. No definite 

 cause could be found for this condition, which is decidedly rare. 



Congestion and inflammation of the liver, together with abscess, 

 are common in the tropics, and require special consideration (p. 1910) . 



Atrophic cirrhosis of the liver is very common in the tropics, and 

 though generally there is a history of alcohol, still, this is by no 

 means always so, and sometimes the cause is not evident. We 

 believe that cirrhosis of the liver of malarial origin is much less 



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