GENERAL REMARKS 



1907 



frequent than is admitted by many authors. It will be shown 

 presently that various parasites cause cirrhosis. 



Primary cancer of the liver has been met with, but is very rare. 

 On the other hand, secondary cancer is by no means rare. The 

 only non-malignant growth which we have met with was an angioma. 



The protozoal parasites which occur in the liver are Loeschia 

 histolytica, the cause of hver abscess; Leishmania donovani and 

 L. infantum, the causes of kala-azar and the infantile kala-azar ; and 

 the malarial parasites, as has already been noted. Coccidiosis has 

 been found in the tropics in man several times. 



With regard to the trematode parasites of the liver, Fasciola 

 hepatica is only an occasional parasite of man. Fasciolopsis huski 

 [rathouisi) has been seen in a Chinese who showed obscure liver 

 symptoms, and no doubt microscopical examination of the faeces 

 would make diagnosis possible; but there is only one certain case, 

 and the information regarding the symptoms is meagre. Opisthor- 

 chisfelineus 3.ndAmphimerus noverca are the cause of opisthorchiosis, 

 which will be considered later, as will clonorchiosis, caused by 

 Clonorchis sinensis. Dicroccelium lanceatum is considered to be 

 too small to cause any serious symptoms while living in the bile- 

 ducts. Schistosoma mansoni and S. japonicum may both affect the 

 liver (pp. 1589-1867). 



With regard to tape-worms, Tcenia echinococcus is not common, 

 but we have met with one case of echinococcus in Ceylon, which 

 was brought by a Boer prisoner, and Begbie has recorded another, 

 not in the liver, but associated with the lung, in an old resident 

 in Ceylon. One of us has recorded an invasion of the liver by 

 Ascarides, and the formation of abscesses by the agency of these 

 worms. We have also recorded Porocephalus armillatus in the 

 liver. 



Disease of the gall-bladder is common in the tropics, and we have 

 met with acute and chronic inflammations. Gall-stones are often 

 met with, probably as sequelae to typhoid fever, but also arising 

 from other causes. Suppuration of the bile-ducts we have only, 

 seen once, and oedema of the wall of the gall-bladder we have also 

 only found once. Obstructive and catarrhal jaundice are met with 

 fairly frequently in the tropics. 



Rupture of the liver may take place as the result of traumatisms, 

 and recently Herzog has recorded this accident in a Filipino woman 

 as the result of a native obstetrical practice, which consists of 

 traction on a cloth wound round the abdomen. In this case the 

 rupture had been caused by the perforation of the tip of the eleventh 

 rib into the fatty liver. 



The pancreas, in our experience, is not infrequently found 

 diseased. We have met with the following types of inflammation 

 in Ceylon 



1. Acute haemorrhagic pancreatitis. 



2. Acute suppurative catarrh of the ducts. 



