[ 6i ] 
The organs involved are shown in tabular form :— 
Liver. Stomach. Pancreas. Lungs. Orbit. 
7 3 221 
In 5 the liver was primarily affected, in two it was secondary to disease 
>f the Stomach or Pancreas. In the Pancreas it appeared to be primary in 
one case. In the lungs in both cases the growth was secondary. In the 
irbit it was primary. 
The enormous preponderance of Hepatic Malignant growth was not 
imited to the District Hospital, similar cases were met with at the General 
Hospital and elsewhere. It is a common feature of the distribution of 
nalignant disease in other tropical countries as in British Guinea, and is 
lot 'restricted to any one race, as there I have observed it in Negroes, 
Indians and half castes. 
The primary hepatic cases are all of one type and are mainly composed 
of hepatic cells not cells of the biliary ducts. 
Clinically the marked feature and the earliest to attract attention is 
abdominal enlargement due in part to ascites. I he fluid is blood stained 
in some cases, so much so as to appear to the naked eye to be almost pure 
blood. This occurred in two of the cases here. Red corpuscles little 
altered are found in the fluid, and spontaneous coagulation may occur. 
Sometimes when first tapped the fluid may be clear but at subsequent 
operations blood stained. There was no jaundice in these cases. 
The liver is always enlarged and may be felt to be nodular. The 
growths are multiple but vary greatly in size and in number. In three the 
growths were scattered all through both lobes. In the other two one 
growth was much larger than the others and the other masses w ere only 
distributed in the one lobe. 
The surface of the growth is always convex and on section shows no 
cupping or contraction. The consistence varies but is never hard or fibrous 
and may be so soft as almost to give the impression of fluctuation. The 
growths show no tendency to break down or undergo any form of degenera¬ 
tion beyond fatty and pigmentary changes. They may be entirely 
yellowish white and are usually pale in their greater part, but may be 
parti-colored and sometimes appear to be tabulated. 
In one case there w r ere secondary deposits in both lungs but not elsewhere. 
On microscopical examination the growth is seen to be composed of 
large cells, with abundant protoplasm, irregularly hexagonal in shape. The 
cells differ from normal hepatic cells in that the cells stain more readily with 
basic stains, are somewhat larger and more irregular. The arrangement is 
in clumps or columns. The tendency to the formation of columns is more 
marked in some cases than in others, and occasionally these columns are 
*, imperfectly tubular. The fibrous tissue is scanty but more abundant m some 
cases than in others. In none did it form, even in the central parts of the 
|j growth, dense masses. In a few instances the growth was divided by definite 
fibrous strands and in these in one specimen biliary ducts were present. 
There was no definite capsule to the growth, but the surrounding 
hepatic tissue was formed of hepatic cells flattened and compressed. 
In the one instance in which secondary growths occurred in the lungs 
the central part of each of the pulmonary growths contained cells similar to 
those in the hepatic tumour but the periphery of each growth was formed of 
alveoli filled with round celled exudation — secondary pneumonia. 
