147 
A PECULIAR INTRALOBULAR CIR¬ 
RHOSIS OF THE LIVER PRODUCED 
BY THE PROTOZOAL PARASITE OF 
KALA-AZAR 
BY 
LEONARD ROGERS, M.D., F.R.C.P., B.S.. F.R.C.S,, I.M.S. 
PROFESSOR OF PATHOLOGY, MEDICAL COLLEGE. CALCt'TTA 
(Received for Publication i6 March, 1908) 
In my report on Kala-azar, published in 1S97, I described a 
dropsical form of the disease, which appeared, in part at least, to be 
produced by cirrhosis of the liver, which was found in one case post 
mortem. More recent experience has shown this complication to be 
commoner in the more chronic sporadic form of kala-azar, which is 
so frequent in Calcutta, than it was in the Assam epidemic disease. 
These cases, however, were very difficult to verify by finding the 
parasite by spleen puncture on account of the organ receding into the 
abdominal fluid before the point of the needle, although the character¬ 
istic history, greatly enlarged spleen and leucopenia, left no doubt 
in the mind of an experienced physician regarding the true nature 
of the cases. Some degree of fibrosis of the liver was described in 
my first 1897 report, while about a year ago a post mortem on a 
chronic case of kala-azar, which died with all the classical symptoms 
of cirrhosis of the liver, has enabled me to study the advanced stages 
of the affection. I, therefore, propose in the present paper to give a 
somewhat fuller account of the affection than the note in my work on 
Fevers in the Tropics, in which the photograph of a kala-azar patient 
suffering from this type of cirrhosis of the liver is given (opposite 
page 67). The following are the notes of the case referred to above. 
L 
