149 
MICROSCOPICAL EXAMINATION 
The protozoal parasites of kala-azar were found in large numbers 
in the bone marrow, spleen and liver, being mostly of the small size 
seen in chronic cases of the disease. In the liver they were found 
with an oil immersion lens in the endothelial cells of the capillaries 
between the columns of hepatic cells in specially prepared specimens. 
With haematoxylin and eosin only very fine dots could be detected 
in this position, being the nuclei of the parasites, closely resembling 
pigmentation, for which I think I must have sometimes mistaken 
them in my original Assam investigation in i 8 g 0 . The persistence 
of the parasites in the advanced cirrhotic stage of the organ is 
remarkable, and leaves little doubt that they are the cause of this 
peculiar intralobular cirrhosis. 
The general appearance of the liver under a low magnification 
(Zeiss A. Oc. 2) is shown in fig. i of Plate I. To the left is seen 
a portion of the capsule at the site of an extensive fibrous band, but 
it will be observed that there is no marked depression of the surface 
such as produces the hobnail appearance of the common atrophic 
cirrhosis of the liver. The capsule itself also shows but very slight 
thickening. The most striking feature is the universal distribution 
of the cirrhotic process throughout the liver lobules, so that the hyper¬ 
plastic connective tissue widely separates each column of epithelial 
liver cells, and, indeed, makes up the greater bulk of the lobules from 
the portal to the hepatic venules. A careful study of a number of 
sections showed that there is extremely little alteration in the general 
arrangement of the liver lobules, which retain to a great extent their 
shape and size, although the intralobular veins are somewhat less 
prominent than usual. There is distinct cellular and fibrous increase 
around the portal interlobular veins, but not extending far round the 
circumference of the liver lobules as a rule, so that the organ is not 
rut up into small areas of licjintic substance by complete circles of 
fibrous tissue, as in atrophic cirrhosis. This explains the absence 
of the typical )-cllow lobulated appearance to the naked eye on 
section of the organ, which is so characteristic of hobnail liver, and 
has probably led to the new form having been frequently over¬ 
looked, especially in its less marked degrees. The perilobular portal 
tissue shows a few well-marked bile-duct-like double columns of some- 
