I5I 
atrophy of the hepatic cells and also must considerably retard the 
circulation of the portal blood It thus produces the marked ascites, 
which, although the fluid accumulates much less rapidly than in 
atrophic cirrhosis, yet is a formidable and not infrequently fatal 
complication in these unfortunate people, worn out as they are by 
years of fever, and reduced to an extremely debilitated and emaciated 
state. 
FREQUENCY OF INTRALOBULAR CIRRHOSIS OF THE 
LIVER IN KALA-AZAR 
Among 48 post mortems I have performed on sporadic kala-azar 
in Calcutta in the last few years, marked cirrhotic changes were 
present in the liver in four ; while in seven more, slighter degiees of 
fibrosis were met with. The latter number is certainly too low, for 
in half the cases the exact consistence of the organ was not recorded 
in the post mortem notes, and this degree is very easily overlooked 
On the other hand, the liver was noted to be softer than normal in 
nine cases, so even slight fibrosis is very far from being constantly 
met with. This is due to the extreme variation in the duration of 
this fever, namely, from a few months to five to ten years. In my 
work on Fevers in the Tropics a table of the degree of enlargement 
of the liver in different stages of kala-azar is given, from which it 
appears that marked enlargement of the liver is rarely seen before 
the end of six months fever, while the cirrhotic condition usually only 
appears after several years illness. 
MALARIAL CIRRHOSIS OF THE LIVER 
In view of the fact that until the last few years kala-azar has 
always been classed as ‘ malarial cachexia,’ the discovery of the 
above-described form of cirrhosis due to kala-azar raises the question 
as to how far descriptions of malarial cirrhosis of the liver may have 
been based on cases of kala-azar erroneously diagnosed as malarial. 
In tliis connection it is wortli recording that in five years pathological 
experience at the Medical College, Calcutta, I have only once met 
with a case of undoubted malarial cirrhosis of the liver, in which the 
microscopical picture of uniform extensive thickening of the peri¬ 
lobular connective tissue with much black pigment in its lymph 
spaces, and to a less extent in the intracellular tissue throughout the 
