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AN  ACCOUNT  OF  A  FORM  OF 
SPLENOMEGALY  WITH  HEPATIC 
CIRRHOSIS,  ENDEMIC  IN  EGYPT 
BY 
li.  H.  DAY,  M.D,  B.S.  (Lond.),  M.R.C.P, 
MEDICAL  TUTOR  AND  REGISTRAR,  KASR-EL-AINY  HOSPITAL,  CAIRO, 
AND 
A.  R.  FERGUSON,  M.D.,  C.M, 
PROFESSOR  OF  PATHOLOGY,  GOVERNMENT  SCHOOL  OF  MEDICINE,  CAIRO. 
{Received  for  publication  30  July,  1909) 
INTRODUCTORY 
All  medical  men  who  have  had  experience  of  native  practice  in 
Egypt  are  aware  of  the  frequency  of  cases  of  ascites  due  to  hepatic 
cirrhosis.  Thus  we  find  that  such  cases  account  for  4  per  cent,  of 
admissions  to  the  medical  wards  of  Kasr-el-Ainy  Hospital,  Cairo,  as 
compared  with  0  9  per  cent,  in  the  large  London  hospitals.  This 
fact  is  striking,  as  it  occurs  in  a  country  where  the  large  majority  of 
the  inhabitants  are  Moslems  and  alcoholic  excess  is  rare.  Moreover, 
its  prevalence  in  children,  and  peculiar  clinical  and  pathological 
characters,  easily  distinguish  it  from  the  ordinary  European  variety. 
Familiarity  with  the  condition  of  the  liver  and  spleen  in  such 
cases  enables  one  to  recognise  the  great  prevalence  of  the  disease 
in  an  earlier  stage,  before  the  onset  of  ascites.  An  enlargement  of 
both  these  viscera  is  frequently  noted  in  patients  admitted  for  various 
complaints,  and  the  liver  may  be  felt  in  all  stages  of  cirrhosis. 
Finally,  it  is  a  common  experience  to  find  splenic  enlargement  without 
obvious  hepatic  changes  in  patients  who  present  no  history  nor  signs 
of  malarial  infection. 
The  notorious  difficulties  of  tracing  hospital  patients  at  home 
are  as  nothing  compared  with  the  impossibility  of  obtaining  any 
reliable  information  whatever  of  the  antecedent  or  subsequent 
histories  of  native  patients  seen  in  hospital.  Only  large  experience 
