380 
can  partly  remedy  this  defect,  and  the  history  and  course  of  the 
disease  must  be  gathered  more  from  careful  observation  of  patients 
admitted  in  various  stages  rather  than  from  a  senes  of  individual 
cases  followed  from  the  commencemenl  to  the  end. 
GENERAL  ETIOLOGY 
Incidence.  Hepatic  cirrhosis  must  be  considered  one  of  the 
common  diseases  which  affect  the  native  Egyptian,  although  much 
less  prevalent  than  trachoma,  ankylostomiasis  and  bilharziosis.  A 
census  of  native  patients  in  the  medical  wards  of  Kasr-el-Ainy 
Hospital  showed  that  over  4  per  cent,  were  admitted  for  ascites,  and 
no  less  than  another  16  per  cent,  had  the  disease  in  easily  recognisable 
form,  while  an  additional  ;  per  cent,  had  chronic  splenic  enlargement 
which  in  most  instances  represented  the  earliest  stage  of  the  disease. 
This  cirrhosis  frequently  complicates  ankylostomiasis  and 
pellagra,  and  is  especially  common  when  these  two  diseases  exist  in 
combination.  This  association,  while  striking  clinically,  has  little 
direct  relationship,  for  advanced  cases  of  both  diseases  generally 
show  no  signs  of  cirrhosis  during  life  or  at  autopsy.  Further, 
ankylostomiasis  and  pellagra  are  the  two  commonest  diseases  on  the 
returns  from  the  medical  side. 
A  truer  idea  of  the  prevalence  of  the  disease  is  afforded  by  the 
results  of  a  special  routine  examination  of  all  native  patients  admitted 
to  the  surgical  and  eye  sections  (septic  cases  excluded).  Of  a  total 
of  300  of  all  ages  : 
8  per  cent,  had  splenic  enlargement  (chronic). 
3'3  per  cent,  had  enlargement  of  the  liver  and  spleen. 
2' 3  per  cent,  had  definite  cirrhosis  with  enlarged  spleen. 
This  total  is  not  large  enough  to  show  the  incidence  at  each  decade 
with  accuracy,  but  the  results  so  far  bear  out  the  age  incidence 
recorded  below.  On  this  point  an  interesting  investigation  has 
already  been  begun  by  Dr.  E.  H.  Ross,  Medical  Officer  of  Health  for 
Cairo,  who  examined  over  7,000  children  under  16  years  of  age  and 
found  6' 8  per  cent,  with  enlarged  spleens. 
A  ge.  The  appended  chart  shows  the  numbers  and  ages  of  cases 
admitted  during  two  years,  in  two  curves,  the  continuous  line  showing 
the  age  incidence  among  patients  with  well-established  disease  and 
