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much  the  same  as  in  the  alcoholic  variety.  The  records  of  fatal  cases 
show  that  death  occurred  on  an  average  four  months  after  the 
appearance  of  ascites ;  the  longest  interval  was  four  years. 
Occasionally  one  meets  cases  where  the  patient  has  been  temporarily 
or  permanently  cured.  Thus  two  patients  were  tapped  and  remained 
free  from  ascites  for  three  and  a  half  and  twelve  years  respectively. 
A  recurrence  in  the  latter  case  proved  fatal,  and  at  the  autopsy  no 
sign  of  syphilitic  disease  was  discovered.  Operation  omentopexy 
has  not  so  far  given  encouraging  results,  perhaps  owing  to  the 
advanced  state  of  the  disease  at  the  time. 
The  immediate  cause  of  death  was  commonly  hepatic  insufficiency, 
the  patients  gradually  passing  into  a  comatose  state — occasionally 
with  jaundice.  Lung  complications  and  heart  failure  from  exhaustion 
account  for  most  of  the  remainder. 
Pathological  Account  of  the  Disease 
A  disease,  characterised  as  this  is,  by  initial  fever,  a  chronic 
course,  and  a  group  of  symptoms  referable  to  slowly  progressive 
changes  in  the  liver,  with  either  concurrent  or  consecutive  changes  in 
the  spleen,  exhibits  many  points  of  resemblance  to  Kala-azar.  We 
have  accordingly,  during  the  past  four  years,  examined  the  blood, 
spleen-pulp,  and  liver  tissue  during  life,  from  such  cases  as  illustrated 
the  many  clinical  features  in  typical  fashion. 
Before  proceeding  to  summarise  the  results  of  these  observations, 
it  may  at  once  be  said  that  we  have  never  found  in  material  taken 
from  spleen  or  liver  any  parasites  with  the  characters  of  the 
Leishman-Donovan  body. 
The  blood  has  been  examined  by  us  in  upwards  of  forty  cases. 
Ihe  majority  of  these  were  admitted  to  hospital  for  the  relief  of 
ascites,  cirrhotic  change  m  the  liver  with  splenic  enlargement  being 
already  well  established.  The  degree  of  anaemia  is  sometimes 
extreme,  only  1,330,000  red  corpuscles  per  cubic  mm.  being  recorded 
n  one  of  our  cases.  The  average  number  of  red  corpuscles  per 
cubic  mm.  in  the  forty  cases  examined  wms  2,635,440.  The  red 
corpuscles  exhibit  very  considerable  variations  in  size  in  the  more 
advanced  stages  of  the  disease,  although  the  discoid  form  is  usually 
preserved.  Polychromatophilia  is  frequently  observed,  chiefly 
