388 
of  cirrhosis  of  the  liver  in  some  degree,  exclusive  of  the- types  above 
mentioned,  in  no  less  than  g'g  per  cent,  of  1,430  autopsies  recorded, 
Of  this  proportion,  4  5  cent,  may  be  said  to  have  died  as  a  direct 
result  of  the  secondary  changes  induced  by  cirrhosis,  exhaustion  after 
repeated  recurrences  of  ascites  being  probably  the  most  frequent 
cause  of  death.  In  the  remainder,  cirrhosis  of  the  liver  was  discovered 
incidentally,  death  m  these  cases  resulting  from  a  great  variety  of 
other  diseases.  In  those  cases  in  which  the  disease  was  more  or  less 
directly  responsible  for  death,  this  occurred  in  the  large  majority  of 
cases  at  about  thirty-five  years  of  age.  Exceptionally,  however,  the 
same  changes  were  encountered  in  subjects  of  over  sixty  years  of  age. 
The  most  typical  morbid  appearances  were  met  with  in  young  subjects 
dying  between  the  ages  of  seven  and  twenty-one  years.  Approxi¬ 
mately  one-third  of  these  cases  was  associated  with  some  enlargement 
of  the  liver  ;  in  the  remaining  two-thirds,  the  organ  was  either  normal 
or  slightly  reduced  in  size. 
The  cases  in  which  cirrhotic  changes  in  the  liver  were  accidentally 
encountered  were  of  the  most  diverse  character.  The  type  of  cirihosis 
met  with  under  these  circumstances  has  been  of  the  fine  diffuse 
variety,  and  not  such  as  to  induce  much,  if  any,  external  alteration 
of  the  organ.  With  few  exceptions,  there  is,  in  these  cases,  a  slight 
general  enlargement  of  the  whole  organ,  as  well  as  a  moderate 
enlargement  of  the  spleen.  Microscopically,  the  evidences  of  cirrhosis 
are  slight,  a  certain  amount  of  cellular  fibrillated  tissue  mixed  with 
lymphocytes  surrounding  groups  of  lobules.  In  a  typical  case  seen 
at  this  stage,  and  undisturbed  by  any  coincident  disease,  the  liver 
cells  were  for  the  most  part  large,  swollen  and  highly  granular.  Their 
nuclei,  stained  by  the  Romanowsky  method,  were  paler  than  usual, 
and  each  contained  several  nucleoli,  which,  by  their  depth  of  staining, 
contrasted  strongly  with  the  remainder  of  the  nucleus.  Here  and 
there,  minute  isolated  foci  of  necrotic  appearance,  surrounded  by 
collections  of  small  mononuclear  cells,  were  met  with,  resembling 
generally  those  seen  in  the  liver  in  typhoid  fever  infections.  Careful 
search  made  both  in  films  and  sections  for  parasites  always  yielded 
negative  results. 
In  cases  where  death  was  directly  attributable  to  the  results  of 
long-established  cirrhosis,  the  picture  presented  by  the  liver  is  very 
different.  The  organ  in  these  cases  is  generally  reduced  in  size, 
