Hepatic Cirrhosis

TIhC 0CCLPTen1CC inI h1o0Spitall Within a conmparatively shiort space of time of touIr unuISula.l examllples of cirrhosis of tihe li\-er in-younil-chil(lren has le(d us to Iake this comlnlLI1liunictionl. Disorders of tihe liver in chil(lhoo(l ha\ve iii recent N'ears not attracted imiuchi attentioni in tihis country, and we feel that tlhe mere ventilation of the suLb)ject, thIough,0LI we mXVn have little new to add, may serve ausIeful purpose. It is possilble tthat others besi(les ourselves have beeni iniclinedi to be t(*wi(le(l in their N iews upon cirrihosis of the liver by a recollection of cases of ailcoholic cirrhosis in the adult, an(l to recall such symptoms as chronic and omitiing, liamatemilesis, ascites, j.lu(lice, pruritus, dilate(l capillaries on the cheeks, the caput me(lusw, an(l concomitant restilts of the paxrtiCt.lar cause suchl as sleeplessness, wasting, loss of memnory, and tremilor. Again it is possible that a(dmittinig the rarity of alcohol ats a causal factor in tile child we incline over much to a syphilitic origin. It is, we believe, a more illumin.ating, thiouglh certainly a dliflicult undertaking, to (liscardI entirely our \ iews upotn citrrhosis of the liver in adults and to approach the problem in the child from the clinical and(i pathological features at that age. Among the symptoms that we associate with cirrhosis of tile liver in childhood there atre many of those which we have already mentione(d ini referring to alcoholic cirrhosis. Epistaxis may be frequent, an(l telangiec-tases are often present, so that the face ma) present at a glance an aspect similar to that of chronic alcoholism. Ascites, however, an(l (lilatation of thle superficial abdominal-eins, are ofteni absetit, and more remarkable still thlere may be no (ligestive (listurbaince. Special features related to chil(dhoo(d are infantilism,niI a familial occurrence of the (lisease, whiich in its frequlellnc is N erv striking. In adults suffering from chronic cirrihosis there may occur a suddeni intenisification of the jaund(lice with fever, nervous\ smptoms and(leath in coma, anIlid microscopy shows an acute (lestruction-of liver cells. In child-11hoo(, also, such a development may supervene and be a cause of death from acute red atrophy. In these instances we seem to2)e able to trace a correlation between the urgenit symptoms and the dlestruction of the liver cells. Here in child anid a(lult the picture is i(leitical. In chilireni, however, more thianl in adults, this (cxacerbation of (ldamge to thie hepatic cells may assume a subacute form, possibly …