The Pathogenesis of Hepatic Cirrhosis

. evoked the interest of doctors in this hospital. Dr. K. T. Kurian, my co-worker in the medical wards, has had occasion to note the diet of the people in three or four centres, and he has intimate knowledge of the habits and natural conditions of this northern part of Travancore. In the assessment and evaluation of the setiological factors, therefore, his information and help have been found valuable. The distribution of cirrhosis, and diet.? Travancore can be divided into three areas, the coastal sandy belt, the midlands, and the highlands full of hills and forests. The coastal belt is divisible into two halves, one north of Quilon and the other south of Quilon, extending to the Cape. The northern part is full of backwaters, and is damp and sandy, but the southern part, is comparatively dry and hilly. Further, in the northern half of the coastal belt between the extreme coast and the midlands is the marshy Kuttanad area where paddy is grown in large quantity. South of Quilon there is not much difference between the coastal area and the middle zone, since the land tapers to an angle towards Cape Comorin. Near the southern extremity is the Nanjinad area, famous here for the quality of rice produced. Liver disease is more common round about Kottayam than round Trivandrum. The preponderance of hepatic cirrhosis also is noticed in the Kottayam area. Though amoebic abscess the liver and hepatitis are frequently observed ^ the marshy Kuttanad area, it has to be admitted that cirrhosis of the liver is most common in the Kottayam area. Amoebic infection is common in both the areas under reference. Alcoholism also is common in these areas. What then is the factor that predisposes to a greater mcidence of hepatic cirrhosis in the Kottayam area ? A solution of this problem is likely to east some light on some factors influencing the causation of liver cirrhosis. In the Trivandrum area, rice is the staple food. Fish is available in all the parts round about. Fresh and leafy vegetables are also plentiful. Tapioca is available but it is not so intensely cultivated in this area as in the Kottayam area, and it is not so commonly used or food here as elsewhere. In the Nanjinad area (the coastal belt still further south of nvandrum), tapioca plantations are few. This area is famous for the champa rice produced from the extensive paddy-fields. In general this area is dry and healthy. Green and leafy vegetables can be had at all times, and fresh fish also is available. In this Nanjinad area, cirrhosis of the liver is less common than