Notes and Observations on 'Infantile Biliary Cirrhosis'

cases and the detailed notes collected from various sources, it is my idea to present in a connected form the important points associated with the disease. Infantile biliary cirrhosis, infantile cirrhosis of the liver, or infantile liver, is a definite disease entity of infants characterized by an insidious onset, a rather slow course, enlargement of the liver and spleen, jaundice, late ascites, and an invariably fatal termination. It cannot be a form of kala-azar as Castellani and Chalmers (1919) have suggested, as it is found in many parts of India where kala-azar does not exist. History.?No mention of the disease is made in any of the older writings. Sen (1887) first described it and mentioned it as one of the causes of hepatic enlargements in infancy. In the following year Gibbons (1891) described in detail the morbid anatomy and pathology of the disease. Mukherji's (1922) booklet on the subject is the next notable contribution. Since then, a few papers on the subject have appeared, mostly dealing with its aetiology and treatment. Geographical distribution.?It is noteworthy that the disease has not been reported from outside India except one similar case from Mexico and a few cases from North China. Whether the ^etiological factors operating are particularly Indian or whether the disease is merely not reported from other countries, it is yet difficult to say. In India, cases have been reported mostly from Calcutta, Bombay, Madras and the United Provinces. It is common in Malabar, Travancore and Mysore. Mukherji (1922) says that the disease is more prevalent in the cities and the mofussil towns than in the villages. Possibly this is due to the greater opportunities for accurate observation in the cities, and not to any really restricted