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610 feverishness, constipation, anorexia, irritability of temper, thirst, and languor call attention to the child's condition. On examination the liver is found to be enormously enlarged, extending perhaps to the umbilicus or even lower. The surface of the organ is smooth; the edge, at first rounded and prominent, as the liver begins to contract becomes sharp and distinct and can be readily grasped between the fingers, the swollen organ feeling hard and resistant. Fever of a low type sets in; the sallowness deepens into profound jaundice; the stools are pale, the urine is dark; and there may be ascites, with puffiness of the feet and hands. Sooner or later, death from cholæmia ensues. Pathological anatomy and pathology.— Surgeon-Major Gibbons, who has given an elaborate and most careful account of the pathological anatomy of this disease, concludes that it is a peculiar form of biliary cirrhosis, the consequence of the action on the liver cells of some irritant of gastric origin, which leads to degeneration of the cells in the first instance, with subsequent increase of intercellular connective tissue and, later, of the portal sheaths. The formation of new bile-ducts between the hepatic cells, which is a well-marked feature, he regards as evidence of a natural curative effort having for its object a regeneration of the liver cells.

Treatment.— Hitherto, in this disease, treatment has been of little avail. There is some ground, however, for thinking that early removal from the endemic locality, and a complete change of wet-nurse and food, might have a beneficial effect.