The development of a true atrophic cirrhosis of the liver due to malarial in fection is as yet an undecided question, and must be, in any event, of rare occur rence. Kelsch and Kiener, however, dis tinguish three forms of chronic malarial hepatitis ([1] with hyperinia; [2] with cirrhosis; [3] with adenomata) and two groups of cirrhosis ([1] insular cirrhosis with nodular hepatitis, and insular cir rhosis with diffuse parenchymatous hepa titis; [2] annular cirrhosis, with nodular or diffuse parenchymatous hepatitis).
Both Marchiafava and Bignami deny that true cirrhosis follows malaria, and make the following distinctions: In the case of malarial cirrhosis or hepatitis the increase in the connective tissue is peri lobular, and surrounds the individual lobules, and the branches of the portal veins are not obliterated. In true at rophic cirrhosis the hyperplastic con nective tissue surrounds a number of lobules, retracts upon them, and leads to compression of the portal vessels. The changes taking place in the liver-cells in the two conditions are also different, be ing, as the result of malaria, of a grave nature and primarily local, while in true atrophic cirrhosis they depend upon the newly-formed perilobular connective tis sue.
The row. — The marrow of the long ones, particularly in the upper and lower portions, is usually red and its consistence somewhat increased. The microscopical examination reveals pro liferation, more or less active, of the cel lular elements of the marrow, and greatly increased vascularity. The mononuclear myelocytes, both large and small, are in creased and many of them show evidences of degeneration. Nucleated red blood cells, or normoblasts, are found in large numbers, as well as a few megaloblasts or gigantoblasts. Pigment disappears f Tom the bone-marrow much earlier than from the other organs. In rare cases the marrow presents the same features as is • SilOW ing a . i• r f gigantoblasts , s No mark( (1 changes oe