ATROPHIC ALCOFIOLIC CIRRHOSIS (LAENNEC'S CIRRHOSIS) Most of the reported cas.es of this disease are from England where the poor children in the large cities are given brandy and gin at an early age, but the number of cases reported from other countries (France, Germany, Italy, Switzerland) is daily increasing. Hutinel believes that comparatively small amounts of alcohol may give rise to cirrhosis of the liver in childhood ancl that the period of alcoholic indulgences need not be long. The duration of the disease is shorter than in adult life, its course subacute. In the preliminary stage there is dyspepsia, loss of appetite, tympanites and constipation. Diarrhcea sets in at times and the children lose flesh. Then ascites appears with hypertrophy of the spleen and usually dilatation of the superficial veins of the abdomen (caput medusa,). The atrophy of the liver which develops insidiously may now be demonstrated if the ascites is slight or after abdo minal puncture. Dulness on percussion is diminished, especially over the left lobe of the liver. Palpation may reveal the increased density
of the liver and perhaps, also irregularities on the surface. Jaundice is absent or scarcely noticeable (subicterus). Later in the disease rhages may occur Clusmatemesis, epistaxis, inelna). Finally dropsical effusions appear and the child succumbs, often from cedema of the lungs.
All observers are agreed that the diagnosis is difficult. Our most difficult task is to differentiate cirrho.sis from tuberculous peritonitis. In favor of the latter disease is its greater frequency. In those cases where the two diseases are associated (a not infrequent occurrence) the diagnosis offers unusual difficulties. Hutincl observed that cirrhosis of the liver in childhood was frequently associated with tuberculous disease of other organs, and this was also true of the cases recently reported by Beck, and Passini. The pathological findings are the same as in adult life.