HYPERTEOPHIC CIRRHOSIS OF THE LIVER (HANOT'S CIRRHOSIS) Bypertrophic cirrhosis is met with more frequently in childhood than the atrophic form. The etiology is still completely unknown. Itutinel, judging from the manifestations and course of the disease, classes it as a subacute infectious hepatitis, brought about by an unknown agent. Si:me cases may follow the acute degenerative processes. We can ascribe no importance to syphilis, alcoholism, malaria, or to the acute infectious diseases (scarlet fever, diphtheria, etc.) as factors in the production of hypertrophie cirrhosis. Evidently accessory factors of whose nature we are ignorant are necessary. Some authors ascribed the disease to chronic gastro-enteritis, but we know nothing definite. In 2 cases of this digease described by Audenouct (one 11 months and one 16 months old) no marked digestive disturbances had gone before, nor had there been any acute infectious disease.
Chronic intensely marked jaundice with considerable enlargement of the liver and spleen characterizes the disease; ascites is not present or develops later. The cirrhosis runs a variable course; febrile attacks
associated with pain about the liver alternate with pyrexia.
The liver is large, of a firm wooden consistency. Splenic enlarge ment may be so considerable that the organ can be felt to the right of the navel simulating the leukfemic spleen. We often encounter in chil dren a very large spleen with relatively little increase in size of the liver, associated with joint deformities, especially of the fingers and toes. Arrested growth is a further characteristic of cirrhosis in childhood, says IIutinel. The children remain small and the limbs slender in strik ing contrast to the marked distention of the abdomen. Throughout the disease the liver remains large and jaundice persists. The fatal termination is reached after several years, but in infants the disease runs a more rapid course.