(536 DISEASES OF THE LIVER. 



parenchyma of the liver, and they undergo retrogressive metamorpho- 

 sis, during which fat granules appear in them, as happens under sim- 

 ilar circumstances in other cells and other tissues. This second form, 

 fatty degeneration^ is one symptom of many structural changes of the 

 liver ; we have already mentioned it in cirrhosis, and shall often refer 

 to it again. Here we shall only consider the first form, fatty liver in 

 the strict sense, or, as we may call it with Frerichs, fatty infiltration. 



On superficial observation, the circumstances under which fatty 

 liver occurs appear very varied : for, on the one hand we find it, along 

 with an excessive production of fat throughout the body, where the 

 supply of nutriment is excessive and its consumption limited ; and, on 

 the other hand, it occurs with excessive emaciation, where there is in- 

 creased consumption of the body. This contrast is, however, only 

 apparent ; both circumstances agree in causing an abnormal amount 

 of fat in the liver. In the one case, fat or the substances from which 

 it is formed in the body are supplied from without ; in the other case, 

 fat is reabsorbed from the subcutaneous and other tissues rich in fat, 

 and taken into the blood. 



If we inquire more minutely into the first-mentioned mode of de- 

 velopment of fat, we find that the persons affected with fatty liver are 

 chiefly those who exercise but little, while they eat and drink freely. 

 But by this mode of life they are subjected to conditions analogous to 

 those under which we place animals when we wish to fatten them. 

 We do not let the latter work, but shut them up in a pen, and give 

 them plenty of hydrocarbons. But, under this treatment, one animal 

 will become fat readily and quickly, while another will do so slowly 

 or not at all ; in the same way, of two persons living alike, one will 

 become fat and have fatty liver, while the other will remain lean and 

 his liver will be healthy. We do not know the causes of the individ- 

 ual predispositions, which appear to be sometimes congenital and he- 

 reditary in some families, or the causes of immunity of other persons to 

 fat bellies and livers. They may depend either on easy or difficult 

 assimilation of nutritive materials ; or on slow or rapid consumption of 

 tissue. If there be a decided predisposition, the disease appears to 

 develop on ordinary mixed diet, if more of it be consumed than is re- 

 quired to supply the place of what has been used up ; if the predis- 

 position to fat be slight, it only occurs where there is an excessive 

 supply of fats, hydrocarbons, and particularly of spirituous liquors. 

 It is probable, but not absolutely certain, that the latter act by retard- 

 ing the transformation of tissue. 



The frequent occurrence of fatty liver with tuberculosis of the lungs 

 has long been remarked ; their connection has been ascribed to incom- 

 plete oxidation of the hydrocarbons, and their transformation into fat, 



