FATTY LIVER-HEPAR ADIPOSUM. 687 



lue to impaired respiration. But as fatty liver rarely occurs in other 

 ^ling-diseases where the respiration is also affected, and as it often re- 

 sults from tuberculosis of the bones and intestines, and from carci- 

 nomatous and other diseases in which the patients emaciate, the ob- 

 structed respiration cannot be the sole cause of its occurrence in tuber- 

 culosis of the lungs. Sudd and Frerichs agree with the theory first 

 advanced by Larrey, that it depends on too much fat in the blood, 

 and that this was due to the emaciation and reabsorption of fat from 

 other parts of the body. Perhaps the grade of the fatty liver is 

 somewhat influenced by the cod-liver oil so much given of late for 

 tuberculosis of the lungs. 



ANATOMICAL APPEARANCES. Slight amounts of fatty infiltration 

 do not alter the size or appearance of the liver, and can only be recog- 

 nized by the microscope. In higher grades the liver is enlarged, but 

 usually appears flattened; the edges are generally thickened and 

 rounded off. In many cases the increase in size and weight is but 

 slight, in some it is very decided. The peritoneal covering of the 

 fatty liver is transparent, smooth, and shining ; occasionally it is trav- 

 ersed by varicose vessels. According to the grade of the fatty infil- 

 tration, the surface of the liver is yellowish red, or distinctly yellow. 

 We often notice that the yellow color is interrupted by reddish spots 

 and figures, which correspond to the vicinity of the central veins. The 

 consistence of the liver is diminished ; it feels doughy, and pits on 

 pressure with the finger. On incision, we meet little resistance ; a 

 coating of fat remains on the warmed knife-blade. But little blood 

 flows from the cut surface, which is also yellowish red or yellow, and 

 shows the red spots and figures above mentioned. 



On microscopic examination, according to the grade of the disease, 

 the enlarged and usually rounded liver-cells appear either filled with 

 fine fat globules, or these have united to form single larger drops, or, 

 lastly, individual liver-cells are entirely or mostly filled by one large 

 drop of fat. The infiltration always begins at the periphery of the 

 lobules of the liver, that is, near the interlobular veins, the termina- 

 tions of the portal vein ; it rarely extends to the vicinity of the central 

 vein (whose freedom causes the red spots in the yellow liver), and 

 even then the liver-cells in the centre are usually less infiltrated than 

 those at the periphery. The chemical examination of the liver often 

 shows enormous quantities of fat. In one very fatty liver, Vauquelin 

 found 45 per cent, of fat, in one case Frerichs found 43 per cent., 

 and when the substance of the liver was freed from water he found 78 

 per cent. According to Frerichs, the fat consists of olein and mar- 

 garin in variable proportions, with traces of cholesterin. 



One variety of fatty liver is what Home and RoJcitansky call waxy 



