638 DISEASES OF THE LIVER. 



liver. It depends on the same structural changes, but is distinguished 

 by a waxy dryness, a peculiar brilliance and intense yellow color. 



SYMPTOMS AND COURSE. In most cases of fatty liver there are no 

 subjective symptoms, and, on objective examination also, only high 

 grades of the disease can be recognized. In fat persons, and in those 

 with consumption of the lungs, we should examine the region of the liver 

 from time to time, even without their complaining. If, in these cases, 

 we find an enlargement of the liver, which is the more readily recog- 

 nized as the liver is usually elongated, has thickened edges, and from 

 the relaxation of its parenchyma hangs far down (Frerichs), and if the 

 enlarged liver be painless, its surface smooth, its resistance slight, so 

 that we cannot readily feel the lower border, these symptoms suffice 

 to complete the diagnosis, on account of the frequent coincidence of 

 fatty liver with these states. 



If the fatty liver be of high grade, as occurs particularly in topers, 

 as in any other enlargement of the liver, there may.be a feeling of 

 fulness in the right hypochondrium. If the abdominal walls, the 

 omentum, and mesentery be also very fatty, the fulness of the abdo- 

 men and the tension of its walls may impede the movements of the 

 diaphragm and interfere with respiration. In such persons the secre- 

 tion from the sebaceous glands is usually so increased that then* skin 

 shines with fat, and, when they sweat, the sweat runs from their skin 

 in large pearls ; this condition of the skin, which is due to the same 

 state of affairs as the fatty liver, is often mentioned as one of its 

 symptoms. 



As fatty livers rarely cause any trouble, as on post-mortem ex- 

 amination the bile is usually found in normal amount and quality, as 

 they can be generally well injected, and as there are usually no symp- 

 toms of congestion in the abdominal organs, the belief has gradually 

 gained ground that the fatty infiltration neither impairs the functions 

 of the organ nor interferes with its circulation. But this supposition 

 only appears correct for the lower and medium grades of the disease. 

 In the highest grades, after death, we often find but little bile in the 

 bile-ducts, and the faeces in the intestines are but slightly colored. 

 The weakly constitution of such patients, particularly their known in- 

 tolerance of bleeding, also indicates disturbance of the function of the 

 liver, From the varicosities not unfrequently found on the capsule of 

 fche liver, Frerichs concluded that the compression of the blood-vessels 

 also caused a slight congestion of the vessels before they enter the 

 liver. It is true there is no enlargement of the spleen or ascites, but 

 the gastric and the intestinal catarrh appear to depend, at least partly, 

 on this congestion. Eilliet and Barthez, consider it not improbable 

 that the profuse diarrhoea which occurs without perceptible structural 



