A well-marked case is distinguished by the following anatomical characters: the liver is enlarged, the increase of size taking place chiefly in a lateral direction; its edges are flattened and swollen, the peritoneal covering is smooth, shining, transparent and tense; the organ is soft and pits on pressure; its color, internally and externally, is uniformly yellowish-red or light yellow, resembling that of autumnal foliage; it is pale and exsanguine, and contains a large amount of fat, as evidenced by the greasy deposit when cut with a dry warm blade, or as proved by submitting the liver to high temperatures.

The disease consists in a deposition of free adipose tissue to such an extent as not only to replace the true glandular structure, but to penetrate the entire parenchyma to the exclusion of the vascular tissue.

In the earlier stages of the affection the various signs alluded to are less marked.

Two conditions chiefly favor its production:

In the first instance it very commonly accompanies tubercular phthisis; and, according to the researches of Louis, is found in two-thirds of all cases of phthisis. Andral has explained this occurrence on the ground of impeded secretion of hydrogen by the lungs; but extended investigation allows us to conclude that this impediment, which is not even demonstrable, is not the cause of the deposit; but that it is an essential constituent or pathognomonic combination of the tubercular dyscrasia, inasmuch as it allies itself with tubercular affections of every kind, with tubercle of the intestinal mucous membrane, of the bronchial glands, the serous membrane, the bones, etc.

Secondly; The fatty liver is also developed - independently of tubercle - in consequence of a luxurious and indolent regimen, in children that have been gorged with food, and especially as a result of dram-drinking. In this case it is accompanied by accumulations of fat in the omentum, the mesenteries, the pericardium, the heart, and the subcutaneous cellular tissue, by fatty degeneration of the muscular fibres of the gall-bladder, and even of the muscular tissue of the heart; the common integument has a leaden hue, and the perspiration has a greasy appearance and a peculiar odor. The fat bears throughout a resemblance to tallow.

The waxy liver is a variety of the fatty liver; it is distinguished from the latter by a color resembling that of beeswax, by its greater consistence, dryness, and brittleness; and these qualities depend upon a peculiar modification of the infiltrated fat, which, although accumulated to a considerable amount, leaves but few traces on the scalpel.

Occasionally the tallow is seen deposited at a few points only, or it accumulates at particular spots. They are commonly superficial, though they are also seen in the deeper parts in the shape of irregularly-circumscribed maculae, which are the more conspicuous by their change of color the less the other portions of the liver are involved in the disease, and the darker they are.