That condition of the liver in which a separation of the yellow and reddish-brown substances takes place, especially if the former predominates, and which presents a close resemblance to the section of a nutmeg, has been termed the nutmeg-liver; it is commonly considered as a hypertrophy of the so-called white or secreting portion, the red portion either remaining unaltered or being more or less condensed by the former.

According to our own researches the nutmeg liver occurs under two different conditions, and there are consequently two varieties.

aa. In One case it appears as an enlargement of the capillaries of the biliary canaliculi, accompanied probably by hypertrophy of the latter (the secreting substance), and resulting from excessive secretion of bile and stasis of the secretion. The two substances are the more defined, the darker the color of the bile and of the red substance.

/B/B. In the other case it is due to an increased deposit of the fat normally due to the liver.

In either case we trace several degrees:

Firstly, In the lowest degree the normal distinction between the two substances is simply more marked, the white substance appearing more developed;

Secondly, In the second degree the predominance of the white substance becomes more apparent, and forms circumvolutions that envelope the red substance;

Thirdly, In the highest degree the organ approaches, in the first variety, to the granular; in the second, to the fatty liver.

The liver appears, in the second variety, to be slightly enlarged, at least it is never diminished in size; in the advanced stages it has a tendency to become flattened, and to expand whilst its edges are thickened.

Mechanical hyperaemia of the portal system from disease of the heart is peculiarly liable to encourage the development of the nutmeg liver. The affection occurs very frequently; it may present no symptoms whatever, or be accompanied by distinct signs of hepatic disease, though not such as to indicate the specific derangement. In the form in which it presents the early stage of the fatty liver, it most probably gives rise to the numerous complaints which are relieved by neutral salts, alkalies, mineral waters containing these substances, saponaceous compounds, and the so-called resolvent vegetable extracts.