We studied the morbidity of chronic hepatitis C in patients referred to a tertiary care medical facility. The medical records of 500 consecutive cases of chronic hepatitis C were examined for the following: (1) source and time of exposure, (2) signs and symptoms of liver disease, (3) degree of alcohol intake, (4) liver biopsy findings, (5) extrahepatic disease manifestations, and (6) coexisting illnesses that could have an impact on morbidity. Morbidity and histologic findings were evaluated in relation to the duration of hepatitis C. The onset of infection could be determined in 376 patients (75%). A close relationship between the length of infection and disease features was not observed. Fatigue was common at all stages of infection. Whereas cirrhosis occurred more frequently in patients with disease of long duration, 15-24% of patients had signs of advanced liver disease (ascites, encephalopathy, thrombocytopenia) within six years of exposure. Overt extrahepatic manifestations of chronic hepatitis C occurred infrequently, and depression was reported in 24% of untreated patients. In conclusion, in patients referred to a tertiary care setting, chronic hepatitis C is often associated with significant morbidity.