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Interest in infectious hepatitis has been greatly increased by the large number of cases occurring in our armed forces during the war. Whether there has been a corresponding rise in incidence among civilians in the United States is not known since it is not generally reportable; but it is worthy of note that a significant rise in the civilian rate has been reported in several other countries. 1 We have already pointed out that this disease is more serious than was previously thought and have emphasized the importance of its prompt recognition and proper treatment. 2 However, the diagnosis of sporadic cases, especially the nonicteric types, offers difficulties not encountered during epidemics. Because of these difficulties we feel justified in presenting a detailed report of the practical problems involved in the clinical diagnosis. MATERIAL AND METHODS Our experience, gained largely in the army, is based on the observation of approximately

The theory that circulating substances play an etiological role in arterial hypertension has been revived recently by a series of studies carried on by Bohn and his associates.1,2,3 These investigators of the Volhard clinic have reported the finding of increased amounts of pressor substances in the urine and in the blood of patients with “pale hypertension” (Volhard). In view of the important implications of Bonn's conclusions, we have reinvestigated this problem.Because of the fact that several hormones and chemical substances are present in greater concentration in the urine than in the blood, and because large amounts of urine are readily obtainable for maximum chemical concentration, we have studied particularly extracts of urine. Blood and chest, abdominal and cerebrospinal fluids were also tested, both before and after extraction. In order to ascertain the efficacy of the alcohol-acetone fractionation of pressor and depressor substances, we have tested biologically not only the alcohol but also the ...

VIRAL HEPATITIS B Although considerable presumptive evidence concerning carriers of hepatitis virus B (serum hepatitis virus) can be seen in retrospect to have accumulated since 1920, when Stokes and others 1 suggested that an infectious agent was responsible for liver injury following parenteral injections of bismuth or arsenicals in the treatment of syphilis, it was not until Findlay and MacCallum, 2 J. P. Fox and others (1942), and the armed services, during World War II, used yellow fever vaccine buffered with human serum 3 that striking evidence was obtained of the presence of carriers of this virus in the general population. Additional data, accumulated in England from studies on serum pools used in measles prophylaxis 4 and in the United States from experience gained with American National Red Cross plasma pools, 5 have suggested that a considerable proportion, probably 0.2 to 0.5%, of the general population carry hepatitis virus B

IT HAS been known for many years that infectious hepatitis may occur in infants and small children.1Relatively few cases, however, have been reported, and the incidence of the disease in children under 3 years of age is said to be low.2Molner and Meyer,1efor example, in reporting on 194 children with the disease from Detroit, found only 5 between the ages of 1 and 4 years, but 77 between the ages of 5 and 9 years. Although this age differential may be due in part to residual maternal immunity or to the lack of exposure, it may also be the result of failure to recognize the disease. The degree of susceptibility would appear to be fairly high from Cookson's1hfinding that 20 of 66 children, mostly under 4 years of age, in a children's nursery acquired hepatitis with jaundice. Adequate descriptions of the clinical and laboratory findings in

INTRODUCTION It is well established that infectious hepatitis may occur in infants and small children,* although it is considered rare at this age.† Relatively few cases have been reported, and while the clinical picture and course of the disease are reasonably well known, the laboratory findings have not been well documented. According to most observers, the disease in this age group is unusually mild, transitory, and without sequelae.‡ On the other hand, persistent and progressive cases § and fatalities ∥ have been reported. In addition, evidence has been presented that in infants and small children cirrhosis of the liver may sometimes develop as a result of viral hepatitis.¶ Whether the infectious hepatitis strain of virus is involved in such cases has not been definitely determined. Regarding the nonicteric form of the disease in infants and small children, practically nothing is known beyond the fact that it occurs. A few cases

The surgical treatment of portal hypertension has depended primarily on the use of portacaval or splenorenal shunts. 1-13 The shunt procedures are usually performed in patients who have hemorrhaged from esophageal varices, the surgery being done during a quiescent period. The use of balloon tamponade has been the most universal method of controlling the acute bleeding from esophageal varices. 14 Recently, however, portacaval shunts have been recommended as an emergency procedure in acutely bleeding patients. 15 Difficulty in the management of these patients, particularly the cirrhotic patient, has led to the introduction of various other procedures, such as gastroesophageal reaction, 16,17 transection of the upper stomach with resuturing, 18,19 and transesophageal ligation of varices. 20-22 Ligation of arterial supply to the liver and spleen has also been advocated by some. 23-26 Much of the difficulty in comparing mortality of surgically and medically treated patients is the great influence exerted on

IT HAS been known for many years that anemia is frequently present in chronic liver disease, especially in cirrhosis of the liver. The etiology, however, has been obscure and has been the subject of considerable discussion. Since the anemia is often macrocytic in type, as first noted by Gram, in 1883,1and subsequently confirmed by others,* it was only natural that a deficiency in the anti-pernicious-anemia factor be suspected. This explanation, however, has been largely discredited because of the lack of response to liver extract † and because the bone marrow is rarely megaloblastic in character.‡ In addition, it has been shown by Schiff and coworkers15that extracts made from cirrhotic livers are able to produce a hematological remission in patients with pernicious anemia. In 1904 Bleichroeder first described the occurrence of red bone marrow in the femur of patients with cirrhosis and made the statement that "in

In a previous communication we have reported our observations on acute infectious hepatitis in the Mediterranean theater.1During the course of these studies it became apparent that certain patients failed to recover promptly, exhibiting symptoms and findings indicating persistent hepatic disease for prolonged periods of time with a tendency toward exacerbations and remissions. These cases present a sufficiently distinctive and uniform clinical picture to justify their consideration as a separate group or syndrome, which we have called chronic hepatitis. By the use of the term "chronic" we refer only to duration without implication regarding the nature of the pathologic process or the eventual prognosis. Although the existence of this condition has been recognized by others,2we believe that this is the first detailed clinical description based on adequate material. Because of the large number of persons who have had infectious hepatitis during the last few years, the interpretation

For many years it has been known that pressure over the vagus nerve produces slowing of the heart.1Not until 1923, however, was the true mechanism of this phenomenon recognized. Hering2conclusively demonstrated in animals that slowing of the heart and other effects of such pressure are due to reflexes arising in the carotid sinus. His work has been amply confirmed, particularly by Heymans.3The application of these findings to man has been rather recent. A report of fifteen cases by Weiss and Baker4demonstrated that an abnormally sensitive carotid sinus mechanism can be responsible for attacks of unconsciousness and convulsions and that such attacks can be reproduced by pressure over one carotid sinus. In most of the fifteen patients the attacks were associated with cerebral anoxemia resulting either from cardiac asystole or from a primary reflex depression of the blood pressure. In two patients, however

The danger of accidentally transmitting disease from one person to another by means of a common hypodermic syringe has generally been looked on as remote. This is particularly true when dealing with apparently healthy persons. In fact, until recently, syphilis and malaria were the only common infections which were known to be readily transmitted in this manner. With the widespread and frequent use of syringes in the modern practice of medicine, the demonstration that another disease, virus hepatitis, may be so transmitted becomes a matter of considerable importance. It has now been experimentally demonstrated that virus hepatitis, including both the infectious or epidemic and the homologous serum type, may be transmitted to human beings by the parenteral injection of infected serum.1As little as 0.01 cc. of serum has been sufficient to produce the disease.2The filterable agent is present in the blood during botn the preicteric and

The "side ache," or "stitch in the side," that occurs with exercise in normal persons is well known to layman and to physician alike. It was mentioned by Pliny the Elder and by Shakespeare. In spite of its frequent occurrence, it has received little attention in the medical literature. Explanations regarding its mechanism have been largely speculative. I have been able to find only four papers in which actual data concerning its nature have been recorded. Benjamin,1in 1923, stated that this pain occurred only in "constitutionally inferior children." He claimed that because of faulty vasomotor regulation, exercise resulted in congestion and swelling of the liver and the spleen. The pain was due to visceral distention and to pulling on the suspensory ligaments. He stated that relief was obtained by deep breathing, by tightening of a belt or by local external pressure. He detected enlargement of the liver and

Excerpt INTRODUCTION During the last five years the incidence of infectious hepatitis has approached epidemic proportions among both civilians and military personnel in various parts of the world.1...

Since the pioneer work of Hering 1 in 1926 a mass of experimental data has accumulated concerning the function of the carotid sinus in animals. The significance of the carotid sinus mechanism in man, particularly as regards certain abnormal bodily states, has, however, not been duly appreciated in the United States until recently. One of us (S. W.) and Baker 2 reported the cases of a series of fifteen patients, all of whom complained of attacks of unconsciousness, with or without convulsions, which were caused by a hypersensitive carotid sinus reflex. In a recent publication we 3 reported studies of thirty-two additional patients suffering from syncopal attacks of carotid sinus origin. This syndrome is reflex in nature, and the reflex pathways are parts of the autonomic nervous system. In other reports 4 we presented evidence of the nature of other types of reflex syncope, such as vasovagal, vagovagal and oculocardiac

A tissue culture system is described which permits identification and propagation of isolates from the blood of hepatitis patients. Techniques first described in 1956 have been greatly improved. Viruses thus isolated produced hepatitis in 3 clinical studies. Incubation period, symptoms, clinical manifestations, and laboratory findings were typical of infectious hepatitis. Viruses were consistently reisolated from these cases and specific neutralizing antibodies were demonstrated. Limited studies indicated at least 3 distinct virus serotypes, 2 of which produced hepatitis with jaundice. Application of ultrafiltration, ultracentrifugation, and electron microscopy to infectious tissue culture fluid revealed 12 to 18 mμ particles not found in controls. Similar particles were noted in infected cultured cells. Despite difficulties, these clinically proved laboratory techniques insured continued characterization of hepatitis viruses. These techniques may eventually become tools for diagnosis and preparation of antigens and vaccines.

Outbreaks of infectious (epidemic) hepatitis have been recognized for at least 200 years and probably for very much longer.1Although they are particularly extensive among armies in the field, civilian epidemics have also been frequently encountered. Accurate data are not presently available in this country because the disease is not generally reportable, but according to our personal experience epidemics are constantly occurring. That this virus infection represents one of the commoner infectious diseases occurring in this country is shown by recent studies with a specific skin test material.2It was found that approximately 35% of adults had positive reactions, indicating presumptive prior infection with the virus. The importance of this disease, however, is due not only to its high incidence but also to its relatively serious nature. Although the mortality rate is usually under 1%, the period of disability is frequently prolonged, and the occurrence of chronic cases

In the past, several investigators have postulated increased amounts of hormones of a pressor nature in the blood of patients with arterial hypertension. Others have suggested as a cause of hypertension the retention in the blood and tissues of metabolic products having a pressor action. One of us (Dr. Weiss 1 ) has recently discussed these various theories, and a critical analysis with references can be found in that paper. In recent years, interest in the relation of such substances to hypertension has been stimulated again, largely through the work of two groups of investigators in Germany. Lange and Felix, 2 in 1933, claimed to have found diminished amounts of a specific depressor substance in the blood and increased amounts in the urine of patients suffering from essential hypertension, and increased amounts in the blood and decreased amounts in the urine of patients with nephritic hypertension. They advanced the theory that

For many years prior to this war infectious hepatitis was considered to be a relatively infrequent and unimportant disease. During the last four years, however, cases have been appearing in increasing numbers in both civilians1and military personnel in various parts of the world. This has afforded opportunity for the study of large groups of cases and has led to a reawakening of interest in the disease among both investigators and clinicians. Our own interest in this condition began in 1942 when two of us (M. H. B. and R. B. C.) participated2in an official investigation of the so-called "postvaccinal" hepatitis at Fort Custer, Michigan. At that time an extensive clinical and laboratory study was carried out on over 2,000 individuals who were recipients of yellow fever vaccine, 700 of whom were hospitalized with jaundice. This experience subsequently proved most valuable when we were given the opportunity

During the last decade research in the field of liver disease has greatly increased and the volume of publications has become enormous. Due to rapid developments in the basic sciences and the application of new techniques, scientific investigation in this area has been extended in depth as well as extent. As a result there is a very real need for a book of this sort. In essence this volume consists of 24 critical reviews of selected aspects of liver disease. In each case the authors are authoritative investigators in their own fields. In general, subjects have been chosen in areas where recent advances have taken place. For example, "Auto-Immunity in Liver Disease" is discussed by MacKay and Wood and the "Response of the Liver to Injury" by Popper and Schaffner. The latter chapter is beautifully illustrated and concerns the ultrastructure of the liver as seen through the electron microscope. Other