Viral hepatitis

Abstract

The physicians of the 8th century A.D. recognised an infectious jaundiced disease, and from that time epidemics of jaundice have occurred, especially in time of war. It was not until 1855 when 181 people out of 1291, vaccinated against smallpox, developed a condition which Bamberger described as cattarhal jaundice that a serious attempt was made to identify the disease and determine the pathology. It was suggested that a mucous plug secreted by an inflammatory condition in the duodenum blocked the outflow of the common bile duct.In 1918 the virus was suggested as the agent causing jaundice, but no more certain description of it was given. Clinical cases were often confused with Weil's disease, and not until the 1940s was a clear difference in aetiology demonstrated. Volunteers either ingested faecal material or were given serum injections frthm patients with the disease and they developed a similar condition, although no agent could be isolated.This very brief historical account helps to show why the term 'Viral' hepatitis is of recent origin. Until the virus could be isolated, it was still only conjecture that the causative organism of a particular clinical condition was a virus, however strong the epidemiological or pathological grounds for the statement. Isolation was claimed by Rightsel and his fellow-workers in 1956, but even up to the present the virus, or as thought nowadays viruses, have not been precisely described.In this essay, it is proposed to discuss briefly the nature of the viruses, the pathology; clinical features, diagnosis, treatment and prophyllaxis and spend proportionately more space in discussing the epidemiological and serological aspects of viral hepatitis. Two separate conditions are included under this heading, infectious hepatitis and serum hepatitis. Their differentiation is on mode of infection, incubation period and epidemiological pattern, rather than a clear difference of causative agent.