THE liver is the largest organ within the human body and at the same time does the greatest number of different jobs—upward of five hundred. It therefore should not be surprising that at times it gets inflamed when invaded by certain poisons, bacterial or viral organisms. Inflammation of the liver is known as hepatitis. In the United States, from 30,000 to 70,000 cases of hepatitis are reported each year. The actual total may be very much greater.

There are several kinds of hepatitis. Infectious hepatitis is caused by contamination of one’s water or food supply by the stool or fecal matter of someone who is a carrier of hepatitis. A person can carry the hepatitis virus without himself being disabled or made sick by it. This kind of hepatitis has an “incubation” period of between fifteen and forty days. That is, it takes that long after the virus has invaded one’s body before its symptoms manifest themselves, and they do this rather abruptly. Infectious hepatitis may run its course without one’s being aware of it, which is one reason why there may be many times as many cases of it as are reported. Only two tenths of one percent, or one in five hundred reported cases of infectious hepatitis, results in death.

Quite similar to infectious hepatitis is toxic hepatitis. This generally is caused by certain drugs or chemicals that might be taken through the mouth, inhaled, absorbed by the skin or received through injections. An important function of the liver is to detoxify poisons that enter the body. But certain poisons may be too strong for the liver to handle and so may either harm the liver or interfere with its eliminating other poisons from the circulation.

The most serious liver inflammation is called serum hepatitis. It generally is caused by a transfusion of contaminated blood, although drug addicts also transmit it from one to another by means of hypodermic needles. Its incubation period is from 60 to 160 days, or about four times as long as that of infectious hepatitis. The length of time it takes to manifest itself doubtless is one reason why the number actually reported is far below the actual number.

But the most serious fact about serum hepatitis is that, while only one in five hundred who get infectious hepatitis dies from it, as many as one in ten of those who get serum hepatitis dies as a result. So there may be as many as 3,000 deaths from the 30,000 cases in the United States each year. Until recently it was believed that only by means of blood transfusions or hypodermic needles could serum hepatitis be transmitted, but now there seems to be some evidence that it can be spread in other ways.

A Mysterious Disease
Repeatedly writers on the subject refer to hepatitis as a mysterious disease. Why? For one reason, because up until now man has not been able to isolate the virus that causes it. Thus science writer Lawrence Galton stated: “Of all the diseases that afflict man, few are more debilitating to the sufferer, more frustrating to the scientist and ultimately more mysterious and elusive than hepatitis.”

Another reason why hepatitis deserves to be termed mysterious is that its symptoms are by no means clear-cut; and this, incidentally, may be another reason why there evidently are so many more cases of hepatitis than are reported. A person may have had hepatitis but thought he was merely having a bad cold, a touch of the flu, a bad case of indigestion or diarrhea, not recognizing the nature of his health problem. Thus it has happened that physicians have had patients operated on for gallstones or had exploratory operations performed because of suspected cancer, only later to discover that the patient had been suffering all along from hepatitis.

What Are the Symptoms?
Whether the hepatitis is of the infectious or serum kind, the symptoms are quite similar except that in serum hepatitis they appear much later, and are likely to be more severe and long lasting, as much as six months or more. Among the symptoms generally associated with hepatitis are a pain in the upper right part of the abdomen, loss of appetite, headache, nausea, fever, upset stomach, loose bowels and malaise, that is, a feeling of not being well. As a rule, four days after such symptoms begin, jaundice appears. Bile may be detected in the urine and the stool may become clay colored.

Evidently hepatitis is caused by a vital agent. It laid low a whole team of robust football players back in the fall of 1969. Members of a certain United States eastern college football team were reportedly “dropping like flies” because of having drunk contaminated water a few weeks before. More than 98 percent of all those connected with the college’s football team were involved.
But the difference between the hepatitis case that was recognized because of its severity and the mild case that went undetected could well be due to the state of nutrition and general health of the individual. This seems borne out by the fact that the death toll from hepatitis is fifteen times as high in certain Asiatic lands where there is much malnutrition as it is in Western lands where people get plenty of good food to eat.

Preventing Hepatitis
As to preventing infectious hepatitis, this is largely a matter of making certain that one’s water supply is not contaminated. In large cities this presents less of a problem than it does in small towns and villages and in the rural communities, where the water supply might easily become contaminated by sewage. Care along these lines would indicate caution as to one’s water supply and washing one’s hands thoroughly after using the toilet and before preparing food.

There is also the hazard presented by shellfish, particularly clams, because of their having been contaminated by sewage in the water. Apparently not without some hygienic reasons was the prohibition to ancient Israelites against eating all manner of shellfish.
It has been stated that the only sure ways to prevent serum hepatitis are not to have any blood transfusions and to use only disposable hypodermic needles.

Among the efforts to minimize serum hepatitis that have met with a measure of success have been the freezing of blood (for which researchers are still trying to find the ideal method); separating red blood cells, keeping them until needed, and then using them instead of whole blood. But these have not completely solved the problem.

Recently certain medical scientists have developed the “Australian factor,” produced by experiments on small monkeys known as marmosets. Currently this factor is being offered the medical profession as a means of detecting the hepatitis virus in blood. But not all in the medical profession are enthusiastic about it. Thus Dr. R. Kelsey, pathologist at Illinois Masonic Hospital, who has done much research along these lines, stated: “As far as we are concerned existing tests for Au antigen are very poor screening devices detecting no more than 20 to 25 percent of those who have classical viral hepatitis.”

Additionally, Au antigen testing “gives a false sense of security. The idea of requiring Au antigen testing for all transfused blood is ludicrous at this time.”
Other workers in the field have come up with the Hepa-Gent (HG) test, for which they have great hopes and for which they have made great claims. However, some who have made quite some use of it are rather cautious in expressing approval of it, or giving it unqualified support.

Efforts to prevent serum hepatitis include those directed toward greater care in collecting blood. For example, the State of New Jersey Health Department found that if the blood came from dope addicts or suspected dope addicts the risk of serum hepatitis was seventy times as great as the average. But as for the difference between risks presented by ‘good’ volunteer blood banks as compared with ‘bad’ volunteer blood banks and the difference between ‘good’ commercial blood banks as compared with ‘bad’ commercial blood banks, Dr. M. J. Goldfield at New Jersey Health Department stated: “In spite of all our preconceived ideas concerning good blood banks and bad ones and our blind faith that blood from a well-run bank will be associated with less hepatitis . . . the risk of hepatitis did not vary significantly from one commercial blood bank to another or from one volunteer bank to another.” In other words, a well-run commercial blood bank still has three times the risk of hepatitis that a poorly run volunteer blood bank has!

Coping with Hepatitis
Some doctors let their hepatitis patients eat and do as they please, within reason, whereas others order complete bed rest and nourishing food.
There are some who highly recommend extra vitamins for hepatitis patients. Thus Dr. Fishbein tells of British researchers who have found water-soluble vitamins, such as vitamin C, helpful. Others say that taking vitamin C in very large doses together with vitamin B12 in comparatively large doses is helpful. The use of vitamins as well as to what extent patients should be allowed to eat fat are controversial matters. However, all are agreed that alcoholic beverages should be strictly avoided in cases of hepatitis.
In brief, the lesson seems to be, Work to keep the body in good health. Keep food and water free from contamination, and avoid blood transfusions



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