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HEPATITISFROM A CORRESPONDENT

AT the meeting of the Czechoslovak Society of Gastro-enterology and Nutrition in Carlsbad on Sept. 20-24 oneof the main themes was hepatitis.

Dr. V. KUBELKA (Prague) has isolated a virus (the Motolvirus) from the blood of patients with infective hepatitis. Afterone passage on the chorioallantoic membrane of nine-day-oldchick embryos, it showed specific cytopathogenic effects inthe course of 35 passages in monkey-kidney-tissue cultures,although it failed to reveal such effects in Hela-cell culture.It caused fatal hepatitis in mice, and also agglutinated variousanimal erythrocytes in the cold. Intradermal injections of theinactivated formolised virus produced an allergic reaction in60% of patients convalescing from hepatitis, compared with15% of control subjects.

Dr. A. K. SHUBLADZE (Moscow) has also isolated a virusfrom the blood of patients with hepatitis, and maintained it inchick-embryo fibroblast tissue-culture. Another strain from

dog hepatitis has been grown in dog-kidney tissue-culture.Neither strain could be adapted to Hela cells. She notedcertain similarities between the human and dog strains: bothwere associated with intranuclear elements in liver cells, andboth had hepatoencephalotropic properties. The severity ofcanine hepatitis was much more pronounced if there is accom-panying spontaneous infection with Pasteurella pestis or a

non-haemolytic streptococcus. Synergistic bacterial and virusinfection resulted in a mortality of almost 100%, com-

pared with 10-20% among dogs affected only by virus

hepatitis. Dr. Shubladze had not established the specificityof these various human and animal hepatitis viruses byserological means. They were antigenically related to

viruses of the spring-summer and Japanese encephalitisgroup, but not to other neurotropic viruses such as Coxsackie,herpes, lymphocytic choriomeningitis, rabies, and equineencephalomyelitis.

Since 1950, notification of infective hepatitis has been

compulsory in Czechoslovakia, and this has aided epidemio-logical studies. Dr. K. RASKA (Prague) said that epidemicsstarted in schools, and it was three times commoner in childrenattending nursery-schools. These school endemics hadsmouldered on for six to ten months, until prophylacticy-globulin had been introduced.

Dr. J. HONEJSI (Prague) suggested that the most satisfactorybiochemical tests were the enzymatic ones, such as the levelof serum-transaminase activity. Although more sensitive thanthe commonly used flocculation tests, none provided a specificdiagnosis, which depended on virus isolation and the develop-ment of standard serological and skin tests.

Dr. 1. B. BRICK (Washington) drew attention to extrahepaticmanifestations which were sometimes overlooked, but oftenprovided valuable pointers to the diagnosis of chronic hepatitisor cirrhosis. They included white, ridged, and clubbed nails,muscle wasting, red palms, xanthomas and pigmented creases,parotid enlargement, Dupuytren’s contractures, and vascularspiders.

Dr. J. CAROLI (Paris) presented a strong case for combiningdiagnostic aspiration biopsy of the liver with direct inspectionof the liver by laparoscopy and even laparophotography.Colour photographs obtained by peritoneal endoscopy aidedanatomical classification, helped in assessing the prognosis,and, when recorded serially, were useful in evaluating theresponse to treatment.

Dr. E. KLIMKOVA (Prague) drew attention to the value ofelectroencephalography in evaluating the neuropsychiatricsequelae. Although not specific, the slow waves might be help-ful in following the course and assessing the response to

therapy. Dr. J. LIBANSKY (Prague) had analysed a series oftwelve cases in which prolonged hyperbilirubinaemia hadfollowed acute hepatitis. This condition must be distinguishedfrom Gilbert’s familial jaundice and from congenital hxmolyticstates.

In England NowA Running Commentary by Peripatetic Correspondents

William Harvey, when he left England in 1636 accompanyingthe Earl of Arundel on his embassy to the Emperor of Germany,took great pains that his sede was in order and we can imaginehis chagrin when, to use his own words, he received

"

a veryunjust affront being stayed and commanded by this podesta tohave gone in the lazeretto with no cause or suspicion alleged ".He chose the open fields rather than the lazeretto andthere he was detained, although he said " my business requiresexpedition" for " God knows how long". A letter to theAmbassador, Lord Feilding, produced some amelioration of hisliving conditions, but he suffered an attack of sciatica and whenhe had been impeded in his progress for eleven days a heavymessage from the Senate of Venice said he must wait anotherseven or ten or twenty days.

I, like Harvey, set out this year thinking all was in order, butI was wrong. I wanted to cross the Transjordan/Syrian borderen route for Lebanon. Transjordan and Syria have broken offdiplomatic relations. The protecting power, Indonesia, issued avisa for transit but presentation of it at the frontier got thesimple remark, " You have been in Israel and it is illegal toenter Syria ". I had to retreat to Jerusalem, fly to Beirut,which cost an extra E10, and saw Damascus only from the air.Later when I was on the boat from Cyprus to Turkey, a fellowpassenger who heard I was taking the Orient Express home,asked if I had any difficulties getting visas for Bulgaria andJugoslavia. My agent in England told me this was unnecessaryif I didn’t get off the train. How wrong he was. Rememberingthe golden rule of travellers-" There is always the BritishConsul "-I consulted him on arrival at Izmir (the moderncorruption of Smyrna), and he verified that I must have visaswhich I could get at Istanbul. There the British Consul saidI would be lucky if I got them in 48 or 72 hours, and that theBulgars were very difficult. In Izmir I got my photographs intwo hours. On arrival at Istanbul I got some extra Turkish

money and was at the Jugoslav Embassy at 10.30 A.M. andreceived my visa by 11.15 A.M. and was at the BulgarianEmbassy at 11.30 A.M. and was told, after filling up a form, tocall for the visa next day. Explaining that I must travel thatafternoon to attend a medical conference in Germany, I wassent to a higher authority who said he would do it if he had

r time and if I would wait. His interpreter said, " The Consul

l is very kind, he will help you ". By 12.20 P.M. I had the visa,took a taxi to the Golden Horn, had lunch with a friend,visited St. Sophia’s (its mosaics being beautifully uncovered

, from Moslem plaster by Oxford and Harvard graduates), the-

Blue Mosque, and the erstwhile Sublime Court, and got theOrient Express at 15.45, feeling my curses which I thought Iwould cast on the Bulgars should be reserved for the English

1 agent who had wasted the only morning I had to spend ins Istanbul.i, However, I felt my fate was evidently better and less deserv-e ing than Harvey’s.

... *

Time marches on and the sea is almost empty. The last ice-cream van has disappeared, and the last fish hook has beendrawn from swollen finger and reluctant fish. But let’s admitit, we still have our fun. What with carnival procession, circus,and election all squeezed into two glorious days we hardlyknew where we were. The carnival was the best ever; thecircus, for once in the centre of the town, took care of the crowdwhen the procession had passed. After that of course therewas no time to go to the last-night electioneering speeches.We didn’t worry. We all knew whom we were voting for, so whyrisk getting muddled at the eleventh hour ? Thursday came,and what with T.v., wireless, and loudspeakers going roundthe town it was every bit as good as last night’s circus andnothing to pay. Friday the whole town slept late. After allwe had done our bit. We had voted and stayed up till 4 A.M.watching it all on T.V. and had earned our rest. Then Sundayand the anticlimax. The moon has lost its moon face. Truly