Viral hepatitis: overview and historical perspectives.

It is a privilege and an honor to be asked to present a general overview and a historical perspective of a subject that has occupied the last 20 years of my medical career. I can assure you that when I accepted this assignment, I did not regard it with a "jaundiced eye." It is particularly appropriate to discuss viral hepatitis with military consultants to the Armed Forces because it is well known that this disease has had a profound effect on military as well as civilian populations throughout the world. During the past three or more centuries "epidemic jaundice" (viral hepatitis, type A) has been recognized as an important military disease, especially during periods of war. Outbreaks were recorded in Germany in 1629 and in the British Army in Flanders in 1743. Epidemics occurred in military and civilian populations at the time of the siege of Paris during the Franco-Prussian war in 1870. Other epidemics occurred during the Boer War in South Africa and in the Japanese Navy during the war with Russia in 1904. This trend continued during the course of all subsequent conflicts: World Wars I and II, the Middle East Wars in 1948, 1956, and 1967, and more recently the Korean and Vietnamese Wars. During the past 50 years the term "epidemic jaundice" referred to a disease that had other names in various parts of the world: jaunice des camps in France, Soldatengelbsucht in Germany, infective hepatitis in England, Botkin's disease in Russia, and acute catarrhal jaundice, epidemic hepatitis, and infectious hepatitis in the United States and other parts of the world. More recently the term proposed by MacCallum in the 1940's, "viral hepatitis, type A," has been adopted. Unlike epidemic jaundice, an ancient disease, serum hepatitis (type B hepatitis) has a more recent history. The first outbreak was described less than 100 years ago by Liirman (1). The occurrence of smallpox in Bremen in 1883 was followed by an extensive vaccination program. The vaccine at that time was prepared from glycerinated lymph of human origin. Of 1289 vaccinated shipyard workers, 191 (15%) developed jaundice after intervals of several weeks to 6 months. In contrast, of 500 unvaccinated new employees, none became jaundiced. In retrospect, it is obvious today that Liirman's report of an epidemic of icterus in 1883 represented the first recognition of an epidemic of viral hepatitis, type B. During the first half of this century it became obvious that epidemics of jaundice were occurring in patients attending venereal disease clinics, diabetic clinics, and tuberculosis clinics, and in children who received inoculations of measles and mumps human convalescent serum, in patients who received blood transfusions, and in