Heroin Addicts in a Casualty Department.

Liver Disease-Bouchier et al. MEDICAL JOURNAL gamma-globulin and that, in liver disease, the antibody is frequently a macroglobulin, while in D.L.E. it is predominantly a 7S gamma-globulin (Weir and Holborow, 1962). Positive A.N.F. tests were found in the absence of a positive L. Mackay and Wood, 1962). Unlike Calabresi and Greenberg's (1960) findings, antinuclear antibodies were not found in the sera from alcoholic subjects. The abnormal proteins responsible for these serological findings might be a response to the liver damage or they may be an expression of the underlying, possibly genetic, abnormality of the reticulo-endothelial system. Relatives of patients with rheumatoid arthritis show significant increases in the positivity rate of the S.C.A.T. compared with relatives of healthy subjects (Ball and Lawrence, 1961), and healthy first-degree relatives of patients with agammaglobulinaemia also have an increased incidence of positive rheumatoid agglutination tests as well as frequent abnormalities of gamma-globulin (Fudenberg, German, and Kunkel, 1962). Their presence in certain types of liver disease points to an abnormality of the immunological apparatus. Serological studies on relatives of patients with chronic liver disease might be useful in revealing a genetically determined abnormality. Summary Serological studies for the presence of antinuclear antibodies, "rheumatoid " factors, and thyroglobulin antibodies were undertaken in 116 patients suffering from alcoholic, " juvenile," cryptogenic, or primary biliary cirrhosis or from virus hepatitis. An increased incidence of positive latex and sheep-cell agglutination tests, compared with normals, was found in all the varieties of liver disease studied. The highest number of positive results were encountered in juvenile, cryptogenic, and primary biliary cirrhosis ; in alcoholic cirrhosis and virus hepatitis the positivity rate was lower. The latex test was more often positive than the sheep-cell test. Antinuclear antibodies were present in 42% of 38 sufferers from juvenile cirrhosis, and compared with normals their incidence was increased also in cryptogenic cirrhosis. They were not detected in patients with alcoholic cirrhosis and virus hepatitis. The incidence of thyroglobulin antibodies did not differ from that found in normal subjects. During 1962 at least 30 heroin (diacetylmorphine) addicts were seen, 20 by the author personally, in a casualty department in central London. Nearly all these addicts volunteered the information that they took the drug, and injection marks were usually obvious. Hence it is thought that few addicts were missed among the patients attending the department. The number of known pethidine or morphine addicts seen here was much smaller. …