Jaundice & War: Viral Hepatitis and Other Causes of Jaundice in Times of War

Abstract

Outbreaks of illnesses with jaundice have long been recognised in armies during times of war. Warfare results inter alia in continuing gross disruption of all aspects of public and personal hygiene, facilitating the spread of gut borne infections. The treatment of wounds and shock with intravenous blood, serum or plasma exposed recipients to a number of blood-borne pathogens including certain agents of viral hepatitis. With our present knowledge of the different types of viral hepatitis and other infectious diseases and conditions that may be associated with jaundice, it is of interest to review accounts of such outbreaks, clinical features, and deductions made by contemporaries concerning aetiology, epidemiology and communicability. For many years the hypothesis of 'duodeno-biliary catarrh', propounded by Bamberger and Virchow in the mid-nineteenth century, was accepted as explaining the jaundice occurring in viral hepatitis.1 It was thought, on the basis of post-mortem appearances, that inflammatory swelling of the mucosa of the second part of the duodenum and the ampulla of Vater - i.e. the opening of the common bile duct into the duodenum - caused blockage to the draining of bile, resulting in jaundice, hence the name 'catarrhal jaundice'. Only in the 1940s was it recognised that viral infection of the liver itself, with resulting inflammation, was responsible. It should be noted that the first confirmatory laboratory test for any type of viral hepatitis became available in 1970 as a consequence of Baruch S. Blumberg's work that resulted in the detection of hepatitis B surface antigen.2 In 1974 we had the first serological test for hepatitis A and could at last reliably distinguish the two main varieties of viral hepatitis.3 It then came as a surprise to find that there were types of hepatitis that were neither A nor B, specific tests for which were developed much later.