Most Wanted Virus

Few diseases are more mysterious than viral hepatitis--a liver inflammation for which there is no known cure, caused by at least two elusive viruses that no scientist has ever seen. Operating under a dozen aliases (e.g., bilious attack, acute yellow atrophy), hepatitis has occasionally been confused with such unrelated ailments as malaria and mononucleosis, was once believed to be a penalty for excessive drinking. During World War II hepatitis was epidemic in the armed forces of the major combatants as well as in many civilian populations, and more than 170,000 cases were reported in the U.S. Army alone. Because of the difficulties of diagnosis, and because the Public Health Service kept no statistics on the disease until 1952, peacetime outbreaks were thought to be relatively few and largely limited to overcrowded orphanages, mental hospitals and prisons.

But by last week, as the PHS recorded 944 new cases across the nation, hepatitis had become the third most common reportable disease in the U.S.--behind measles and strep-scarlet fever--and a full-blown menace to health. Four for One. The latest PHS figures, which cover the third week in October, bring to 31,259 the number of hepatitis cases reported in the U.S. so far this year, and the year-end total is expected to fall shy only of 1954's record 50,093. Reported cases are believed to be only a fraction of the actual total; Kentucky Epidemiologist J. Clifford Todd estimates that there have been four victims in his state--with 1,628 cases, the nation's hardest hit--for every one reported. In Colorado's heavily Mexican-American counties along the Ar kansas River, the hepatitis rate is so high that the state's 1960 toll (903 cases) already is the worst in its history. Oregon has reported 950 cases.

Physicians make a sharp distinction between infectious hepatitis, usually spread by fecal matter, and the relatively rare serum hepatitis, or "needle jaundice," which is carried only by the blood, is therefore contracted from transfusions or improperly sterilized hypodermic needles. Infectious hepatitis can be spread in a number of ways. A disastrous epidemic struck Delhi, India early in 1956, when a huge sewage canal overflowed into the Jumna River, from which both Old and New Delhi draw water. Within eight weeks, 30,000 cases and 420 deaths were recorded. Sewage-contaminated water has been blamed for small outbreaks this year in Nicholas County, W. Va. and Hawkins County, Tenn. But the PHS says that most infectious hepatitis is transmitted by person-to-person contact, e.g., by small children who forget to wash their hands after they go to the toilet.

The infectious variety takes two to six weeks to develop. Common symptoms: jaundice, headache, fever (up to 104DEG), nausea, loss of appetite, diarrhea, enlarged liver, mental depression. Unlike any other contagious disease, hepatitis is harder on women than men. Only about three in every 1,000 hepatitis victims die from the disease, but even mild attacks are thought to precipitate progressive liver disease and cirrhosis. Many patients recover after seven or eight weeks, but others are still sick at the end of a year or more, and relapses are fairly common. Some patients become unwitting carriers of the serum type, retaining the virus in their system for years. For this reason, no person on record as having had hepatitis is permitted to donate blood for transfusions.

"Wash Your Hands." Infectious hepatitis may be forestalled if gamma globulin is given while the disease is incubating, but gamma globulin shots are painful, costly and scarce. The PHS's protective advice: "Wash your hands." Antibiotics have no effect, and once the disease takes root, doctors can do nothing but put their patients to bed, forbid alcohol, treat their symptoms and feed them a nutritious, vitamin-rich diet. In severe cases, ACTH and cortisonelike drugs may help to prevent coma and clear up jaundice.

Researchers at one drug company, Parke, Davis, recently claimed to have isolated the hepatitis virus, but the claim was hotly disputed and never proved. All other attempts have failed. The virus is relatively insensitive to heat, cold, chemicals and ultraviolet rays. No vaccine can be prepared because the disease perversely refuses to infect any animal but man. The hepatitis bug's small size and its frequent presence in fecal matter indicate that it may actually be an enterovirus --one of a group of particularly tiny viruses (including polio) that are found in the human intestinal tract. Says the PHS's Dr. Leon Rosen: "Isolating the hepatitis virus is the No. 1 unsolved problem of contemporary virology."

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