Infectious hepatitis is an infectious disease caused by a virus. Formerly the condition was simply called jaundice; now we know that catarrhal jaundice is produced by an inflammation of the liver resulting from an attack by the virus which is specific for that disease. Epidemiologists believe that the virus gets into the human being by two possible routes: 1) by inhaling a droplet from the throat coughed into the air by people who are infected, and 2) by consuming contaminated food or water.

A similar condition called homologous serum jaundice follows the injection of blood or serum from certain donors who harbor a virus that attacks the liver. This type of jaundice has a longer incubation period than infectious hepatitis-namely, from 50 to 140 days after the transfusion, compared to 25 or 46 days after receiving the virus by the routes previously mentioned.

Since the use of one syringe and a different needle for each person in a series of mass injections has been shown to be involved sometimes in causing homologous serum jaundice, doctors urge the only sure way to prevent this is to provide a heat-sterilized needle and a separate syringe for each person. Usually infectious jaundice causes gastrointestinal trouble, including nausea and loss of appetite, occasionally with fever, before the jaundice which is characteristic of this condition first appears. Symptoms include some upper abdominal pain on the right side and a loss of appetite associated with nausea. Vomiting and diarrhea occur in about one-fifth of the cases. Occasionally the liver is found to be enlarged and tender.

The jaundice and the symptoms gradually subside in from one to three weeks. When the jaundice has cleared completely and the patient is becoming convalescent, relapses may occur and the jaundice will reappear. Rest in bed is one of the most important treatments. Most of the patients get well and do not have any after-effects; about 90 per cent recover in this way. The number of people who die is exceedingly small, perhaps something like one in every 500 people who are infected with this virus. In one or two per cent of the infected chronic liver damage occurs, and these people can be troubled thereafter with hardening and scarring of the liver.

Certain factors seem to predispose people who have infectious hepatitis to having a serious case instead of a mild one. Probably the most important factor is a low state of nutrition. The high mortality observed in outbreaks among the native people in such areas as India where famine has been prevalent is not seen in healthy European countries, where mortality rates are much less. In undernourished communities, the mortality rate may be fifteen times that among well nourished people. Severe injuries or bums associated with infectious hepatitis make the condition much worse, and pregnancy is reported to increase the risk of serious and permanent damage to the liver. Since malnutrition, injuries, bums and pregnancy all are related to disturbance of the protein metabolism, the massive damage to the liver that occurs when people have diets deficient in protein seems to bear a definite relationship to the severity of infectious hepatitis.

Although various methods of treatment have been tested, no specific chemical substance has been found which is effective against the virus of infectious hepatitis. Rest in bed for as long as the illness persists is one of the most important forms of treatment. When the bile has disappeared from the urine of the patient, he is allowed to leave his bed in order to attend to his toilet. Otherwise he must have complete rest in bed until the enlargement of the liver and the tenderness have disappeared. After infectious hepatitis, return to work must be gradual since the condition leaves patients seriously exhausted.

Protein is necessary to maintain the integrity and function of the liver. The diet in infectious hepatitis should be rich in protein and carbohydrate but poor in fat. The fats must not, however, be so severely restricted that the food will become unpalatable and the patient will lose his appetite and quit eating. The diets recommended are 150 grams of protein, 350 grams of carbohydrate and 50 grams of fat which provide about 2,500 calories. This is more than ample for a person confined to bed. Since the appetite is weak, the meals are to be small and given at frequent intervals. People who are severely undernourished and who sustain infectious hepatitis may have extra mounts of certain basic amino acids, methionine, cystine or choline, which deficiencies seem to enhance the virulence of the virus. British investigators suggest that water-soluble vitamins, particularly ascorbic acid, must be provided in adequate amounts to these patients, and also the vitamins of the B complex.

Therefore, in addition to rest and careful supervision of diet, the treatment of infectious hepatitis is applied to control of unpleasant symptoms like constipation, the use of sedatives to insure rest and sleep and other methods of treatment to control nausea and vomiting. If much water is lost by vomiting and diarrhea, the provision of extra fluid is important.