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LIVER DISEASE IN AUSTRALIA-ANTIGEN CARRIERS
494 in 1961, and that this effect shows a deterioration with the same effect in any preceding period. That the effect is a real one is further supported by the reversal of the mortality gradient for certain common causes of death-for example, coronary disease, cerebrovascular disease, and diabetes mellitus. Although, as I wrote in my letter, overall mortality is steadily falling, this fact should not delay inquiry into the causes of the present increasing inequality in social-class
class
i
compared
mortality. Department of the Regius Professor of Medicine, Radcliffe Infirmary, Oxford.
NICHOLAS WALD.
LIVER DISEASE IN AUSTRALIA-ANTIGEN CARRIERS
SIR,—Singleton et al. emphasised that the majority Au-positive blood-donors had liver disease. We too are engaged in Rome in screening for Au-antigen carriers. Liver biopsies were performed on 6 clinically normal carriers without raised transaminase levels. In all, definite liver damage was present. The lesions were limited to small scattered inflammatory areas with some infiltration of lymphocyte/monocyte cells and endothelial hyperplasia. Within these areas hepatocytes had undergone regression, with cloudy swelling and vacuolisation but no necrosis. 2,3 We judged these lesions to represent silent minimal hepatitis.44 In all cases, electron-microscope examination after uranyl-acetate staining disclosed within the hepato-
of
cytes intranuclear virus-like particles of 18-20 nm. diameter. The round or slightly oval particles were usually found in clusters surrounded by areas of rarefied chromatin (fig. 1). Many had a distinct central core with a denser peripheral wall (fig. 2). No particles resembling those found in the nuclei were detected in the cytoplasm. A preliminary account of these findings was presented at a recent seminar on viral hepatitis.5.6s Singleton, J. W., Fitch, R. A., Merrill, W. A. H. Lancet, 1971, ii, 785. 2. De Bac, C., Melis, M., Carpino, F., 1.
D., Kohler,
P.
infett. parassit. 1971, 23, 14. Ricci, G. V. International Congress of Infectious Diseases, Vienna, Aug. 31-Sept. 5,
that these particles, because of their intranuclear size, appearance, position, and uranyl-acetate staining, represent hepatitis virus. It seems possible that larger particles seen with a different technique (negative staining) by Almeida et al. are similar to ours. It may be suspected that the Au-antigen carriers are also virus carriers. Indeed, various degrees of liver injury have been described as minimal, persistent, or chronic hepatitis,1.4.8 while Banke et awl. found no evidence of damage in Danish blood-donors. The chronic presence of the virus may then generate different kinds of liver damage according to the host reaction. Racial and geographic factors are probably responsible for the extreme variations. It is very
likely
II Clinic of Infectious Diseases, University of Rome, Policlinico Umberto I, 00161 Rome.
GERMANO RICCI CARLO DE BAC.
Laboratory of Cellular Biology, Consiglio Nazionale Ricerche, Rome.
FELICE CARAMIA.
F., Rettberg,
Monacelli, M., Lacava, V. It. J. Immunol. Immunopath. (in the press). 3. De Bac, C., Tamburello, O., Carpino, F., Monacelli, M. G. Mal.
4.
Fig. 2-Spherical particles of differing density, approximately 18 nm in diameter ( x 200,000).
1970.
Caramia, F., De Bac, C., Ricci, G. Seminar on Viral Hepatitis, Paris, June 14-16, 1971. 6. Caramia, F., De Bac, C., Ricci, G. Am. J. Dis. Child. (in the press).
5.
EMPLOYMENT MEDICAL ADVISORY SERVICE BILL
SIR,-The Avonmouth case, deplorable though it is, arises fortunately at a crucial moment to influence important
legislation. When I became an Appointed Factory Doctor, over twenty years ago, and joined the then moribund Association of Certifying Factory Surgeons, I was told that there were two reasons for taking the job: it was easy money, and my right of entry as A.F.D. might lead to a paid position as company adviser. The Factory Inspectorate encouraged the joint appointment as a simple way of developing occupational medicine. The joint appointment is not only undesirable but unethical. I have numerous examples of situations which would have been intolerable had I also been the paid
employee. Inspectorate, under the present Bill, are apparently permitted to perpetuate this undesirable practice. It is the wish of the Society of Occupational Medicine. The medical officer of a large firm in this area preferred not to take on the job of A.F.D. because, he said, he felt this avoided any suspicion of conflict of loyalties and would help him through an impartial expert to reinforce pressure company
The Medical
Fig. t—HepaHe-ceU nucleus. Many virus-like particles are visible near the nuclear brane (uranyl acetate and lead hydroxide, x 60,000).
mem-
7. 8.
Almeida, J. D., Rubenstein, D., Stott, E. J. Lancet, 1971, ii, 1225. Prince, A. M., Hargrove, R. L., Jeffries, G. H. Trans. Ass. Am.
9.
Physns, 1969, 82, 265. Banke, O., Dybjaker, E., Nordenfelt, E., Reiniche, V. Lancet, 1971,
i,
860.
class
i
compared
mortality. Department of the Regius Professor of Medicine, Radcliffe Infirmary, Oxford.
NICHOLAS WALD.
LIVER DISEASE IN AUSTRALIA-ANTIGEN CARRIERS
SIR,—Singleton et al. emphasised that the majority Au-positive blood-donors had liver disease. We too are engaged in Rome in screening for Au-antigen carriers. Liver biopsies were performed on 6 clinically normal carriers without raised transaminase levels. In all, definite liver damage was present. The lesions were limited to small scattered inflammatory areas with some infiltration of lymphocyte/monocyte cells and endothelial hyperplasia. Within these areas hepatocytes had undergone regression, with cloudy swelling and vacuolisation but no necrosis. 2,3 We judged these lesions to represent silent minimal hepatitis.44 In all cases, electron-microscope examination after uranyl-acetate staining disclosed within the hepato-
of
cytes intranuclear virus-like particles of 18-20 nm. diameter. The round or slightly oval particles were usually found in clusters surrounded by areas of rarefied chromatin (fig. 1). Many had a distinct central core with a denser peripheral wall (fig. 2). No particles resembling those found in the nuclei were detected in the cytoplasm. A preliminary account of these findings was presented at a recent seminar on viral hepatitis.5.6s Singleton, J. W., Fitch, R. A., Merrill, W. A. H. Lancet, 1971, ii, 785. 2. De Bac, C., Melis, M., Carpino, F., 1.
D., Kohler,
P.
infett. parassit. 1971, 23, 14. Ricci, G. V. International Congress of Infectious Diseases, Vienna, Aug. 31-Sept. 5,
that these particles, because of their intranuclear size, appearance, position, and uranyl-acetate staining, represent hepatitis virus. It seems possible that larger particles seen with a different technique (negative staining) by Almeida et al. are similar to ours. It may be suspected that the Au-antigen carriers are also virus carriers. Indeed, various degrees of liver injury have been described as minimal, persistent, or chronic hepatitis,1.4.8 while Banke et awl. found no evidence of damage in Danish blood-donors. The chronic presence of the virus may then generate different kinds of liver damage according to the host reaction. Racial and geographic factors are probably responsible for the extreme variations. It is very
likely
II Clinic of Infectious Diseases, University of Rome, Policlinico Umberto I, 00161 Rome.
GERMANO RICCI CARLO DE BAC.
Laboratory of Cellular Biology, Consiglio Nazionale Ricerche, Rome.
FELICE CARAMIA.
F., Rettberg,
Monacelli, M., Lacava, V. It. J. Immunol. Immunopath. (in the press). 3. De Bac, C., Tamburello, O., Carpino, F., Monacelli, M. G. Mal.
4.
Fig. 2-Spherical particles of differing density, approximately 18 nm in diameter ( x 200,000).
1970.
Caramia, F., De Bac, C., Ricci, G. Seminar on Viral Hepatitis, Paris, June 14-16, 1971. 6. Caramia, F., De Bac, C., Ricci, G. Am. J. Dis. Child. (in the press).
5.
EMPLOYMENT MEDICAL ADVISORY SERVICE BILL
SIR,-The Avonmouth case, deplorable though it is, arises fortunately at a crucial moment to influence important
legislation. When I became an Appointed Factory Doctor, over twenty years ago, and joined the then moribund Association of Certifying Factory Surgeons, I was told that there were two reasons for taking the job: it was easy money, and my right of entry as A.F.D. might lead to a paid position as company adviser. The Factory Inspectorate encouraged the joint appointment as a simple way of developing occupational medicine. The joint appointment is not only undesirable but unethical. I have numerous examples of situations which would have been intolerable had I also been the paid
employee. Inspectorate, under the present Bill, are apparently permitted to perpetuate this undesirable practice. It is the wish of the Society of Occupational Medicine. The medical officer of a large firm in this area preferred not to take on the job of A.F.D. because, he said, he felt this avoided any suspicion of conflict of loyalties and would help him through an impartial expert to reinforce pressure company
The Medical
Fig. t—HepaHe-ceU nucleus. Many virus-like particles are visible near the nuclear brane (uranyl acetate and lead hydroxide, x 60,000).
mem-
7. 8.
Almeida, J. D., Rubenstein, D., Stott, E. J. Lancet, 1971, ii, 1225. Prince, A. M., Hargrove, R. L., Jeffries, G. H. Trans. Ass. Am.
9.
Physns, 1969, 82, 265. Banke, O., Dybjaker, E., Nordenfelt, E., Reiniche, V. Lancet, 1971,
i,
860.