STUDIES ON THE RELATIONSHIP OF THE HEPATITIS VIRUS TO PERSISTENT SYMPTOMS, DISABILITY, AND HEPATIC DISTURBANCE (“CHRONIC HEPATITIS SYNDROME”) FOLLOWING ACUTE INFECTIOUS HEPATITIS 1

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Abstract
Serum and feces specimens and liver tissue (biopsy) were obtained from 3 subjects who had persistent symptoms and other evidence of continued hepatic disturbance (chronic nonicteric hepatitis) following acute hepatitis that had been induced by oral inoculation with a known strain of "infectious hepatitis" virus. In an attempt to clarify the relationship of the hepatitis virus to the persistent symptoms and continued hepatic disturbance, volunteers were inoculated orally with materials collected 3-12 months after the onset of the disease. Following ingestion of the feces prepn., 3 of the 5 volunteers developed mild illnesses after 18-20 days. Likewise, 4 of the 5 volunteers developed illnesses of mild to moderate severity 15-36 days after ingestion of a suspension of the liver tissue. None of the 5 volunteers who ingested the serum pool developed significant illness during a 5-month period of observation. The symptoms and manifestations of those who became ill include 2 or more of the following malaise, headache, anorexia, nausea, vomiting, abdominal cramps, and pain in the right upper quadrant. Two presented tenderness in the liver area and, in one of these, the liver became moderately enlarged. In spite of moderately severe symptoms in 2 of the cases, laboratory evidences of hepatic disturbance in all cases either were absent or minimal. None developed overt jaundice. The intervals between inoculation and onset and the clinical manifestations were compatible with mild infectious hepatitis without jaundice, particularly in 2 of the cases. The laboratory evidences of hepatic disturbance usually associated with mild hepatitis, however, were not present. Although no other explanation for the illnesses was apparent, their exact nature and their relationship to the materials used for inoculation are uncertain. Factors of possible importance in interpretation of the results are discussed .