It should be considered that the term of chronic hepatitis does not mean a single disease entity but a certain condition of hepatitis.
Therefore it is a rather broader concept in which various etiological factors are included. Chronic hepatitis is a condition which shows morphologically persistent inflammatory findings in the liver but does not develop cirrhosis. Chronic inflammation of the liver induced by the focus in other organs is also included into chronic hepatitis in a broader sense of the word. Chronic inflammation of the liver alone is considered as chronic hepatitis in a narrow sense.
The fatty liver (Thaler) may be included in this concept of chronic hepatitis. Granulomatous inflammation in the liver such as tuberculosis is also one of the types of chronic hepatitis but should be treated in the special item.
Clinically the following symptoms and signs, although not always accompanied, suggests chronic hepatitis: General malaise, vague abdominal symptoms, subicterus, firm swollen liver, increase of BSP dye retention, elevation of serum γ-globuline, and instability of the value of serum transaminase activity. In the case in which the symptoms of hepatitis still last more than 3 months after the acute episode, it will be neccessary to be kept in mind a possibility of chronicity.
Histopathologically it shows portal inflammation, mobilization of Kupffer cells, focal and/or single cell necroses, and mild or moderate fibrosis which does not develope to pseudolobule.
Diagnosis of chronic hepatitis should be made comprehensively from both clinical and patholgical standpoints.
A nomenclature on the diagnosis of chronic hepatitis is discussed.

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During the period of 9 months, from Sept. 1, 1964 to May 31, 1985, 200 patients were admitted into Sapporo National Hospital and received blood transfusions. The subjects of this review were 98 patients who had been kept under observation more than 3 months after the blood transfusion. Examination mainly consisted of measurement of SCOT and SGPT every 4 weeks.
We assumed that an incubation period would be important in the diagnosis of serum hepatitis. Based on increasings, as well as their processes of alterations, of SGPT, BSP retention and icteric index, the risings of SGPT would be judged as the result of hepatocellular damage.
As the differentials so-called toxic hepatitis must be considered. This would be differentiated by laboratory test such as serum alkaline phosphatase, total cholesterol and eosinophilia, or history of administration of particular drugs prior to the onset.
The diagnosis of serum hepatitis was made, based on laboratory data, subjective symptoms or histological study by liver biopsy.
Results:
1. 28 cases of 98 patients, who received the blood transfusion, had serum hepatitis.
2. The incidence of the hepatitis was 28.6% in patients who received the blood collected at Sapporo District, while 62.59% in patients who received blood sent from Tokyo or Yokohama.
3. No linear correlation exists between the amount of transfused blood and the incidence of serum hepatitis, Frequent transfusions seemed to increase the incidence of serum hepatitis.
4. Duration of incubation was 8-9 weeks in the majority of cases, ranging from 9 days to 18 weeks in 25 cases.
5. Icteric type in the post transfusion hepatitis patients was 25%.

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The incidence and the background factors of post operative hepatitis were investigated on 248 cases from Sept. 1961 to June 1966. As the criteria for diagnosis, transaminase (over 100 units), BSP (over 10% for 45 min.), serum colloidal reaction (positive over 2 items), and compare with the meulengracht units, urobilinogen units in urine and subjective complaints were employed.
1) Hepatitis was recognized in 79 cases (31.8%). Out of the 79, 50 cases (20.2% of total cases) developed jaundice. (63.4% of hepatitis cases).
2) Relaton of the type of blood used to the incidence of hepatitis;
The group in which non-selected blood was used: 44/130 (33.9%).
The group in which the blood of normal valued GPT in serum, was used: 32/105(31.0%)
The group in which the donated or banked blood, was used: 3/13 (23.1%).
(Case of hepatitis/total case)
3) Relation of the operation type to the incidence of hepatitisl;
resection cases 179.......hepatitis cases 63 (35.2%)
collaps cases 69.........hepatitis cases 16 (23.2%)
4) Age, Sex, the size of transfusion and the anti tbc, agents used had no relation to the incidence of hepatitis.
5) Out of 79 cases of hepatitis, 58 cases (73.5%) developed within 2 months after operation and 6 cases (7.6%) appeared after 4 months of operation.
6) Out of 79 cases, 29 were prolonged hepatitis type.
7) GPT was superior as the diagnostic method, GOT and BSP were the next.
8) The use of steroid hormons with liver preparation was effective on recovery of the hepatitis.

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We studied 68 cases of blood transfusion in which 66 of them had had resectional therapy or thoracoplasty for pulmonary tuberculosis, and 2 of them had had resectional therapy for bronchiectasis and pulmonary supuration.
They were divided into two groups; 1) γ-Globulin group of 33 cases to which γ-Globulin were given on the day and the next day of the blood transfusion, and 2) control group of 35 cases to which γ-Globulin were not given.
The purpose of this paper is to report the prophylactic effect of γ-Globulin against posttransfusion hepatitis with reference to our serial studies on post-transfusion hepatitis. 100 mg/ml γ-Globulin solution, in amount of 0.12 ml/kg of body weight, was injected, a half amount on the day and the rest on the next day of the transfusion.
Liver function tests were done within one week before transfusion and once a week after transfusion for the first month, and once a month thereafter for 5 months.
Results:
Abnormally high titers of serum colloid reaction were seen mostly in earlier period after the transfusion. This fact was also seen in the other cases which underwent operations without blood transfusion. These variations were considered not to be related with the clinical symptoms or elevated serum transaminase titers which appeared therafter. The variation of the serum transaminase titers was remarkable in a case which had a titer higher than 100 U. during the test period. The variation of SGOT was seemed to be corelated with that of SGPT.
If any remarkable change of SGPT titer occured, it was usually found in the second month. Pathological findings in several liver biopsies which were conducted simultaneously in such cases indicated hepatitis. In the γ-Globulin group, the variation occured usually in the earlier period of the second month. In the control group, it occured at variable period through the second and third month. In the γ-Globulin group the highest titer of each case was less than 500 U., while in the control group some cases showed a titer higher than 500 U.
Hepatitis occured in 42% of the cases in the γ-Globulin group, and in 48% in the control group. Jaundice appeared in 6 cases (17%) in the control group, and none in the γ-Globulin group.
Our results indicate γ-Globulin used at the time of transfusion have some effect against post-transfusion hepatitis. Dose and dosage of γ-Globulin must be studied further more to obtain better results.

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Our statistical studies of serum hepatitis caused by post-operative blood transfusion, and follow up study for two years from June, 1963 to May, 1965 are summarized as follows;
1. No serum hepatitis was found among those patients who received precisely selected fresh blood transfusion.
2. Ratio of hepatitis to the total numbers of blood transfusion was 7.3%.
3. Climately occurrence of hepatitis decreased gradually in following orders; winter, autumn, summer and spring.
4. Ratio of male to female was twice.
5. Relation between diseases and occurrence ratio, cholangogenic disease was most prevalent among any other diseases obliged to surgical procedure.
6. The occurrence of hepatitis was apparently related with the amount of blood transfusion.
7. Incubation periods was more than one month and majority of cases were 2 to 2.5 months.
8. About 70% of cases showed more than 100 U. both of G. Q. T. and G. P. T.
9. About 70% of patients were return to normal level of G. O. T. and G. P. T. within 4 weeks after the admission.
10. During the course of therapy, recurrence occurred in about 70% of cases.

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The statistical studies of serum hepatitis have been demonstrated at Myojo National Sanatorium since April, 1962 to April, 1966.
The diagnosis of serum hepatitis after blood transfusion was made by increased serum transaminase activity.
The total recipient number is 173 and the incidence of serum hepatitis is 82. 58 cases were observed from April, 1962 till June, 1964, and 24 cases were found from September, 1964 to April, 1966.
We found that difference in incidence of post-transfusion hepatitis was depended on the source of blood donors.
The incidence of post-transfusion hepatitis is 48.3-50% in cases using the blood provided from Midori-juji (blood bank of commercial base), while the incidence of that is 20% in cases using the blood provided by family. When the gamma globulin 20 ml, were given after the operation, the incidence of post-transfusion hepatitis were 42.9%. Therefore the routine administration of gamma globulin 20 ml after blood transfusion is doubtful for prevention of serum hepatitis.

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The amount of donor blood was occupied 60.2% of the whole amount of blood supply in Hokkaido in 1965.
The incidence of post-transfusion hepatitis after donor blood transfusion had been generally lower than that of non-donative (commercial based) blood transfusion, but year after year it has been becoming higher for recent few years, and reached to approximately 6% in 1965.
From this viewpoint, the connection was studied between post-transfusion hepatitis and donor's sex, age, occupation, and frequency of blood offer, level of blood specific gravity, blood type, value of serum transaminase and fraction of serum protein, etc., but nothing was found in this point.
In order to avoid post-transfusion hepatitis, pulmonary resection without blood trans-fusion was performed on 60 cases for the past three years in Asahigawa National Sanatorium. In this case, hepaitis never occured, but liver dysfunctions that were supposed to be occured by the influence of anesthesia and surgical damge were temporarily observed in two weeks after operation.
By abministering proper amount of plasma expander and iron agents without blood transfusion, there was no difference of prognosis between such cases and those after blood transfusion.
As a conclusion, for prevention of post-transfusion hepatitis, it is essential to avoid the misuse of blood transfusion and to give the reasonable amount, even if the blood is donative.

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Hepatic function has been periodically tested in 125 patients who were operated for the pulmonary tuberculosis since June, 1954. (Two of these who have not received the blood transfusion, consequently did not show the hepatic damage.)
1. Criteria of hepatic damage. Serum transaminase values and bilirubin index (Meulengracht) were determined as the indication of the hepatic damage. The cases which show the transaminase value over 160 unit and the bilirubin index over 11 are considered to be hepatic damage.
2. Frequency of the tests. These tests have been performed every two weeks in the first three months, then every month in the consequent months at least for six months.
3. 64 of 133 cases (48.1%) showed hepatic damage and 19 of these cases (14.6%) had jaundice.
4. In the type of blood donnation, commercial based blood showed 57 cases of liver damage in 115 (49.2%) and donative blood 7 of 18 (38.9%). The latter was 10% less than the former.
5. In majority of the cases (80%) hepatic damage and jaundice developed within first three months after blood transfusion.
6. The hepatic damage and jaundice lasted for about three months in 80% of the total cases. The grade of jaundice does not show any significance in the duration of hepatic damage.
7. The relationship between tuberculosis type (NTA) and hepatic damage was not noted.

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We carried out a histologic examination of the biopsy material of the liver obtained during upper abdominal operation. We had 60 cases in all. 44 cases of them were suffering from such digestive disorder as cancer, ulcer, gastritis, 12 cases from gall bladder stone and 4 cases from liver disease. 28 of 60 cases received blood transfusion before the operation.
We investigated a correlation between histopathologic findings of the liver and biochemical tests of the serum and also some influence of blood transfusion upon serum transaminase activity.
The results are as follows:
1. Relation between serum glutamic oxaloacetic, glutamic pyruvic transaminase activity and liver cell: 18 of 35 cases whose transaminase activity was in the normal range had no histologic change of the liver cells, but the other 17 had various sorts of hepatocellular degeneration or necrosis. 6 of 8 cases whose transaminase activity was high had change of the cells, but 2 had no change. 44.2% of the result did not come up as we had expected.
2. Relation between serum globulin and cell-infiltration in the Glisson's capsule: 28 of 33 cases whose serum albumin-globulin ratio was normal had no cell-infiltration into Glisson's, capsule, but 5 had infiltration. 11 of 27 cases whose ratio was low had infiltration, but 16 had no infiltration. Close to half of the latter had hypoproteinemia and also hypoalbuminemia without liver injury.
3. We found 13 cases whose serum transaminase activity was normal by the time of the biopsy and rised after that time. 11 cases had blood transfusion before biopsy. 2 of 11 cases had no histopathologic change in the liver, but 9 had some change. Some may be early stage of serum hepatitis and the others are liver injury having no connection with serum hepatitis.
We think that they seem to have the tendency to contract serum hepatitis when they have any existing injury of the liver.

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1) A Comparative observation was done between the pre- and postoperative liver function (GOT) test, in which the deficiency of Vitamine B₂ played important role.
2) Vit. B₂ metabolism is disturbed during postoperative period of 7 days (diminished blood and urinary excretion of Vit. B₂ following the loading of 5 mg O.D., especially this metabolic disturbance became remarkable on cases of cancer, hepatitis, pulmonary tuberculosis and ileus.

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1) In the initial stage of Schistosomiasis Japonica, hyperfunction of spleen with mild impairment of liver function would be presented, although most of the cases do not show any sign. As the disease progresses, parenchymatous liver dysfunction will be developed and progressed gradually.
2) In the liver cirrhosis presumed to be caused by Schistosomiasis, liver dysfunction and it's progression will be milder than the liver oirrrhosis due to any other cause. But hyperfunction of spleen in Schistosomiasis will be stronger on the contrary.
3) In case of so-called Banti's syndrome in Schistosomiasis, there is no great difference with usual Banti's syndrome in liver function and C. B. C. except eosinophilia.

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With the recent development of surgery, transfusion of blood has become indispensable for surgical treatment and, accordingly, hepatitis after operation has come into serious problem.
We made detailed examinations on 2, 784 in-patients of our surgery during the period from January 1, 1961 to December 31, 1964. Especially, for the study of process after discharge, we made inquiries through return post cards to all the alive to whom transfusion of blood had been applied from January 1, 1963 to December 31, 1964.
The results are reported in the followings:
1) Out of 2, 784 in-patients of our surgery, transfusion of blood was applied to 623 persons, or 22.4% of the total cases, and the average quantity of blood applied was 1, 444 ccper head.
2) 40 patients suffered from hepatitis during four years, which occupied 6.4% of the patients to whom blood had been transfused.
3) In case the patients are classified in five stages according to the quantity of blood transfused, hepatitis rose frequently in proportion to the quantity applied.
4) As for age and sex, hepatitis rose in 23 men and 17 women ranging from 20 to 74 years of age, but most frequently in those aged from 30 to 50, which occupied 60% of the total cases.
5) 36 among the patients in hepatitis were with icterus, while 4 without icterus. Icterus rose in 2 weeks after transfusion of blood in swift cases, or in 6 months in slow cases.
6) As to blood Types, hepatitis was observed most frequently in Types B and AB.
7) Subjective symptom of patients diagnosed to be in hepatitis was general exhaustion for the most part, then want of appetite, nausea and vomition, except 34 patients in icterus.
8) We made Trans-amylase test from the middle part of 1962, so that we could not cover all the cases. As far as we could refer, however, many cases showed a value higher than 300 units both in GO-T and GP-T in 1-3 months after transfusion.
9) As to process of recovery, 22 patients, or 55%, recovered within 3 months. There were five cases, or 12.5%, that continued for longer than one year, which were considered to be chronic.
Summary
Thus, we made statistical observations on 023 cases to which transfusion of blood had been applied, but, as is usual with hospital, we could not have observation period long enough after operation, We often found hepatitis in the patients who came to hospital again because of deterioration of general symptom or rise of icterus.
We cannot define whether this hepatitis was epidemic one or serum hepatitis, therefore,
we collected statistics as postoperative hepatitis in a lump.
As could be seen from the results, our statistics show that the rise of hepatitis was at its maximum in 1963 and decreased in 1964.

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A follow up study has been made on 119 cases of hepatitis admitted to the Sendai National Hospital during past 10 years.
The results are as follows: The serum hepatitis is generally worse than the infectious hepatitis, regardless of their vocation, age and sex. Nearly a half of chronic hepatitis accompanied with livercirrhosis cases died or still under medical care. A good prognosis has been established in hepatitis patients who have been admitted to the hospital within 20 days after the onset and clinically recovered within 2 months. An early admission and radical treatment are emphasized. The diagnostic values of the level of serum transaminase and BSP test is significant on acute hepatitis, BSP test, serum colloid reactions, serum protein content and A/G ratio have specific meaning in the diagnosis of the chronic hepatitis. The liver function in 20 cases who discharged from our hospital several years ago was reexamined with results of normal range, except only one case.

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We examined 326 cases of infectious hepatitis and 173 cases of serum hepatitis who entered the National Hospitals and found a little different results between infectious and serum hepatitis as follows:
1. Course of the illness of serum hepatitis is somewhat prolonged in comparison with that of infectious hepatitis.
2. Death-rate of infectious hepatisis is 4.3%, while serum hepatitis is 2.8%.

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We examined 326 cases of infectious hepatitis and 173 cases of serum hepatitis who entered the National Hospitals and found a little different results between infectious and serum hepatitis as follows:
1. Course of the illness of serum hepatitis is somewhat prolonged in comparison with that of infectious hepatitis.
2. Death-rate of infectious hepatisis is 4.3%, while serum hepatitis is 2.8%.

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