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It was estimated that Hepatitis C first emerged over 3,000 years ago.

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Professor Arthur Bloom wrote to a GP to say that a small percentage of freeze-dried preparations contained the virus of serum hepatitis and therefore were potentially dangerous.

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There were a number of reports that non-A non-B Hepatitis was linked to persistent liver damage.

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The hepatitis risk of commercial blood was markedly higher than that of blood from unpaid donors.

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In a paper by Dr Rosemary Biggs, it was noted that of 1,800 patients whose cases occurred between 1969 and 1971, 302 had been tested by a range of different tests for the presence of the Australia antigen.

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The results of a study of 31 patients at the Royal Free Hospital treated for the first time with concentrate indicated an approaching 100% "attack rate" of hepatitis infection whichever of NHS or commercial concentrate was used, due to the sheer size of the pools.

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In "Liver function in Edinburgh haemophiliacs: a five-year follow-up", a comparison of test results before the introduction of NHS concentrates in 1974 with test results from 1979 showed that the liver function of those treated with Factor 8 concentrate had deteriorated whereas those treated with cryoprecipitate had not.

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An extract from Hospital Week by the American Hospital Association noted that President Nixon had called for a study to improve the blood collection and distribution system that relied on commercial blood banks. Previous studies proved that blood transfusions had caused 30,000 hepatitis infections every year. The risk of hepatitis from commercial blood supply was acknowledged.

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Together with other authors, Professor Garrott Allen concluded in an article titled "Blood Transfusions and Serum Hepatitis" published in Annals of Surgery, that those who received blood from paid donors had a rate of hepatitis infection of 7 to 10 times greater than seen in those who had had volunteer blood.

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Professor Garrott Allen warned in an article titled "Post-Transfusion Hepatitis: A Serious Clinical Problem" published in California Medicine April 1966 that: "The risk of serum hepatitis from transfusions derived from prison and Skid row populations is at least 10 times that from the use of volunteer donors."

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Dr Harvey Alter and others wrote an article titled "The Ausria Test: Critical Evaluation of Sensitivity and Specificity" in Blood December 1973 in which it was observed: "By far, the single most significant measure for the reduction of posttransfusion hepatitis is the total exclusion of the commercial donor."

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Dr Manucci and others wrote an article titled "Asymptomatic liver disease in haemophiliacs" published in the Journal of Clinical Pathology in 1975 which observed liver disease in people with haemophilia and concluded "that repeated and prolonged contact with the infective agent(s) may cause chronic liver damage not associated with overt illness".

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Professor Arie Zuckerman wrote an article titled "Developments in Viral Hepatitis" published in the Journal of Medical Virology in 1978. He reviewed earlier studies and noted that cases of non-A non-B Hepatitis were commonly reported as a cause of persistent liver damage. He summarised: "it seems that this infection may progress to chronic liver disease."

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Dr Berman and others wrote an article titled "The Chronic Sequelae of Non-A Non-B Hepatitis" published in the Annals of Internal Medicine July 1979, which described the progression of non-A non-B Hepatitis to cirrhosis over time.

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The Medical Research Council wrote a letter regarding an ad hoc meeting on non-A non-B Hepatitis to discuss the seriousness of the infection, and the need for research and studies to identify non-A non-B Hepatitis and develop a test. Middlesex Hospital Medical School then wrote to the DHSS noting that non-A non-B Hepatitis might be a problem for people who did not have haemophilia, but had received a transfusion and that it would be logical to co-opt any studies with PHLS.

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Dr George Grady and others wrote that Hepatitis B antigen accounted for around 60% of the cases of post-transfusion hepatitis.

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Mirick et al noted that blood from prison and skid row populations was at least 10 times that from volunteer donors.

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Professor Garrott Allen returned to the theme in several following publications that transfusions derived from prison and Skid row populations was at least 10 times that from the use of volunteer donors.

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Professor Garrott Allen noted that approximately 0.9% of total transfused patients would suffer disability or death due to transfusion hepatitis.

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Matthew Hill

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