GENERAL DISCUSSION 



Best: Prof. Gillman, what is your conception of the cause of liver 

 disease in South Africa ? I realize the breadth of this question. 



Gillman: One can find no so-called "specific" cause such as 

 bacterial or parasitic infections. Since siderosis may commence 

 between the ages of 15 and 16 years and seems to progress rapidly 

 after the age of 20, at a time when nutritional failures — with frank 

 clinical syndromes of pellagra and the like — occur, one suspects very 

 strongly that long-term chronic malnutrition, so common among the 

 African people, is an important aetiological factor. 



It has been suggested by others that parasitic factors may be in- 

 volved. Malaria is certainly not operative, either in Johannesburg 

 or Durban. Helminthiasis and especially hepatic amoebiasis, both, 

 occur in Durban and its environs. However, another study which is 

 being conducted in our group by Dr. N. Lamont indicates that 

 amoebic liver abscess is frequently superimposed upon a previously 

 damaged and siderotic liver. Also, Dr. R. Elsdon-Dew who has for 

 many years worked on amoebiasis in Durban, has provided con- 

 siderable evidence (1949, Amer. J . trop. Med., 29, 337) indicating 

 that the susceptibility to Amoeba histolytica infection is a function 

 of the nutritional state of the individual. Similar evidence has been 

 obtained in experimental animals by workers in Washington (Taylor, 

 D. J. (1950). J. Parasit., 36, sect. 2, 21). So, it would seem that the 

 high incidence of liver disease in the African in the Union is primarily 

 due to long-term chronic under- or mal-nutrition and certainly not 

 to acute deficiencies of one or other known nutritional component. 



Bourne: The pictures that you showed of the deposition of iron in 

 the liver, in particular, are strikingly reminiscent of the accumu- 

 lation of iron which you get in animals with cobalt deficiency, a fact 

 that would support your suggestion that it is nutritional in origin, 

 except that I find it a little difficult to believe that there is a significant 

 cobalt deficiency in these people. 



Gillman: From what I know of the literature on cobalt deficiency 

 (which I believe is mainly Australian in origin) there is usually a 

 profound associated anaemia and the iron seems to be derived from 

 haemoglobin. In Durban, anaemias are much more common than they 

 are in Johannesburg, but are nevertheless rarely profound, even in 

 siderotics — the haemoglobin in these patients ranging from 10 to 12 

 g. per cent. Nor is there any evidence of haemolytic anaemia. In 

 Johannesburg, however, there is no evidence of anaemia of any kind, 



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