SUMMARY Total serum haemolytic complement activity (CH50) and the serum concentrations of both the third and fourth components ofthe complement system (C3 and C4) have been measured in 29 control subjects, 92 patients with chronic hepatocellular disease, and eight patients with large duct biliary tract obstruction. The mean C4 concentration was reduced in all types of chronic liver disease studied. However, the mean CH50 and C3 values were increased in compensated primary biliary cirrhosis, were relatively normal in non-cirrhotic chronic active hepatitis, and were decreased in cryptogenic cirrhosis, particularly when ascites was present. There was a significant correlation between CH50 and C3 in patients with chronic liver disease but no correlation between CH5o and C4 or between C3 and C4. Raised values for CH50 and C3 in primary biliary cirrhosis may be due at least in part to concomitant cholestasis since these values tend to be raised in patients with large duct biliary tract obstruction. Although primary biliary cirrhosis, chronic active hepatitis, and cryptogenic cirrhosis are considered to be part of a spectrum of chronic liver disease associated with disturbed immunity, the results of this study emphasize that there are clearly definable differences between these diseases in terms of the pattern of changes in serum complement.Although some types of chronic liver disease, such as chronic active hepatitis, primary biliary cirrhosis, and cryptogenic cirrhosis are usually associated with evidence of disturbed immunity, so far no immune mechanism has been demonstrated to be of fundamental importance in the pathogenesis of these diseases. One well established cause of cell lysis and death involves the complement system, classically activated by antigen-antibody interaction on a cell surface (Rapp and Borsos, 1970). If this immune process is responsible for liver cell injury in patients with chronic liver disease, there may be associated changes in serum complement. However, changes in the complement system may also arise as a consequence of the disease process itself.It has previously been shown that patients with chronic liver disease tend to have a reduced total serum complement haemolytic activity (Goldner, 1929;Jordan, 1953;Asherson, 1960;Townes, 1967; Inai, Fujikawa, Naguki, Takahashi, Ozono, and Ishida, 1967;Farini, Gambari, Fagiolo et al, 1970;Pagaltsos, Smith, Eddleston, and Williams, 1971; De Meo and Anderson, 1972;Torisu, Yokoyama, Kohler, Durst, Martineau, Schroter, Amemiya, Groth, and Starzl, 1972) and a reduced serum concentration of the third component of comple-

The commonest cause of primary adrenal failure and shrunken adrenals is autoimmune adrenalitis. The same clinical picture with adrenal masses is nowadays most commonly due to carcinomatous spread. Our case emphasizes the importance of obtaining tissue from patients such as these, where no primary lesion is apparent, as occasionally a treatable lymphoma will be found.

An unusually severe and prolonged salmonella enteritis is described in 6 adults; 5 had previously undergone gastric surgery and one had pernicious anaemia. Possible causes are discussed but the probable common aetiological factor was deficient gastric juice. Hypo- or achlorhydric subjects appear more prone to salmonellosis and may become seriously ill as a result. Any diarrheal illness in them should be investigated by the bacteriologist before being attributed to altered physiology alone.

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