Læknablaðið - 01.12.1978, Blaðsíða 68

202
LÆKNABLAÐIÐ
who associated closely over their four
years, in and out, of school while a further
group of students assosiated closely with
only one or two in the former group. When
we looked at names and addresses of
students and of indiviuals in Albany who
had been diagnosed as H.D. over a 20 years
period, it was astonishing how many were
resident at the address given by a member
of the student group. These included a
number of elderly men and women who
avowed that they did not have cases oí
H.D. in their family or knew anyone with
the disease but who did live in the same
house as some young person — and that
young person we found did associate
closely with H.D. cases. The full ramifi-
cation of this epidemic has still not been
ascertained as we were denied the
necessary funds to complete the investi-
gation but we know it extends to well over
40 individuals, and perhaps involves one
third of all cases of H.D. in Albany County
over a period of 20 years or more.
We also found that there was no statisti-
cal method of evoluating this evidence. The
methods proposed and utilised in the Ox-
ford survey45 are not adequate because our
evidence suggests that prolonged close con-
tact is necessary, not just a fleeting en-
counter. It’s not how many people you
know, which may run to many hundreds,
it’s how many you constantly associate
with. To establish this requires detailed
probing into the social circumstances and
private lives of individuals and my collea-
gues and I deeply appreciate the public
cooperation so generously afforded us by
the citizens of Albany. It is our experience,
as it was of Schimpff et al45 in Baltimore,
and of others, that once one really starts
probing the backgrounds of H.D. cases one
soon comes into a nexus of H.D. cases
whose existence may be unsuspected by
the initial case. This is what this new
epidemiology is all about.
Consider an elderly man, a widower,
living alone secluded in an apartment near
New York City. At age 69, he suddenly
develops H.D. and firmly, and quite
correctly denies, that he knows anyone
with the disease or that there is any in his
family. If we leave it at this point, we
have found nothing to give us a clue to
the possible cause of H.D., but who does
he meet? A woman neighbour comes in,
cooks and cleans for him, he visits his
daughter who lives away from him, he
has one friend who is an occasional visitor
and possibly the rabbi calls. All these are
well, have not got H.D. Again we have no
clue. But then see who his few social con-
tacts know. The neighbour has a sister-in-
law with H.D. and she has a daughter
affeeted, the patient’s daughter associates
with two further cases, the occassional
visitor with three, and the rabbi with 3.
In all, a nexus of no less than 8 established
cases of H.D. surround this individual, and
since all 4 our patient regularly sees are
in close association with other cases of the
disease is it not resonable to see here an
instance of case-to healthy contact to case
spread of H.D?
But if healthy contacts exist, might they
not carry the disease to several individuals.
Consider our Albany Contact „H“, a
charming and lovely lady. A brother dies
of H.D. So does a cousin with whom she
associates closely, one of her boyfriends at
school gets the disease, she leaves school
for work in one occupation and the young
man she works with gets the disease, she
changes occupation and in her new post
associates closely with another young man
—• he gets Hodgkin’s Disease. Happily this
ends the sequence, but we have other such
seeming carriers of H.D. to more than one
individual just as we have other instances
of nexuses of H.D. round individuals, a
phenomenon we seem to strike over and
over again but which can only be estab-
lished by close enquiry.
But in Albany when we look at the
overall picture of H.D., we see that in the
years 1952—60, both by year of diagnosis,
which we can compare with other counties
in upstate New York, or by year of report,
there was a heightened incidence of H.D.
followed by a through and in the through
the age pattern of H.D. was altered.50 This,
with any other disease would be called an
epidemic and we regard it as such. In the
through period, the average age at onset