Læknablaðið - 01.12.1978, Page 75

LÆKNABLAÐIÐ
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I have seen and possibly Horders, with an
injury when handlin.g Hodgkin’s tissue in
at least three of these and in two possibly
three a rapid and fatal outcome. We might
be impressed by these cases, as Uddstromer
was, were it not that my second case
turned out to be not Hodgkins Disease at
all but Acute Histiocytosis or the Histio-
cytic HVIedullary Reticulosis of Robb
Smith,40 a condition only recognised subse-
quent to the publications of the cases of
Sisto and Horder which were also acute.
The situation is most unsatisfactory but it
raises the question at to wheter other
Hodgkins Diseases or Histiocytic medullary
reticulosis are infectious diseases or even
could the latter be the acute form of
Hodgkins Disease.
This is not an impossible suggestion. The
whole question of the infectivity of
Hodgkin’s Disease bristles with such un-
certainties. We have the question of its
possible relationship to infectious mono-
nucleosis41 though whether the Epstein-
Barr virus is involved in this is question-
able24 but now it has been shown that
there are sub-types of EBV,:n and that in
families with immunologic defects infec-
tion with the EBV can produce very dif-
ferent effects28 this question is still an
open one. It still is true that every attempt
to demonstrate that Hodgkins Disease is
an infectious disease by the laboratory iso-
lation of an infective agent has been fruit
less.10 It has, however, been equally fruit-
less to find positive evidence that it is a
neoplasm.
Thus, the question as to its nature re-
mains open and much opinion still leans
to the belief that the disease, at least in
young people may be of infective etio-
logy.lð It is argued that perhaps poliomye-
litis may be a model15 but in this disease
it is easily possible to find non-laboratory
evidence that the disease behaves as do
infectious diseases. In both poliomyelitis
and Hodgkin’s Disease the risk increases
with higher social class and small families.
As long as the nature of Hodgkins Disease
is uncertain no one can possibly predict
what items of evidence may be important
in the final solution. This then is the
challenge the disease, as so many other
unsolved disease problems poses. These
questions are not to be answered by
national statistics, mass figures and sur-
veys, but by careful probing into the lives
of patients who develop Hodgkins Disease,
and of their families, relatives, friends and
social acquaintances in school, factory,
leisure resorts and so on. These enquiries
can only be made with the full cooperation
of the public, always in our experience,
most generously given when its purpose
is understood. Indeed when we first
reported the Albany epidemic we were
deluged with requests from the public to
investigate local outbreaks of the disease
which had convinced our correspondents
of its infective nature;65 some of these out-
breaks were very extensive.
Our long negative experiences suggest
that we may have been looking for an
agent in the wrong place, at the wrong
time or with the wrong methods, perhaps
as Dörkens work11 suggests we should look
at animal exposure, perhaps as in some
virus disease when the glands enlarge the
agent has gone,57 perhaps we should scru-
tinise the contacts more closely. Perhaps
we should pay more attention to age and
sex differences, in affluent and non-affluent
circumstances, pay attention to the poten-
tial role of hormones, genetic influences,
shemical exposures. The scope is immense,
the opportunities great and can as likely
be followed in an isolated area as in a
crowded city. Among the qualities wanted
are enthusiasm, scepticism, sympathy and
kindness and good humour and the willing-
ness to probe deeply in this newer epi-
demiology of cancer.
I do not know if Hodgkins Disease is
infectious but I did recognise on the three
occasions I met Niels Dungal that there
were things about him that were infectious,
his enthusiasm, his kindness, which I
personally experienced, and his happy
robust laughter. Our gropings would elicit
his good humored laughter, and his en-
couragement, his enthusiasm, the spur to
fresh endeavours, and his kindness and
sympathy set the atmosphere four our