Burkitt’s Lymphoma: The Discovery and Diagnosis of a New Illness
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Keywords
Burkitt's lymphoma, discovery, diagnosis
Abstract
How medical practitioners make a diagnosis is not well understood. When confronted with what is apparently a new disease, the diagnostician faces a special, perhaps revealing, challenge. In this paper I use the special circumstance of African Burkitt’s lymphoma as an apparently new disease to examine how it was recognized, characterized, and diagnosed between 1958-1963. African Burkitt’s lymphoma seemed strikingly new when it was first detected at a district hospital in Uganda. It puzzled Denis Burkitt and the pathologists who worked with him for about five years. After much study and time, they could only agree that it was a malignant tumour, likely some type of lymphoma. Eventually, the particular geographic restriction of its occurrence and its distinctive distribution in the human body were the features that led to its recognition as a specific entity able to be diagnosed. The controversy that unfolded over five years shows how clinicians proceed to diagnosis, particularly when confronted with what appears to be a new disease.
Résumé
On ne comprend pas encore très bien la manière dont les médecins praticiens établissent un diagnostic. Lor-squ’il est confronté à ce qui semble être une nouvelle maladie, le diagnosticien fait face à un défi particulier, voire révélateur. Dans le présent article, l’auteur utilise la situation particulière de l’apparition du lymphome de Burkitt africain en tant que maladie apparemment nouvelle pour examiner comment il a été reconnu, caractérisé et diagnostiqué entre les années 1958 et 1963. Le lymphome de Burkitt africain semblait éton-namment nouveau lorsqu’il a été détecté pour la première fois dans un hôpital de district, en Ouganda. Il a intrigué Denis Burkitt et les pathologistes qui travaillaient avec lui pendant environ cinq ans. Après y avoir consacré beaucoup d’étude et de temps, ils n’ont pu que convenir du fait qu’il s’agissait d’une tumeur maligne, probablement une sorte de lymphome. Au bout du compte, la restriction géographique particulière de son apparition et sa répartition particulière dans le corps humain ont été les caractéristiques ayant mené à sa reconnaissance en tant qu’entité spécifique, pouvant faire l’objet d’un diagnostic. La controverse qui a duré cinq ans montre comment les cliniciens en arrivent à un diagnostic, particulièrement lorsqu’ils sont con-frontés à ce qui semble être une nouvelle maladie.
References
2. Haddow AJ. An improved map for the study of Burkitt’s lymphoma syndrome in Africa. E Afr Med J 1963;40:429-32.
3. Burkitt D. A tumour syndrome affecting children in tropical Africa. Postgrad Med J 1962;38:71-79.
4. Glemser B. Mr. Burkitt and Africa. The World Publishing Co., New York, 1970; p 65.
5. Streuli RA, Ultmann JE. Non-Hodgkin’s lymphomas: historical perspective and future prospects. Semin Oncol 1980;7:223-233.
6. Davies JNP, Wilson BA, Knowelden J. Cancer in Kampala: A survey in an underdeveloped country. Brit Med J 1958:2:439-443.
7. Davies AGM, Davies JNP. Tumours in the jaw in Uganda Africans. Acta Un Int Cancer 1960;16:1320-1324.
8. O’Conor GT, Davies JNP. Malignant tumours in African children. Brit J Surg 1960;56:526-535.
9. Burkitt D, O’Conor GT. Malignant lymphoma in African children I: A Clinical syndrome. Cancer 1961;14:258-269.
10. O’Conor GT. Malignant lymphoma in African children II: A pathological entity. Cancer 1961:14:270-283.
11. Central African lymphomas (lead article). Lancet 1962;2:1363-1364.
12. Hutt MSR, Wright DH. Central African lymphomas (letter). Lancet 1963;1:109-110.
13. Epstein MA, Herdson PB. Cellular degeneration associated with characteristic nuclear fine structural changes in the cells from two cases of Burkitt’s malignant lymphoma syndrome. Brit J Cancer 1963;22:243-251.
14. Lymphoma in Africa (editorial). New Engl J Med 1963;269:982.
15. Pulvertaft RJV. Cytology of Burkitt’s tumour (African lymphoma). Lancet 1964;1:238-240.
16. Davies JNP, Elmes S, Hutt MSR et. al. Cancer in an African community, 1897-1956: an analysis of the records of Mengo Hopsital, Kampla, Uganda: Part 1. Brit Med J 1964;1:259-264.
17. Cook AR. Notes on disease met with in Uganda, Central Africa. J Trop Med Hyg 1901;4:175-178.
18. Hutt MSR. Introduction and historical background, p1, in Burkitt’s Lymphoma. Burkitt DP, Wright DH. London: E&S Livingstone 1970.
19. Burkitt DP. A lymphoma syndrome in tropical Africa. Int Rev Exp Path 1963;2:69-95.
20. Burkitt D. Burkitt’s lymphoma: A study in medical detection. Abbot Tempo 1967;4:26-33 Ed. Richardson, R.G. Abbot Universal Ltd. 1967 Abbot.
21. Burkitt D. Determining the climatic limitations of a children’s cancer common in Africa. Brit Med J 1962;27:1019-1023.
22. Burkitt DP. Observations on the geography of malignant lymphoma. East Afr Med J 1961; 38:511-514.
23. Burkitt D, Davies JNP. Lymphoma syndrome in Uganda and tropical Africa. Med Press 1961;245:367-369.
24. Burkitt D. A “tumour safari” in East and Central Africa. Br J Cancer 1962;16:379-386.
25. O’Conor GT. Significant aspects of childhood lymphoma in Africa. Cancer Res 1963;23:1514-1518.
26. Epstein MA, Barr YM. Cultivation in vitro of human lymphoblasts from Burkitt’s malignant lymphoma. Lancet 1964;1:38-40.
27. Epstein MA, Barr YM. Characteristics and mode of growth of a tissue culture strain (EB1) of human lymphoblasts from Burkitt’s lymphoma. J Nat Cancer Inst 1965;34:231-240.
28. Epstein MA, Achong BG, Barr YM. Virus particles in cultured lymphoblasts from Burkitt’s lymphoma. Lancet. 1964;283:702-703.
29. Molyneux E, Rochford R, Griffin B et. el. "Burkitt's lymphoma". Lancet. 2012;379:1234–1244.