On the Pathology of Hodgkin's Disease

Dunn, Robert Ian Shaw (1955) On the Pathology of Hodgkin's Disease. MD thesis, University of Glasgow.

Abstract

In Part I an attempt was made to offer a brief and reasonably critical account of the inherent peculiarities of the structure and of the diseases of the reticulo---endothelial system. Particular emphasis was accorded to works which have served to integrate the concept of lymphoid tissue sarcoma. While it is doubtful whether knowledge is yet adequate enough to endorse this idea universally, it has the advantage of being a practical generalisation which simplifies the subject. The view that the morbid process, primary reticulosis, was covered by the generic lymphoid tissue sarcoma was also supported. In Part II some account was given of the lymphatics and lymphoid tissue. In this outline attention was drawn to the mysterious and bewildering problems inseparable from the system. The structure of lymph nodes was given with observations on their development, involution, and possible neogenesis in adult life. From these studies it emerged that the full complement of lymph nodes in the locus examined was probably attained in adolescence or early adult life, and that fat replacement was the usual mode of atrophy. Attention was also drawn to the rarity of fibrosis in physiological nodes, except where it was the result of blood vascular hyaline change. In Part III Hodgkin's disease was studied. In the introduction of this part of the work the historical aspect of the malady was recorded, with, it is hoped, advertisement of interesting and possibly less well-known facts about it. This was followed by a critical consideration on the nature of the disease and its morbid anatomy, the latter being /illustrated illustrated in part by analyses of the cases coming to necropsy at Glasgow Royal Infirmary over a period of fifty years. In this part also were the findings of a large series of biopsy specimens. Here endeavours were made to shew the microscopical variations in morphology in the lesion, and to demonstrate the affinities of other lymphoid tissue sarcomata with the disease. Within the resources available the generic lymphoid tissue sarcoma was established, and links between the better recognised variants were presented with a reasonable degree of conviction. In the necropsy series a detailed study of thirteen cases of Hodgkin's disease or reticulum cell sarcoma was offered. In these it was shewn that the favourite locus was lymphoid tissue, that complete systematisation was rare, and that metamorphosis to a more tumour-like lesion was common. In Part IV two components of the Hodgkin's disease complex were studied in relation to general pathology. The view that fibrosis, an essential and inherent peculiarity of the Hodgkin's disease lesion, was represented in certain other morbid states was submitted. This was illustrated by brief accounts of some diseases where quasi-neoplastic features are shewn by connective tissue. Eosinophilia in tumours was also made the subject of investigation and revealed that the phenomenon, while possibly not so rare as might be expected, was not nearly so common as in Hodgkin's disease. Some evidence was found for the cyto-metaplastic origin of eosinophiles in Hodgkin's disease, but possibly due to the restriction to histological as opposed to cytological methods, the results were not highly conclusive. In Part V an experimental attempt to reproduce the disease by /chronic chronic trypan blue poisoning of rats and mice proved unsuccessful, although interesting results followed. The main contention in this thesis has been that Hodgkin's disease is a neoplasm. Perhaps the following may influence the reader more convincingly than I have been able to do by so much work. The reasons for human beliefs depend chiefly upon Authority, Intuition, and Scientific Method. The last two have been exploited as far as I have been able; the foremost remains. As a junior student I saw a case of Hodgkin's disease first in the wards of the Late Professor Archibald Harrington, at Glasgow Royal Infirmary. I was chagrined at the doubt cast on its nature in the discussion which followed the demonstration; at twenty, one is very intolerant of obscure aetiology! On my return home I imprudently assailed my Father with the question at the dinner table, where even renal oedema was taboo. He was exceedingly angry. There was a dreadful silence, and then he relented - 'of course it is tumour, - but mind to whom you say that' Nothing more was said. I submit that this terse pronouncement has been my most precious axiom, with deepest respect and affection.

• Item Type: Thesis (MD)
• Qualification Level: Doctoral
• Keywords: Medicine, Pathology
• Date of Award: 1955
• Depositing User: Enlighten Team
• Unique ID: glathesis:1955-79134
• Copyright: Copyright of this thesis is held by the author.
• Date Deposited: 05 Mar 2020 11:40
• Last Modified: 05 Mar 2020 11:40
• URI: https://theses.gla.ac.uk/id/eprint/79134