MEDICAL MATTERS:Eponyms - the practice of naming diseases after their discoverer - helps us trace the facts
HISTORICALLY, THE use of eponyms has been valued and promoted in medicine.
Critics of the practice, of which there are a growing number, say it is ego-driven and point out that a disease named in the day of original diagnosis may not accurately reflect all that has subsequently been discovered about that illness.
I am a fan. I find it helps me remember detail in a way that some modern nomenclature does not. Derived from the Greek eponymos - a combination of epi, "upon" and onyma "name" - I also like how eponyms give a historical tribute.
The Epstein-Barr virus is an example of an eponymous organism. Most commonly associated with the development of glandular fever (infectious mononucleosis), the virus was first identified in 1964. Tony Epstein, along with his assistant Yvonne Barr, isolated the virus from tumour cells taken from Ugandan children with a form of cancer known as lymphoma.
There is an interesting Irish thread running through the discovery of this hitherto unknown member of the herpes group of viruses.
Yvonne Barr is a graduate of Trinity College Dublin (TCD). And Denis Burkitt, the doctor who sent the frozen tumour specimens from Kampala, is a famous graduate of TCD's medical school.
After training as a surgeon and completing war service, Denis Burkitt was appointed medical officer to the Colonial Office and dispatched to Uganda. While based in Kampala, he noted a succession of boys and girls with tumours of the jaw.
With typical scientific rigour Burkitt found the jaw tumours were made up of lymphatic tissue that matched swellings found in other parts of the body. He then identified a definite pattern of distribution: most of the young African children with these tumours lived in a band that ran between 10 degrees north and 10 degrees south of the Equator.
Invited to lecture about his new discovery at London's Middlesex Hospital, among Burkitt's audience was Tony Epstein, who at the time was investigating possible links between viruses and tumour formation.
After the lecture, he asked Burkitt if he could send some lymphoma specimens from Uganda. These contained a new form of virus, subsequently named the Epstein-Barr Virus.
But why were the children's tumours confined to such an exact geographical area?
While it now looked like Burkitt's lymphoma was a form of cancer with an environmental cause, unknown in dry parts but common in areas of high rainfall, what was the exact link?
Eventually a hypothesis emerged: did the Epstein-Barr virus cause an increase in lymphoid cells which then turned malignant in people whose immune defences were weakened following a bout of severe malaria?
Other malignancies including Hodgkin's disease and cancer of the nasopharynx (nose and throat) have since been linked with the virus. And it has also been suggested that glandular fever in adolescence could be associated with a greater risk of developing multiple sclerosis (MS) in later life.
A recent Dutch study found that people with MS were twice as likely to have experienced an episode of glandular fever. But, with many people in the Western world infected with the virus, as reflected in the number with specific antibodies to Epstein-Barr, only a small number go on to develop MS.
The neurological disease, in which the body's immune system attacks itself by targeting the tissue that envelops nerve cells, has long been thought to be the result of a combination of genetic and environmental factors. It seems that Epstein-Barr infection contracted after childhood is not only more likely to lead to a debilitating episode of glandular fever, but may also induce immune system changes that trigger MS in a minority of those originally affected.
Meanwhile, researchers in the Mater Hospital, Belfast, writing in the current issue of the European Respiratory Journal, report finding high levels of Epstein-Barr virus in patients with the lung condition, chronic obstructive pulmonary disease (COPD).
Dr Terry McManus and his colleagues postulate that infection with the virus, along with smoking, contributes to the development of the chronic and disabling lung condition.
While there are undoubtedly more chapters yet to be written in the Epstein-Barr story, it shows how a medical eponym can remain highly relevant.
• My thanks to Prof Davis Coakley, author of Irish Masters of Medicine for much of the information in this column
• Dr Houston is pleased to hear from readers at mhouston@irish-times.ie but regrets he is unable to reply to individual medical queries
