616 J Clin Pathol 1990;43:616-618 Early clinical pathologists 2 Thomas Hodgkin: pathologist, physician, and philanthropist J Clin Pathol: first published as 10.1136/jcp.43.8.616 on 1 August 1990. Downloaded from B W Hancock been of major influence in Hodgkin's sub- sequent career. Indeed, when he returned to England he read a paper at the Guy's Physical Society on the use of the stethoscope, and it is thought that he promoted the more general use of this instrument in London and else- where in the United Kingdom. After an unhappy love affair in 1825 Thomas Hodgkin became a licentiate of the Royal College of Physicians and was invited to become the first lecturer in Morbid Anatomy and curator of the Museum of Guy's Hospital. At this time Guy's and St Thomas's Hospital were united, but a disputed appointment in surgery led to open hostility between the two hospitals and the union was dissolved. At this point St Thomas's refused to part with any of the surgical specimens housed in the museum and Guy's then determined to have their own complete medical school, and indeed this was planned and built within six months of incep- tion. So this was a very appropriate time for Hodgkin to return to Guy's and to join Thomas Addison and Richard Bright (to form http://jcp.bmj.com/ "the great triumvirate"'). They shared a desire to compare clinical observations with Figure 1 Portrait of Thomas Hodgkin (courtesy of The detailed study of post mortem examination Gordon Museum, UMDS). findings. Bright and Addison were excellent clinicians and Hodgkin was their outstanding morbid anatomist. Thomas Hodgkin was born into a strong Two years later, as president of the Pupils' on September 28, 2021 by guest. Protected copyright. Quaker community on Friday 17 August, Physical Society, Hodgkin gave an address on 1798 in Pentonville, London (fig 1). His the reform of the medical curriculum-even parents, John and Elizabeth, seem to have in those days a controversial subject and very been strict and earnest Quakers: John was a revolutionary. He indicated the need for an successful private tutor and was particularly adequate time for medical students to undergo skilled in the art of handwriting which was, at clinical studies including morbid anatomy that time, an important part of social upbring- before being allowed to practise and he ing. Thomas was tutored, not at school but by advocated that they should act as assistants to his father, and soon became a skilled linguist physicians, as indeed they did already for and developed many other talents consistent surgeons, as dressers or housemen. with his subsequent brilliant academic career. He maintained a small clinical practice, in After an initial apprenticeship to a Brighton addition to his duties as morbid anatomist and chemist he registered as a physician's pupil of museum curator, but devoted-most of his life Guy's Hospital Medical School in 1819. His to his work at Guy's Medical School and after Yorkshire Cancer degree of Doctor of Medicine (MD) was only four years had catalogued more than Research Campaign Department of awarded in 1823 on a thesis entitled "De 1600 specimens which were arranged to show Clinical Oncology, Absorbendi Functione", written in excellent the pathology of diseases. All his post mortem University of Latin and containing original observations on examinations were preceded by a short clinical Sheffield, Weston Park Hospital, Whitham the absorbative function of blood and lymph. account; microscopy was very little used at Road, Sheffield S10 He then travelled widely through Europe, this time in post mortem work, so the path- 2SJ. and in particular was much influenced by ological findings described are mainly macro- B W Hancock Laennec in Paris, whose teaching on the scopic. Correspondence to: importance of clinical investigation, including It is not generally appreciated that Hodgkin Professor B W Hancock using the stethoscope, in combination with aortic five Accepted for publication described incompetence2 years 5 March 1990 detailed pathological studies, seems to have before Corrigan and also that the paper which Thomas Hodgkin: pathologist, physician, and philanthropist 617 ON SOME well recognised even with current histological technology that differentiation of the syn- MORBID APPEARANCES drome still presents considerable diagnostic J Clin Pathol: first published as 10.1136/jcp.43.8.616 on 1 August 1990. Downloaded from or difficulties. Meanwhile, as he continued his career, THE ABSORBENT GLANDS Hodgkin had taken an ever increasing interest AND in the social aspects of medicine and par- ticuarly in the problems faced by under- SPLEEN. developed and underprivileged ethnic groups. His views, often publicly expressed, on BY DR. HODGKIN. oppressive measures being taken by British colonialists, made him unpopular with many of his colleagues. In 1834 the Royal College of BY DR. R. LEE. Physicians, having altered its ruling that Fellows must be graduates of Oxford or Cam- REA-D JANUARY 10rf AND 24TH, L8t2. bridge and therefore members of the estab- lished Church, invited Hodgkin to become Figure 2 Title page ofHodgkin's classic paper.3 one of the first Fellows under the new rule. This invitation was not accepted, and it seems likely that Hodgkin and many of his physician colleagues felt that the new rules would lead to injustice towards many practising was to immortalise his name is almost cer- physicians in London. tainly not his most important contribution to At this stage of his life Hodgkin had two the medical literature. This latter work was major professional setbacks. Despite being entitled "On some Morbid Appearances of academically superior to his rival, he was not the Absorbent Glands and Spleen".3 In this appointed to a vacancy on the Guy's staff for paper he describes the necropsy appearances an assistant physician. Undoubtedly, Hodg- of seven cases in which he observed the com- kin's tendency to be awkward in the bination of considerable generalised lymph traditional sense, and in particular his known node enlargement, and in six of the cases political views and criticism of colleagues, enlargement of the spleen without any counted against him. Five years later, he was evidence of infection or other inflammatory invited to become lecturer in medicine at St pathology (fig 2). It was only six years later, Thomas's Hospital, to assist in reorganising however, that these observations were the medical school. His appointment was brought more to medical attention when short lived and amid a series of internal Bright quoted them in his own paper on quarrels among his medical colleagues, his http://jcp.bmj.com/ tumours of the spleen.4 Subsequently, Sir tendency towards outspoken involvement Samuel Wilks, in writing a paper on "lar- probably led to his dismissal. During his short daceous disease" (more latterly recognised to period at St Thomas's, however, he wrote be amyloidosis), described a variant of this many of his later medical papers, such as "On disorder5 in which there was a peculiar enlar- the principles and classification of diseases",8 gement of the lymphatic glands frequently and "On the anatomical characters of some associated with disease of the spleen. In the adventitious structures-an attempt to point on September 28, 2021 by guest. Protected copyright. latter part of this paper he had obviously out the relationship between the microscopic encountered Thomas Hodgkin's original find- characters and those which are discernible to ings and gives him full credit for these. In a the naked eye".' later paper (written some 33 years after the After his major professional setbacks his original description) Wilks collected a series medical work fell more and more into the of 15 cases and linked Hodgkin's name per- background and his philosophical and philan- manently with this new entity, "Cases of thropic interests claimed far more of his time. enlargement of the lymphatic glands and He did publish other papers of a visionary spleen (or Hodgkin's disease) with remarks".6 nature, however, one of which was perhaps It is now recognised, of course, that some of the forerunner to our modern clinical con- Hodgkin's original cases were not in fact trolled trials ("Numerical methods of conduc- Hodgkin's disease. In 1926 Fox examined the ting medical enquiries"'") and the other a plea microscopic sections from gross specimens for the adoption of the metric system ("On the preserved in the Guy's Hospital Museum7; weights to be used in medicine"")-some- remarkably, histological appearances had been thing which took another 100 years before preserved despite the fact that the tissues had being accepted by the British medical frater- been kept in fixative for 97 years. He con- nity. cluded that four cases showed typical Hodg- In 1850 Thomas Hodgkin married and con- kin's disease whereas the others were either of tinued to lead a simple life which brought him chronic infection (syphilis, tuberculosis) or of into contact with all aspects of humanity. In non-Hodgkin's lymphoma. These findings are pursuing his philanthropic studies he not surprising really as Thomas Hodgkin travelled extensively abroad championing the himself never claimed any specific pathology, ethnic underdogs. It was on one of these he only pointed out the rather peculiar syn- travels that he contracted acute dysentery drome (of non-infective generalised lym- (possibly cholera) from which he died in 1866 phadenopathy and spienomegaly), and it is on 4 April at the age of 68. There can be no 618 Hancock more fitting tribute than on 15 December patrick Lecture, delivered by Dr Thompson Hancock at the Royal College of Physicians, London in 1966, the centenary 1966, when a symposium was held on Hodg- year of Hodgkin's death.