Thomas Hodgkin

Thomas Hodgkin was born into a devout Quaker family in Bruce Grove, Tottenham in 1798. He espoused the dress and values of his faith, not always to his advantage in his chosen career. At age 21, he wrote an “Essay on the Promotion of Civilization,” in which he criticized the imperialistic behaviour of colonists that led to the degradation or death of North American Indians and other native peoples. Thomas also developed an interest in science and medicine. From 1817 until 1820 he served as apprentice to an apothecary and “walked the wards” at Guys Hospital in London. While a medical student at Edinburgh, Hodgkin visited European medical centres during 1821–1822 and met René Laennec in Paris. Laennec had recently devised the stethoscope and taught Hodgkin how to use it. He received his medical degree from Edinburgh in 1823, the same year he met Moses Montefiore, a wealthy financier and philanthropist who was to become his lifelong patient and close friend.

In 1826, Hodgkin was appointed first lecturer in morbid anatomy and museum curator at the new Guys Hospital Medical School in London. During the next 12 years at Guys, Hodgkin made a number of major contributions. Despite his brilliance Hodgkin was rejected for a clinical staff position in 1837, after which he resigned from Guy’s Hospital. 1857 marked the first of five journeys with Moses Montefiore on behalf of Jews, Christians, and Arabs in various countries. In 1865 Samuel Wilks wrote his paper using the term “Hodgkin’s disease.” In the following year Thomas Hodgkin died of dysentery in Palestine. He is buried in Jaffa.

Hodgkin’s years at Guy’s Hospital were remarkably productive. He performed hundreds of autopsies and catalogued over 3000 specimens in the Green Book. Hodgkin presented the first systematic lectures on pathology in England and published a two-volume monograph. He described aortic regurgitation 5 years before Corrigan. Hodgkin, Richard Bright, and Thomas Addison were contemporaries and became known as “the three great men of Guy’s. All three correlated clinical with post-mortem findings and all had diseases named for them, but Hodgkin’s remains the most familiar.

Hodgkin brought the first stethoscope to Guy’s Hospital and delivered a lecture on Laennec’s method for its use to the hospital physical society in 1822. The older physicians at Guys were unimpressed with this peculiar-looking cylinder and used his stethoscope as a flowerpot, standing it on end. Once they left the room, the students removed the flowers and began examining each other with the instrument. In 1829 Hodgkin published a catalogue of pathologic specimens he had assembled in the museum, which was a landmark contribution. The museum helped make Guy’s one of the leading teaching institutions in London and all of England. Moreover, the availability of material from his own cases enabled others to later confirm his work.

In 1832 Hodgkin published his article ”On Some Morbid Appearances of the Absorbent Glands and Spleen’ In the report he described clinical histories and post-mortem findings of seven patients with enlargement of lymph nodes and spleen but without inflammation or other significant pathological findings. Hodgkin recognized that tuberculosis coexisted in some of the patients, but the firmness and size of the nodes made him conclude that these findings were different. Interestingly Hodgkin did not look at his specimens under the microscope. He had been one of the first people to use Lister’s improved achromatic lenses to examine the details of red blood cells and muscle fibres and the paper he wrote provided the foundations for the modern study of histology. In 1865 Samuel Wilks came across some of Hodgkin’s original cases in the course of other work and it was he who used the term ‘Hodgkin’s Disease’

Benjamin Harrison, Jr., was the administrator of Guy’s Hospital for over half a century (1797–1848); following in the footsteps of his father .He was wealthy, autocratic, and known as “King Harrison,” the hospital board being essentially a rubber stamp for his wishes.

Why didn’t Hodgkin receive the clinical appointment at Guy’s in 1837? There may have been a number of issues leading to Harrison’s decision, including Hodgkin’s refusal of the fellowship in the Royal College of Physicians, his involvement in the newly organized University of London which was regarded by Harrison as a potential competitor to Guy’s, and the fact that Hodgkin had been ill and absent for some time during the year prior to the decision. Another factor probably played a role in Benjamin Harrison’s decision. He was a board member of the Hudson’s Bay Company and was angered by Hodgkin’s outspoken criticism of the company for its exploitation of American Indians. The Hudson’s Bay Company gave guns and alcohol to the Indians in exchange for furs, which brought large profits to the company. Their divergent views placed Harrison and Hodgkin on a collision course that exploded in 1837. The result of this confrontation was a tragedy for Hodgkin and an irreplaceable loss for Guy’s.

After Hodgkin resigned from Guy’s Hospital in 1837, his academic medical career was over. His efforts on behalf of underprivileged and oppressed peoples throughout the world were lifelong. He remained a social reformer. He had played an important role in organizing the new University of London and its medical school, the first secular institution of its kind in England. Hodgkin declined fellowship in the prestigious Royal College of Physicians in 1836. Two years before, the college had repealed its bylaw that limited the fellowship to graduates of Oxford and Cambridge. However, Hodgkin felt that he would be singled out as an exception and it was unfair that other qualified individuals would not achieve election into fellowship

Hodgkin endured major disappointment in his personal as well as his professional life prior to age 40. He was not permitted to marry his true love, Sarah Godlee, because of the Quaker rule prohibiting marriage between first cousins. Even though he petitioned the Society of Friends to make an exception on two separate occasions, he was refused. Later, too late for Hodgkin, the Quaker rule was repealed. He finally married Sara Scaife, a widow and not a Quaker, in 1849.

Hodgkin’s life was devoted to attempts to help the underprivileged and oppressed peoples throughout the world, in North America, Australia, Africa, Syria, the British West Indies, and Liberia, to name a few sites. He lectured on sanitary measures and stressed the importance of protecting child labourers during the early phase of the industrial revolution in England. He cared for the poor, especially Jews in London, and often did not charge fees. He travelled with Moses Montefiore on multiple occasions to help Jews and other oppressed people. He also studied ethnology, geography, and the new science of anthropology. Hodgkin belonged to many organizations with social missions and held leadership positions in some of them. In 1829 he gave four lectures to the public on ways to promote and preserve health. He stressed the importance of adequate oxygen, bathing, and proper disposal of sewage. Hodgkin also warned of the dangers of overeating, excessive alcohol use, tobacco use (“smoking encroaches on the freedom and comfort of others”), and occupational dust exposure. He advocated regular exercise and education (including preschools and equal education for girls and boys). These lectures were given while Hodgkin was still at Guy’s and were remarkable efforts in educating lay persons about personal, social, and occupational health issues.

Moses Montefiore (1784–1885) was a successful financier and philanthropist. An orthodox Jew, he was a fellow of the Royal Society and had been knighted by Queen Victoria for his good works. Montefiore met Hodgkin in 1823 through his brother, who briefly was Hodgkin’s patient but fired him. However, Moses Montefiore and Hodgkin became close friends, and Hodgkin served as personal physician for Moses Montefiore and his wife for many years. Their journeys together for philanthropic purposes included a visit to Palestine in 1866, during which Hodgkin became ill with a dysenteric-like disease and died on April 4. He was buried in Jaffa. On his gravestone is the inscription, “Nothing of humanity was foreign to him”.

Dilys

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