Thomas Hodgkin (1798–1866)

Early life

Thomas Hodgkin (Figure 1) was born in Pentonville, Middlesex, England, into a devout Quaker family ⁴ , the principles of which guided him throughout his life. His father, a successful private tutor, educated his son who soon became a skilled linguist learning Greek and Latin, ¹ and later French, German and Italian. ² Hodgkin spent a short time as an Apothecary’s apprentice before deciding on a career in medicine. In 1819, he registered as a pupil of Guy’s Hospital in London ³ but decided to follow the medical courses in Edinburgh and received his medical degree in 1823. ⁴ During this time he also studied in France and Italy. ⁵ In 1826, he was appointed ‘Inspector of the Dead’ and ‘Curator of the Museum of Morbid Anatomy’ at Guy’s Hospital. After only three years in this position, Hodgkin managed to broaden and organise the museum’s collection so that it contained over 3200 specimens arranged to show the pathology of disease. ⁶ Professor Louis Foville (1799–1878), a distinguished French physician whom Hodgkin met in Paris, described him as ‘the first morbid anatomist of the age’. ⁷ OPEN IN VIEWER

Hodgkin’s Lymphoma

With his appointment as Inspector of the Dead, Hodgkin regularly performed autopsies. This meant that he not only significantly enhanced the collection at the museum but was able also to explore in more detail the pathology he came across. ⁶ In January 1832, his paper ‘On some morbid appearances of the absorbent glands and spleen’ was published in the Journal of the Medical-Chirurgical Society ³ :

… the morbid alterations of the structure which I am about to describe are probably familiar to many morbid anatomists, since they can scarcely have failed to fallen under their observation … They have not, as far as I am aware, been made the subject of special attention … ⁸

In this paper, he described the appearances of seven patients in whom he observed a combination of marked generalised lymph node enlargement and, in six of the patients, enlargement of the spleen without evidence of infection or other inflammatory pathology. ¹ Some of the specimens he described are still part of the collection at Guy’s medical museum (Figures 2 and 3 illustrate specimens from a 50-year-old man admitted in 1829, case number 4770). Hodgkin described the patient as ‘not at all wasted but was rather plump than otherwise … He had a pale and peculiarly cachectic countenance … Nearly, if not quite all of the absorbent glands within reach examination were enlarged … The abdomen was distended’. ⁸ OPEN IN VIEWER

OPEN IN VIEWER

Figure 3.

The histopathological appearance of one of the cases, case 4770, discussed in Hodgkin’s paper ‘On some morbid appearance of the absorbent glands and spleen'. Image courtesy of Gordon Museum, Kings College London.

Although he believed that many other morbid anatomists would have noticed such pathology, it is claimed ⁹ he was the first specifically to identify splenomegaly and diffuse lymphadenopathy as part of a chronic and then eventually fatal disease.

However, Hodgkin’s paper was not well recognised until much later. In 1838, Richard Bright (1789–1858), a Consulting Physician at Guy’s Hospital, reported on some of Hodgkin’s original work although it was not until 1856 that Samuel Wilks (1824–1911), Knighted in 1897, wrote a paper on ‘Lardaceous disease’ that included Hodgkin’s original cases. In 1865, Wilks further described the cases in detail and permanently linked Hodgkin’s name to the disease. ⁴ Hodgkin was also greatly involved in research and education. In 1829, he wrote a classic paper detailing insufficiency of the aortic valve, which had not previously been recognised. ⁵

Commitment to education

Throughout his career, Hodgkin was committed to education at the medical school at Guy’s hospital. His appointment as Curator of the Museum of Morbid Anatomy is thought to have helped make it one of the leading teaching institutions in England. Before this, while travelling in France he studied the use of the stethoscope under René Laennec (1781–1826) at a medical centre in Paris, and brought it back to Guy’s Hospital in 1822. ² He gave lectures on its use to the opening meetings of the Guy’s Physical Society and was thought to promote the more general use of this instrument in England. ¹ Furthermore, Hodgkin reported on the use of the ‘Laryngoscope’ as recognised by Benjamin Guy Babington (1794–1866) in 1828. ¹⁰

Hodgkin gave many lectures throughout his career and in one to medical students he commented ‘the science of medicine … is progressive in its character … [and] offer[s] a great task to the Teacher as well as the Learner’. ¹¹ Hodgkin was keenly aware that knowledge within the medical sphere was constantly evolving and recognised the vital role of scientific research in education. Wilks later described Hodgkin as ‘One of the most ardent workers in the formation of the medical school [in 1825] at Guy’s hospital’. ¹⁰

Commitment to public health

Hodgkin was intimately connected with almost all the scientific bodies in England during his lifetime ¹² and was devoted to public health. He gave many lectures to the public on preserving and promoting health, stressing the importance of adequate oxygen, bathing and proper disposal of sewage. He also warned of the dangers of overeating, excessive alcohol use, tobacco use and occupational dust exposure. ² These lectures given at Guy’s Hospital were commendable efforts to educate the public about physical, social and occupational health. Furthermore, Hodgkin tried to improve care for the mentally ill, to relieve poverty and unemployment, and he stressed the need for better housing. ¹³

Interest in social reform

Hodgkin was internationally renowned for his social activism in championing the emancipation of oppressed Africans, the poor and persecuted Jews. ⁵ He became a vocal spokesman on behalf of the North American Indians and other indigenous groups ¹³ and was a member of the Aborigines Protection Society. Though undertaken in goodwill, his stance on certain social issues hindered his medical career at Guy’s Hospital. It was probably his public criticism of the Hudson Bay Company’s dealings with the Canadian Indians that prevented his appointment to the position of Assistant Physician which he fully expected to achieve. ² Benjamin Harrison (1771–1856), the wealthy Treasurer of Guy’s Hospital, was also the Deputy Governor of the Hudson Bay Company and took great offence to Hodgkin’s public criticism of the Company’s alleged exploitation of American Indians. Harrison exercised an autocratic rule over appointments at Guy’s Hospital and when Hodgkin did not get the job of Assistant Physician he resigned in 1837. ⁴

Personal life

Not only was Hodgkin disappointed with the failure of his career at Guy’s Hospital but he was also distressed at being unable to marry his first cousin, Sarah Godlee. Although he had loved her since childhood, Quaker Rule forbade first cousin marriage and his appeals of the decision were unsuccessful. At age 52 he eventually married a widow, Sarah Scaife, with whom he was happy until his death in 1866. ⁴ In a letter to his wife sent just before his death, Hodgkin wrote ‘My dear love to all my friends … I lament the little service I have done’. ⁷ It is astonishing that a man who achieved all that he did remained so humble. OPEN IN VIEWER

Final years

In his later years Hodgkin devoted more time to assisting the underprivileged and those afflicted by poverty and slavery. He travelled much in his lifetime and in 1866 joined Sir Moses Montefiore (1784–1885), a successful financier, philanthropist and close friend, on a mission to Israel. ¹⁰ Both men felt a keen interest in this country but unfortunately during this visit Hodgkin developed acute dysentery and died on 4 April 1866.

Hodgkin was buried in Jaffa, the oldest part of Tel Aviv, in Israel. Montefiore erected a grave with the inscription “ … a man distinguished alike for scientific attainments, medical skill and self-sacrificing philanthropy … Nothing of humankind was foreign to him’. ¹⁴