Thomas Hodgkin

Born 1798
Died 1866

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English physcian and pathologist, born August 17, 1798, in Pentonville, St. James Parish, Middlesex; died April 5, 1866, Jaffa, Palestine [now Tel Aviv-Yafo, Israel].

Biography of Thomas Hodgkin

Thomas Hodgkin was the most prominent British pathologist of his time and a pioneer in preventive medicine. In a strange contrast to his great popularity, above all in London, stands the fact that Hodgkin was denied a professional advancement. More and more disappointed by medicine he became an Oriental traveller, making important contributions. At Guy's Hospital in London, Hodgkin was a colleague of Richard Bright (1789-1858) and Thomas Addison (1793-1860).

Early life
Thomas Hodgkin was the third of four sons born to John Hodgkin and Elizabeth Rickman. His two younger brothers died in childhood. His parents were Victorian Quakers, members of "The Society of Friends" and living strictly to the rules of their sect. The childhood of Thomas and his younger brother was strongly impressed by the faith and lifestyle of the Quakers. Dancing and the reading of novels were forbidden pastimes, and men, as well as women, were plainly dressed and the children were raised to pursue their activities in silence.

The Hodgkin brothers were highly interested in mechanics, chemistry and electricity, interests which they shared with a cousin named Sarah Adler who was of the same age, and who was later to be the object of Thomas Hodgkin's love. This lovefire was to burn with varying intensity for some 35 years, but the two could never marry, as the Quakers forbade marriage between cousins. The brothers received a broad private education, mainly from their father and, already as a young man, Thomas mastered several foreign languages perfectly: Latin, French, Italian, German, and Spanish.

Student years
In September 1819, at the unusually high age of 21 years, he was entered as a student of medicine at The United Hospitals of St. Thomas's and Guy's. One year later he went to Edinburgh to continue his studies at the University of Edinburgh, where he worked hard, but in his letters to his parents he criticised most of the lectures for their dullness and lacking punctuality. His critique was later supported by no less than Charles Darwin.

At this time it was common for medical students to go abroad to broaden their knowledge, and thus Hodgkin, in 1821, went to Italy and France, mainly working in Paris hospitals. René Théophile Hyacinthe Laënnec (1781-1826), the inventor of the stethoscope, made a strong impression on Hodgkin, who brought back to England a stethoscope and. On his return to London, still a student, he delivered a lecture on the stethoscope at a meeting of the Guy's Hospital Physical Society. The instrument was received with scepsis, but Hodgkin's close friend and later collaborator, William Stroud, saw its importance and subsequently developed the flexible stethoscope.

Hodgkin qualified in Edinburgh in 1823 with a treatise on the physiological mechanisms of absorption in animals - written in Latin. Following graduation Hodgkin travelled in Europe. In Italy he met a wealthy Jewish family named Montefiore. One of the members of the family was Sir Moses Montefiore (1784-1885), "the Jewish Pope", with whom Hodgkin was later to undertake several travels around the Mediterranean.

A London physician
In December 1825 Hodgkin was elected member of the Royal College of Physicians of London, and with the support of elder colleagues from Guy's, was appointed to a position as physician to The London Dispensary. These public dispensaries are somewhat comparable to present day emergency receptions, and it was mostly the poor and sick who came there. These institutions were financed by donations, collections and students fees. Physicians and surgeons worked there part time without pay, while the pharmacists received some compensation. Hodgkin quit this worked after two and a half years of service after unjustly having been critisised for being absent during a brief period of illness. He also pointed to the fact that the ability to work much and for no pay was decisive when hiring people - not their medical qualifications "On the mode of selecting and remunerating medical men for professional attendance on the poor of a parish or district".

Besides his clinical duties Hodgkin in 1825 was appointed lecturer in morbid anatomy and curator of the Pathology Museum at Guy's Hospital Medical School, which was established at this time. It was in this tenure he commenced his career as a pathologist, which he exercised with great enthusiasm and originality. As early as in 1829 Hodgkin published a catalogue of the museum's 1.677 preparations demonstrating the influence of various diseases on organs and tissues. Within short time Hodgkin had established a reputation as the leading pathologist of his time.

Judging from his general practice, Hodgkin would probably have been a certified disaster as a businessman. Having been up all night with a very rich patient, Hodgkin received a blank cheque which he filled in with 10 pounds, then added insult to injury by saying that the patient didn't seem to be able to afford more. The patient never consulted him again. It was said of him that he was so reluctant to demand a fee, that many of his friends would not ask him for a consultation.

Thomas Hodgkin was also a pioneer in preventive medicine. His lecture On the means of promoting and preserving health was published in book form in 1841. It contains four parts; in the first he discusses air, light, cleanliness, clothes and breathing, in the second the important of both solid and liquid food. The training of muscles and mental capability are discussed in separate parts, and the book ends with a discussion of the importance of education for young people.

For his achievements in medicine Thomas Hodgkin in 1836 was offered fellowship of The Royal College of Physicians. Until 1834 only physicians educated at Oxford or Cambridge - being members of the established church - had been eligible for this exclusive circle. Hodgkin turned down the invitation because of what he considered to be the general injustice concerning the choice of members for the society.

In 1827 Thomas Hodgkin became the first reader in England lecturing on pathological anatomy. The lectures were published in 1836 and 1840 as Lectures on Morbid Anatomy. Among his many case studies was an exact description of the symptoms of acute appendicitis, a disease which was not generally recognized until 50 years later.

Thomas Hodgkin was dark haired, short and lean, high tempered and highly appreciated as a lecturer.

Hodgkin’s disease
1829 was the year of Hodgkin's early important contributions to pathology. In his capacity as conservator, Hodgkin published a catalogue of the preparations at Guy’s Hospital. In that year he wrote a long paper on the classification of unexpected intra-thoracic and intra-abdominal tumours and discussed how cancer spread. This article was gradually expanded to two volumes titled The morbid anatomy of serous and mucous membranes - a work of basic importance to modern pathology. The same year he described the aorta insufficiency in an article titled On the retroversion of the valves of the aorta in the London Medical Gazette. Sir Dominic John Corrigan (1802-1880), whose name is attached to the discovery of aortic insufficiency published his findings twenty years later, Corrigan’s pulse.

Hodgkin also discovered the biconcavity of the red corpuscles and the cross-stripes in muscle fibres, and he described the acute appendicitis with perforation and peritonitis.

Hodgkin described the disease that bears his name in 1832, in a paper titled On some morbid appearances of the absorbent glands and spleen, published in Medico-Chirurgical Transactions, the journal of the Medical and Chirurgical Society in London.

In 1865 another British physician, Samuel Wilks, described the same disease picture, independently of Hodgkin and with greater precision. As he later became acquainted with the work of Hodgkin, he recognized the latter’s priority and named the condition for Hodgkin, in an article in Guy's Hospital Reports titled Cases of enlargement of the lymphatic glands and spleen, (or, Hodgkin's disease) with remarks. Since then Hodgkin’s disease has become one of the best known of all medical eponyms

His original preparations of lymphoagranulomatosis maligna are still preserved at Guy’s Hospital. In histological reexaminations in 1926, 60 years after the death of Hodgkin, his diagnosis was confirmed in three of seven cases. His other cases were non-Hodgkin lymphomas, tuberculosis or other lymphatic diseases with similar characteristics.

Hodgkin versus Babington
Despite his undisputed competence Hodgkin was rather unpopular, particularly among his elder colleagues, due to his constant demand for a thorough reform of medical education. His stubborn social engagement and his reports on questions of slavery did nothing to improve this.

The business manager of the hospital said that he would not have anybody at the hospital who had been seen with an Indian - a hint to Hodgkin's well-known liberal views - the same year - 1837 - he was one of the founders of The British and Foreign Aborigines Protection Society. As a result of Hodgkin's efforts an equivalent society was established in France - though more of a scientific than humanitarian purpose.

A highly engaged member of the Society of Friends, Thomas Hodgkin demonstrably wore the equivalent clothing.

The incident that ended Hodgkin's career at Guy’s Hospital took place in 1837 following the death of James Cholmeley - who used the stethoscope as a flower vase. According to plans Addison was appointed physician, leaving open a position for assistant physician. Hodgkin immediately wrote to the hospital board applying for the position, and asking to be allowed to continue as curator of the Guy's pathological museum. Unfortunately for Hodgkin, though, there was also a Dr Benjamin Babington, a physician and scientist of some merit, a friend of Hodgkin's - and a competitor for the position as assistant physician.

Babingtons greatest asset may have been the fact that he was the son of William Babington, physician to Guy's until 1811. His father had been a highly respected and beloved physician at the institution, he was rather extrovert and enjoyed great popularity with his students - qualities that to some degree had been inherited by his son. Babingtons sister was the first wife of Richard Bright, one of the three giants of Guy's (Addison, Bright and Hodgkin). Despite attempts from many of Hodgkin influential friends and relatives to influence the board, Benjamin Babington was elected assistant physician to Guy's Hospital. The following day Hodgkin quit Guy's Hospital forever, moving on to St. Thomas’s Hospital.

As Hodgkin was highly recognised for his clinical merits, he had played an important part in establishing Guy's Hospital as an independent medical school of the highest quality, and was held in high esteem by his students, this decision caused a lot of controversy.

For the rest of his life Hodgkin devoted a major part of his time to questions of social medicine, above all the medical problems of the poor and underprivileged, like American Indians and natives of Africa. The British and Foreign Aborigines Protection Society, founded with three others, existed until 1909 when it was merged with The British and Foreign Anti-Slavery Society.

Forbidden love
When Sarah Goodlee, the object of Thomas Hodgkin’s love, lost her husband in 1836, the relationship between the two cousins was resumed. There was talk of marriage, but again the sect stood in the way of happiness. In 1840 Hodgkin made a last effort; through an article titled "On the rule which forbids the marriage of first cousins" he attempted to change the rule, but to no avail. As Hodgkin dared not, or would not, act against the rules of the sect, the romance did not continue after 1847. On January 3, 1849, Thomas Hodgkin married Sarah Frances Callow (1804-1874).

Late years
Despite memberships in several learned societies, one of the oldest in service in the Senate of the London University, to the establishment of which he had contributed importantly, Hodgkin, seemingly from deep personal disappointments, retired more and more from medicine and devoted himself to philosophical, geographical, and ethnographical studies. He was engaged in the Royal Geographical Society and played an important part in the establishment of the Ethnological Society in 1843.

From his early years Thomas Hodgkin was a friend, and from 1925 physician to, the successful businessman and philantroper Moses Montefiore (1784-1885). During the last years of his life Hodgkin spent much time with Montefiore. The two friends frequently visited the Near East, although the climate there caused Hodgkin great problems. Hodgkin's last journey to Israel took place in the autumn of 1866, with Sir Moses. Already before embarking on the journey Hodgkin's health had been deteriorating, and he was unable to complete the journey to Jerusalem, but spent the last time of his life in the care of a British diplomat in Jaffa.

Thomas Hodgkin died on April 5, 1866, and was buried in a small protestant churchyard in Jaffa. Sir Moses carried the costs of erecting an obelisk by his grave which beared the inscription "Here rests the body of Thomas Hodgkin M.D. of Bedford Square, London. A man distinguished alike for scientific attainments, medical skills and self-sacrificing philantropy". Although this churchyard is now closed, his grave still remains.

Since then his grave has become forgotten and overgrown, but the medical achievements of Thomas Hodgkin will persist, and one may ask, what this man would have achieved if he, and not Benjamin Babington, had been appointed to the position of assistant physician to Guy's Hospital.

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