Sir Jonathan Hutchinson
- Bernard-Horner syndrome (Claude Bernard)
- Boeck's sarcoid
- Horton's disease I
- Hutchinson's angina
- Hutchinson's dehidrosis
- Hutchinson's disease
- Hutchinson's facies
- Hutchinson's freckle
- Hutchinson's mask
- Hutchinson's melanotic disease
- Hutchinson's patch
- Hutchinson's prurigo
- Hutchinson's pupil
- Hutchinson's sign 2 (Sir Jonathan Hutchinson)
- Hutchinson's teeth
- Hutchinson's triad
- Hutchinson-Gilford disease
- Mortimer's disease
- Peutz-Jeghers syndrome
- Souques-Charcot geroderma
Biography of Sir Jonathan Hutchinson
Jonathan Hutchinson was born to a Quaker family in Selby, Yorkshire, where his father had a prosperous flax business. He shared his parents' religious convictions and initially planned a career as a medical missionary. Instead, in 1848 he became an apprentice to Caleb Williams, an apothecary and surgeon of York. He received his professional qualification from Bartholomew’s Hospital in 1850. During his student days in London Hutchinsom became involved with philanthropic Quaker Missions, with the aim of alleviating misery and uplifting the impoverished.
During his student time Hutchinson gained the friendship of his mentor, Sir James Paget (1814-1899), whose patronage facilitated his career as a surgeon. One of the most versatile clinicians of the nineteenth century, Hutchinson was affiliated with a large number of hospitals.
In 1851 he studied ophthalmology at Moorfields and was an ophthalmologist to the London Ophthalmic Hospital. He practised surgery at Bartholomew's from 1854. He was also venereologist to the Lock Hospital, physician to the City of London Chest Hospital, and general surgeon to the London and Metropolitan Hospitals. From 1859 to 1883 he was surgeon to the London Hospital, and he also worked at the Blackfriars Hospital for Diseases of the Skin, being elected to the staff in 1867 and becoming senior surgeon. Hutchinson developed a special interest in congenital syphilis, which was common in London in his time, and he was responsible for delineating the natural history of the disorder. It is said that he saw more than one million patients with syphilis in his lifetime.
Hutchinson was a member of the Dermatological Society of London. He was a fellow of the Royal College of Surgeons from 1862 and professor of surgery there from 1879 to 1883.
Hutchinson had a vast clinical experience and he published his observations in more than 1,200 medical articles. Despite his busy practice he produced the quarterly Archives of Surgery, which ran into 11 volumes from 1890 to 1900; although he was the only contributor, this journal had a wide circulation and was held in high regard.
A present mind of no humour
Although his intellectual attributes were unchallenged, Hutchinson had his critics. Ernest Gordon Graham Little (1867-1950) commented: "He was a tall, stooping, spare figure, wearing an unbeautiful straggling beard at a time when beards were obsolete. He was totally devoid of any sense of humour and like most humourless men, incredibly obstinate in clinging to his opinions long after they had been demonstrated to be untenable".
A more charitable observer, who attended a lecture delivered by Hutchinson, stated: "What we saw that day was a tall man with a great dome of a head, dark eyes looking benevolently through steel-rimmed spectacles, and a white beard which came well down on his chest. He was dressed in a suit of black broad cloth and looked like an absent-minded professor, though there was nothing in the least absentminded about his delivery. I do not remember what he talked about that day but he held us completely for an hour. He spoke rather slowly and solemnly, and what he said was clear and logical. There was nothing scintillating about it, but you felt he was speaking out of immense knowledge. Occasionally he illustrated his point by some unexpected simile and there was a distinct North Country intonation in his voice, which seemed somehow to make what he said trustworthier.
In England the term morbus Hutchinson-Boeck has been used for benign lymphogranulomatosis, now commonly known as Boeck's sarcoid, named for the Norwegian dermatologist Cæsar Peter Møller Boeck (1845-1917).
In January 1869, a 58 year-old coal-wharf worker, John W, attended Jonathan Hutchinson at the Blackfriars Hospital complaining of purple skin plaques, which had gradually developed over the preceding two years, somewhat symmetrically on his legs and hands. They were neither tender nor painful and did not ulcerate. Hutchinson considered that the skin lesions were in some way related to the patient’s gout.
“He came on account of a number of peculiar patches of dark purplish colour on his extremities . . . He had an attack of gout in the metacarpophalangeal joint of his left forefinger while under treatment. No medicine had much effect on the eruption; he took at different times, colchicum and magnesia, arsenic, acid iron mixture, iodide of potassium, and simple alkaline mixture. No special local treatment was adopted, only an ointment of lead and mercury being ordered.”
Hutchinson’s first published account of this patient appeared under the title “Case of livid papillary psoriasis” in his Illustrations of Clinical Surgery, 1877. In a much later publication, “On eruptions which occur in connection with gout”, Hutchinson (1898) recalls this first example with the remark, “He has suffered from gout, and he finally died of contracted kidneys. I was inclined to consider the skin disease as essentially connected with gout . . .”
John W died in 1878 at the age of 64 years from kidney disease, after treatment at King’s College Hospital, London. It is now recognized that patients with sarcoidosis, particularly those with chronic skin lesions, have disordered calcium metabolism leading to renal calculi and terminal renal failure.
Hutchinson is hard to beat when it comes to presidencies: president of the Pathological Society 1879-1880, president of the Ophthalmological Society of Great Britain 1884-1885, president of the Royal College of Surgeons 1889, president of the Neurological Society 1887, president of the Medical Society of London 1892, President of the Royal Medical and Chirurgical Society 1894-1896, and president of the International Dermatological Congress 1896. He was knighted for distinguished service to medicine when aged 80 years, in 1908.
Hutchinson’s clinical collection of illustrations was so vast that both the Royal College of Physicians and Surgeons refused it, for lack of space, but it was acquired after his death by the Johns Hopkins Medical School through Sir William Osler.
In his personal life Hutchinson had 31 years of happy marriage with his wife, Jane, and their numerous offspring. His family lived in his country home in Haslemere, south of London, which he visited at the weekends and holidays, while he lived in his London house during the working week. He shared the latter establishment with his friends Edward Nettleship (1845-1913), Waren Tay (1843-1927) and John Hughlings Jackson (1835-1911).
Hutchinson held deep moral convictions throughout his life, although he moved away from strict Quaker religious dogma. He died at Haslemere in 1913, a patriarch aged 85 years, after choosing his own epitaph: “A Man of Hope and Forward-Looking Mind”, which was inscribed on his gravestone.
A plaque of him was erected on 15 Cavendish Square, W1, in 1981.
Works by Sir Jonathan Hutchinson
The work of Jonathan Hutchinson is remarkable in both quantity and diversity. His writings reveal an encyclopaedic mind conversant with virtually every area of medicine and one able to communicate effectively. As surgeon to London Hospital and later the Royal College of Surgeons, Hutchinson made numerous original observations, most notably in the area of congenital syphilis and skin diseases. Much of his work is preserved in the eleven volume Archives of surgery (1890-1900), a journal written entirely by him. For a brief period of time he was the editor of the British Medical Journal.
- On the form of dyspepsia which usually attends phthisis.
- Report on the effects of infantile syphilis in marring the development of the teeth.
Transactions of the Pathological Society of London, 1858, 9: 449-456. Hutchinson’s teeth.
- A clinical memoir on certain diseases of the eye and ear, consequent on inherited syphilis. London 1863.
- Surgical Diseases of Women.
In: Timothy Holmes (1825-1907): A System of Surgery, Theoretical and Practical, in Treatises by Various Authors. 4 volumes, London 1860-1864; 2nd edition in 5 volumes, 1869-71, etc.
- On constitutional syphilis.
In Sir John Russel Reynolds ( 1828-1896), publisher: System of Medicine.
- Transmission of syphilitic taint from the foetus to its mother.
- The rectangular catheter staff for lithotomy.
- On injuries of the head.
The Astley-Cooper prize treatise for 1865.
- Clinical illustrations of amaurosis.
- Lesions of the eye in connexion with injuries to the fifth nerve.
- Illustrations of clinical surgery.
Volume I. London, J, Churchill, 1875-1878.
- Clinical lectures on rare diseases of the skin.
- A successful case of abdominal section for intussusception.
Medico-Chirurgical Transactions, London, 1874, 57: 31-75.
In 1871 Hutchinson was the first successfully to operate on a case of intussusception, in a two year-old infant.
- On gangrenous eruptions in connection with vaccination and chickenpox.
Medico-Chirurgical Transactions, London, 1882, 65: 1-12.
Original description of varicella gangrenosa.
- A rare form of lupus (marginatus).
Archives of Surgery, London, 1889-1890, 1.
Plates d 13-14: “Hilliard’s lupus”.
Hutchinson made an innovation in terminology when he named the disease after the patient instead of the physician describing it. See also Polyclinic, 1900, 2: 104-109, for a fuller description of this patient.
- Lectures on clinical surgery.
Part 2; London, J. & A. Churchill, 1879.
On page 298 is the first description of hydradenitis destruens suppurativa, later named “Pollitzer’s disease” from the latter's important description of it in Journal of Cutaneous and Genitourinary Diseases, Chicago, 1892, 10: 9-24.
- P. Daser:
Sir Johathan Hutchinson.
Münchener Medizinische Wochenschrift, 1913, 60: 1605-1606.
- L. R. Cahn:
Some Notes on Sir Jonathan Hutchinson. (1828-1913).
American Journal of Surgical Pathology, New York, 1979, 3: 563-566.
- D. G. James:
Centenary commemoration of sarcoidosis and of Jonathan Hutchinson.
British Medical Journal, London, 1969, ii: 109-110.
In memoriam Jonathan Hutchinson (1828-1913). Sarcoidosis, 1984; 1: 63-64. Obituaries:
- British Medical Journal, 1913, pp. 1398-401 and 1632.
- British Journal of Dermatology, Oxford, 1913, 25: 225-227.
- Lancet, London, 1913, I: 1832, and II, page 430.
- Edward Nettleship (18145-1913): Ophthalm. Rev. 1913, pp. 225-230.
- Julius Hirschberg: Englands Augenärzte. Leipzig, 1915, pp. 234-238.
- Hermann Vierordt: Medizin-Geschichtliches Hilfsbuch. Tübingen, 1916; pp. 140-150.