Houston, Texas (Spring 2017)
Thomas Hodgkin was born in 1798 into a middle class Quaker family then residing in Pentonville, a village north of London. His father was a private tutor and Hodgkin’s early education was also conducted at home, balancing instruction in the Quaker tenets of simplicity and social justice with a wider understanding of science, language, geography, and history. The family maintained relations with many of Britain’s most prominent humanitarians and anti-slavery activists, and at home “he dined with North American Indians, free blacks from America, and former Caribbean slaves bound for Sierra Leone.”[i]
He entered medical school a serious, high-minded young man, dressed always in a long black coat and flat-brimmed hat, adhering strictly to the Quaker manner of addressing others as “thee” and “thou”. He applied himself to his studies, and though his eventual completion of medical training in Scotland and France left him nominally a physician, his interests were seldom confined by disciplinary considerations. Indeed, it was while starting his medical studies in Edinburgh that an eighteen-year old Thomas Hodgkin published an “Essay on the Promotion of Civilization” in which he criticized the emphasis missionary societies placed on religious conversion of native peoples over efforts to first improve their material quality of life.
After almost a decade traveling abroad, Dr. Hodgkin returned to London to take up a lectureship in anatomy at the Guy’s Hospital. Though he spent endless hours teaching students and expanding the hospital’s specimen collection, he remained full of restless energy, researching, writing, and thinking long into the night.
In his seminal 1832 manuscript “On Some Morbid Appearances of the Absorbent Glands and Spleen”, Hodgkin laid out the clinical and pathologic similarities in seven patients first seen at Guy’s. The microscopic techniques of modern pathology did not exist. There were, of course, no blood tests or X-rays. All that was left to him were the powers of his eyes and his ears, honed over years of minute observation.
He described how the patients initially presented – febrile, losing weight, fluid accumulating in the abdomen, enlarged lymph nodes palpable in the neck and underarm. Their decline and eventual death. He told how he then cut them open and studied closely which lymph nodes were involved with disease and which were not. The color and quantity of the fluid contained in the peritoneal cavity. The characteristic appearance of the spleen.
Through this painstaking examination, he observed how this affliction differed from those with which he was already familiar. He noted how the lymph nodes were not warm or painful as they would have been in an inflammatory condition and the absence of pus contained within, a cardinal feature of most bacterial infections. On cutting into the nodes, he remarked on their “uniform texture throughout…the consequence of a general increase of every part of the gland” and that “this enlargement of the glands appeared to be a primitive affection of those bodies, rather than the result of an irritation propagated to them…through the medium of their inferent vessels.”[ii]
When tissue samples of these patients were examined microscopically almost a century later, perhaps it was not a surprise that three of them did indeed contain Reed-Sternberg cells, which had, in the intervening decades, been identified as the sine qua non of what was by that time commonly called Hodgkin’s Lymphoma.
Not to merely look, but to really see. Thomas Hodgkin had done that, identifying a disease and proposing a mechanism for it using nothing but what was inside of him. Yet even now, on the verge of real academic success, Hodgkin could not help but to again turn his penetrating gaze outwards to the injustices he saw in British society.
He vociferously advocated for the immediate abolition of all American slaves and their eventual resettlement in West Africa. He wrote on the inadequate medical care provided to those who could not afford private physicians, the proper function of charity programs, and the lack of easily available clean housing for the working poor. He corresponded with missionaries of every faith and Quaker acquaintances across the British Empire, learning from them about imperial policy and its effects on native peoples.[iii]
In 1833 Dr. Richard King, Hodgkin’s colleague at Guy’s Hospital, joined a Royal Navy expedition to the shores of the Canadian Arctic, where, some one hundred and fifty years earlier, the King of England had awarded The Hudson’s Bay Company absolute power to make laws, undertake military operations, and enjoy a total monopoly of trade. In his letters home, Dr. King told Hodgkin about the effects of the fur trade on the native population, remarking on their ongoing decline due to the hard alcohol and venereal disease introduced by the Europeans, and “that as long as the Hudson’s Bay Company exist, this noble race must remain in status quo.” Yet he ended his letter with an admonishment to his friend, that “out of respect to our Treasurer, I would rather [these observations] were not mentioned.”[iv]
The official in question was Benjamin Harrison, the treasurer and chief executive officer of Guy’s Hospital, who also served on the executive committee of the Hudson’s Bay Company. Hodgkin knew that Harrison was an imperious man who brooked no criticism of his leadership, yet when he received King’s letter he could not help himself, ignoring the warning it contained and immediately sending his superior an earnest letter calling conditions in the territory of the company “no less appalling in…ultimate results than the slave-trade itself”. Harrison was not pleased.
The perceived insult took on greater significance as he was at that very moment considering which one of the junior faculty at Guy’s to promote to the newly-opened, tenured position of Assistant Physician. The chief rival to Hodgkin for the position was Dr. Benjamin Babington, a suave, well-connected descendant of a long line of prominent physicians. Though Hodgkin’s publication record, renowned lecture series in pathology, and growing reputation as a clinician made him the more qualified candidate, his reflexive advocacy for the Canadian tribes against the corporate interests of the Hudson’s Bay Company had soured Harrison, who soon turned the rest of the hospital leadership against him. Despite the last-ditch efforts of Hodgkin’s family, many admirers, and friends, the results of the final vote of the hospital board on the issue of promotion returned a resounding 23-2 in favor of Babington.[v]
Following his denial of tenure at Guy’s, Hodgkin soon lost interest in academic medicine, devoting his attention to the moral issues that increasingly consumed him. In 1837, he helped found the British and Foreign Aborigines’ Protection Society in order to promote “the advancement of uncivilized tribes.”[vi] In this, he continued his condemnation of missionary groups, which he felt still failed to understand that true Christian civilization could only follow when native peoples were first made materially secure. He wrote furiously to his missionary acquaintances and published his views in newspapers and pamphlets, and yet from the first his society was beset with financial troubles and a lack of interest from the general public.
As in his earlier scientific efforts, Hodgkin felt that the truth as he saw it should have been self-evident to anyone else with a rational mind, and he was “grieved that Missionary Societies and their supporters have so very generally deserted and kept aloof” from his cause, “few if any of them condescending to reply officially”.[vii] His peers, though respectful of his knowledge and passion, found him ever more humorless and arrogant.
Even with the eventual failure of his Society, Hodgkin remained undeterred in uncompromising advocacy for those harmed by what he saw as the unending European thirst for conquest. Fittingly, it was while on a humanitarian mission in British Palestine that Hodgkin died suddenly at the age of 67, struck down by a bout of dysentery. He was buried in Jaffa, Israel, where his tombstone still stands today, inscribed with the words “Nothing of humanity was foreign to him.”
In his own time, Hodgkin’s scientific work also met with mixed success, and the paper outlining what would eventually become his most famous observations was lost to collective memory soon after its original publication. In 1865, Dr. Samuel Wilks was preparing his own presentation on what he thought was a never before characterized clinical syndrome of lymph node enlargement when his research uncovered Hodgkin’s original work. Perhaps it was in deference to his own more gentlemanly instincts that Dr. Wilks eventually gave credit for these observations to Hodgkin and what he had written three decades prior. Yet even this attribution was most likely made in error. As Louis Rosenfeld remarks in his study of Hodgkin’s life and work, soon after the publication of his own paper, Dr. Hodgkin had received correspondence from a colleague regarding the 1666 anatomical study De Viscerum Structura, in which the Italian physician Marcello Malpighi had himself described a diseased spleen and disseminated enlargement of lymph nodes in a young girl under his care.[viii]
As a physician in training, I continue to struggle with the boundaries of my obligation to my fellow man, but Thomas Hodgkin had never recognized any limit to his duty. To him, a patient in clinic with swollen lymph nodes was as deserving of his full energies as a tribesman crushed by colonialism in British Canada. Yet I could not help but wonder where that absolute commitment had gotten him – blocked in advancing the medical career that had once seemed so promising, frustrated at every turn in his efforts to effect change in a society he saw as venal and corrupt, and remembered to this day for a disease he never discovered in the first place.
- Zoë Laidlaw, “Slaves and Aborigines: Thomas Hodgkin’s Critique of Missions and Anti-Slavery” History Workshop Journal 64 (2007): 134.
- Thomas Hodgkin, “On Some Morbid Appearances of the Lymph Nodes and Spleen,” Med Chir Trans 17 (1832): 69-97.
- Louis Rosenfeld, “Thomas Hodgkin: Social Activist,” Ann Diagn Path 01 4(2000): 124-133.
- Edward H. Kass, Anne B. Carey, and Amalie M. Kass. Thomas Hodgkin and Benjamin Harrison: Crisis and Promotion in Academia,” Medical History 24: (1980) 197-208.
- Kass, “Thomas Hodgkin and Benjamin Harrison: Crisis and Promotion in Academia,” 197-208.
- Ronald Rainger, “Philanthropy and Science in the 1830’s: The British and Foreign Aborigines’ Protection Society,”Man 15 (1980): 707.
- Laidlaw, “Slaves and Aborigines,” 142.
- Rosenfeld, “Thomas Hodgkin,” 124-133.
KIRTAN NAUTIYAL is a second year fellow in hematology and oncology at the Baylor College of Medicine in Houston, TX.