Marshall A. Lichtman
Rochester, New York, United States
|Obelisk over Hodgkin grave site in Jaffa, Israel. Moses Montefiore, on his return to England, purchased a column of Aberdeen granite nine feet tall and had it inscribed with a lengthy tribute to Hodgkin “as a mark of my respect and esteem.” It was transported to Jaffa and installed over the gravesite. Photo by Avishai Teicher. Via Wikimedia|
In 1832, a paper entitled On Some Morbid Appearances of the Absorbent Glands and Spleen was read to the Medico-Chirurgical Society of London by its secretary, as Thomas Hodgkin (1798–1866) was not yet a member. In it, Hodgkin described the clinical histories and gross postmortem findings of seven patients with enlarged lymph nodes and spleen. He appreciated that these findings represented a primary disease arising in the absorbent glands (lymph nodes) and not a process reacting to another “irritation.” In retrospect, some cases may have represented different diseases (e.g. another type of lymphoma or lymphadenitis), but his paper was important because it was the first to propose a disease that originated in the lymphatic organs that was not secondary to another disorder, such as an infection. Richard Bright, Hodgkin’s colleague at Guy’s Hospital, reinforced Hodgkin’s findings by including two of these cases in a paper on abdominal tumors published in 1838, crediting Hodgkin with highlighting the progressive character and local origin of this disease of the absorbent glands, the term used for lymph nodes at the time.
Hodgkin’s observations were forgotten for about twenty-five years, when in 1856 Samuel Wilks (1824–1911) reported ten cases that included four of Hodgkin’s original cases. He classified them into four types and introduced a fifth type, which was characterized by “a peculiar enlargement of the lymphatic glands frequently associated with disease of the spleen.” Wilks thought at the time that his observations were original. In his subsequent research, Wilks discovered Richard Bright’s paper on abdominal tumors, in which Bright had included several of Hodgkin’s case descriptions. Wilks realized his error of omission and made amends for his oversight by using the designation “Hodgkin’s disease” in a subsequent paper entitled “Cases with enlargement of the lymphatic glands and spleen (or Hodgkin’s Disease)” for a group of fifteen cases published in 1865. This eponymous designation, Hodgkin’s disease, which more than a century later was amended to Hodgkin lymphoma when the cell of origin was conclusively determined to be a B lymphocyte progenitor, has been ensconced in the medical lexicon for the last 155 years.
In 1926 Herbert Fox (1880–1942), professor of pathology and director of the William Pepper Laboratory of Clinical Medicine at the University of Pennsylvania, traveled to Guy’s Hospital and examined stained tissue sections he prepared from the gross specimens of three of Hodgkin’s cases (Case II, IV, and VI) preserved in the Gordon Museum of Guy’s Hospital in London. Fox confirmed the histopathological diagnosis of Hodgkin’s disease in two of the three cases and lymphoma of another type in the third. Seventy-three years later, in 1999, Fox’s conclusions were supported by Robert (Robin) Nigel Poston (b.1944) in the Department of Experimental Pathology, King’s College and Guy’s Hospital, London, who found Reed–Sternberg cells on histological and immunocytochemical examination in the same two cases shown by Fox to be Hodgkin’s disease. The third case was compatible with another type of lymphoma in agreement with Fox’s findings.
Hodgkin was a physician’s pupil at Guy’s Hospital Medical School and attended the University of Edinburgh Medical School. He wrote his Doctor of Medicine thesis in Latin on the function of blood and lymph. During Hodgkin’s studies in France in 1821 he met René-Thêophile-Hyacinthe Laënnec (1781–1826), the inventor of the stethoscope (initially a hollow wooden tube), who taught him how to use it and, on his return to Guy’s Hospital, he promoted the use of the stethoscope for examination of the heart and lungs among colleagues at Guy’s. Laënnec was a physician, but also a flutist and carved his own wooden flutes. This concordance of interest in sounds and the construction of devices to make them led him to his invention of a wooden tube to foster audition in the cardiac examination.
Hodgkin described aortic valve incompetence in 1829, five years before the Irish physician Dominic John Corrigan (1802-1880). He described appendiceal perforation fifty years before Reginald Heber Fritz (1843-1913), a pathologist at Harvard Medical School. Hodgkin urged reform of the medical curriculum so as to increase science training for medical students. He was among the earliest to propose a residency for physicians to improve their postgraduate medical education (“An Essay on Medical Education,” 1828). He became the curator of the pathological museum at Guy’s Hospital and was designated one of the “three great men of Guy’s” along with Thomas Addison, who described Addison’s disease (adrenal cortical insufficiency), and Richard Bright, who described Bright’s disease or glomerulonephritis (renal insufficiency). He was one of the first physicians to denounce the use of tobacco and was a prime mover in the Anti-Tobacco Society. He was a proponent of reanalyzing clinical findings in the context of postmortem studies, the forerunner of the clinicopathological conference. Hodgkin was one of the leading pathologists (morbid anatomists) of his era. As curator of the pathological museum at Guys Hospital, Hodgkin cataloged the clinical and postmortem findings of 1,600 specimens, correlating their pathological and clinical features. Despite his accomplishments and remarkable breadth of interests, Hodgkin was not selected to the position of Physician to Guy’s Hospital after Bright’s retirement, a position to which he aspired. This disappointment led him to pursue his other interests.
Hodgkin had broad humanitarian commitments, and in some ways his seminal contributions to medicine and medical education have obscured his other societal contributions. He was raised as a Quaker and wrote an essay at age twenty-one on the mistreatment of indigenous peoples, including the American Indians, by European colonists (“Essay on the promotion of civilization”). He committed his later life to humanitarian interests. As a young physician, he was recruited to accompany Abraham and Henrietta Montefiore on a trip from Paris to the south of France and Italy as a compagnon de voyage skilled in medicine, because Abraham Montefiore had severe tuberculosis. This relationship resulted in his meeting Abraham’s brother, Moses. Hodgkin became a lifelong friend and physician to Judith (1784-1862) and Moses Montefiore (1784–1885), the renowned English financier, humanist, and philanthropist. Montefiore was awarded a knighthood and baronetcy by Queen Victoria. He was also the Sheriff of London for a short time. Hodgkin and Montefiore shared concern for the dispossessed of the world. Hodgkin was an outspoken critic of the African slave trade and other inhumane behavior of the day. He was the heart of the Aborigines Protection Society, an organization raising consciousness about the victims of colonialism in North and South America, New Zealand, Australia, Western and Southern Africa, British India, and other places. Montefiore shared these views and made financial contributions to such initiatives.
Montefiore was committed to reinvigorating the Jewish population of Palestine, then within the Ottoman Empire. Montefiore alone, and later with Hodgkin, made arduous and dangerous trips to Russia, Morocco, Egypt, Palestine, and Turkey, which required sailing the English Channel, then traveling overland by horse and carriage, and in some cases making a second voyage across the Mediterranean Sea. These voyages were an effort to aid beleaguered Jews subject to discriminatory actions by tsars and sultans, including accusations of ritual murder. These trips were often successful but very challenging and hazardous, especially as both men aged. As the President of the Board of Deputies of British Jews, Montefiore felt it was his duty to make trips to distant places where the Jewish community was under threat. Montefiore was deeply committed to the Jewish community in Palestine, making multiple trips there to help improve the position of its Jewish population. He contributed to building facilities and establishing programs there to support the community. His trips to the region included a visit with the new sultan, Abdul Aziz, in Constantinople, the seat of the Ottoman Empire, of which Palestine was a part. There he gained the promise of the sultan to continue the privileges given to Jews by the previous sultan, including concessions for land and building in Jerusalem. He traveled to Damascus to save Jews falsely accused of ritual murder. He unsuccessfully intervened at the Vatican for a seven-year-old Italian Jewish child kidnapped by the Vatican Police who was being schooled in Catholicism. The child had been baptized by a servant in the household during a serious illness. He was unsuccessful in seeing the pope or getting the authorities at the Vatican to return the child to his parents, despite strong support from many secular authorities. He traveled to Spain and then Morocco and enlisted the assistance of the queen of Spain and her emissaries in convincing the sultan of Morocco to release Jews falsely accused of ritual murder. In all of his later trips, Hodgkin accompanied him, fulfilling a promise made to Lady Judith Montefiore before she died. He ministered to Montefiore’s health needs and was a friend, companion, and supporter of his initiatives to improve the lives of Jews in Palestine and throughout the diaspora.
Hodgkin died of a severe diarrheal disease (possibly cholera) in 1866 while accompanying Montefiore on a trip to Palestine. Hodgkin is buried in what was at the time the Protestant cemetery in Jaffa. Montefiore later erected a granite obelisk at Hodgkin’s burial site on which he engraved a commemoration to their forty-year friendship. (Figure) Hodgkin’s wife and brother included an inscription on the opposite side of the obelisk that included the phrase “Humani nihil a se alienum putabit” (“nothing human was foreign to him”). A mausoleum at Ramsgate, England, the burial suite of Judith and Moses Montefiore, is one of the uncommon Jewish religious sites remaining in Western Europe. It is the site of an annual pilgrimage by ultra-orthodox Haredi Jews on the anniversary of Moses Montefiore’s death.
More information may be found about the life and times of these two extraordinary men in the biographies cited below.
Kass AM, Kass EH. Perfecting the World. The Life and Times of Dr. Thomas Hodgkin 1798-1866. Harcourt Brace Jovanovich, Publishers, Boston, 1988. The definitive biography of one of the most distinguished physicians, medical educators, and humanitarians of the 19th century. It includes much detail about the relationship of Hodgkin with Montefiore.
Green A. Moses Montefiore. Jewish Liberator, Imperial Hero. The Belknap Press of Harvard University, 2010. A comprehensive biography of one of the most prominent Jews and Jewish philanthropist of the 19th century.
MARSHALL A. LICHTMAN, MD, is a Professor Emeritus of Medicine and of Biochemistry and Biophysics and Dean Emeritus, School of Medicine and Dentistry, at the University of Rochester Medical Center. He edited the Elsevier Journal, Blood Cells, Molecules, and Diseases from 2000-2013 and has been an editor of eight editions of the text Williams Hematology, now in its 10th edition and of its companion manual, Williams Clinical Manual of Hematology.