Thomas Hodgkin

Thomas Hodgkin: The Quaker Who Named a Cancer

In 1832 a curator of anatomical specimens at Guy's Hospital published a paper on seven patients whose lymph glands and spleens had swollen and hardened without any infection to account for it. Nobody paid much attention. Thirty-three years later a colleague named Samuel Wilks, having independently rediscovered the same condition, went back to the old paper, recognised what Thomas Hodgkin had seen, and insisted the disease be called Hodgkin's. By then Hodgkin had lost his hospital career, spent his fortune on unpopular causes, and had one year left to live.

A Quaker Education

Hodgkin was born on 17 August 1798 at Pentonville, Middlesex, into a Quaker family — a fact that determined nearly everything about him, from the causes he took up to the doors that closed. Dissenters were barred from Oxford and Cambridge. He entered St Thomas's Hospital Medical School in 1819 and took his M.D. at Edinburgh in 1823, with a thesis on absorption in animals.

The decisive part of his training was a visit to Paris in 1821, then the most advanced medical city in the world. There he learned to use the stethoscope, René Laennec's very recent invention, and absorbed the statistical rigour of Pierre Charles Alexandre Louis, who was in the process of demonstrating by arithmetic that bloodletting did not work. Hodgkin came home carrying both the instrument and the method — the conviction that clinical claims must be checked against counted cases and against what the autopsy shows.

Curator

He joined Guy's Hospital in 1825 as a volunteer clerk and became curator of the museum in 1826. The job sounds minor. It was, in the medicine of that decade, the best possible seat. The museum was the collection of morbid specimens: the diseased organs of everyone who had died in the hospital, catalogued and preserved. Hodgkin spent his days matching what patients had suffered from to what their tissues looked like afterwards, which is the whole business of pathological anatomy.

His output from those years is startlingly wide. He collaborated with Joseph Jackson Lister — father of the antiseptic surgeon — on microscopy, in work that has been described as a foundation of modern histology. He recorded the biconcave shape of the red blood cell and the striations of muscle fibre. He made early observations of acute appendicitis. With the surgeon Charles Aston Key he described, in 1827, the diastolic murmur of aortic valve incompetence, characterising the sound as "a purring, thrilling or sawing kind of noise" — the Key–Hodgkin murmur, and one of the first uses in Britain of the technique he had brought back from Paris.

Seven Cases

The 1832 paper, "On Some Morbid Appearances of the Absorbent Glands and Spleen," is a small masterpiece of description. Hodgkin reported patients with enlarged, indurated absorbent glands — lymph nodes — together with enlargement of the spleen, and argued that this constituted a distinct primary disease of the lymphatic system itself, rather than a secondary effect of inflammation or of a tumour elsewhere. That claim required him to look at a swollen gland and see, not the consequence of something, but the thing itself.

It sank without trace. Hodgkin had no microscope findings to offer and no mechanism, and the paper was the work of a museum curator rather than a consulting physician. Only in 1865, when Samuel Wilks re-examined the cases and named the condition Hodgkin's disease, did the description enter medicine. It has stayed there. Hodgkin lymphoma is now among the most curable of cancers, and its separation from the other lymphomas — the distinction Hodgkin drew from seven autopsies without a microscope — remains clinically fundamental.

The Career He Lost

In 1837 Hodgkin was refused the post of assistant physician at Guy's. The obstacle was the hospital's treasurer, Benjamin Harrison, who is generally understood to have blocked him over his politics — his radical sympathies and his backing of the new, secular University College London. Hodgkin resigned.

He devoted the rest of his life to causes that paid nothing and cost him socially. He was a committed abolitionist. He helped found the Aborigines Protection Society, campaigning for indigenous peoples under colonial rule when almost no one in British public life thought their treatment a scandal, and he supported the Ethnological Society of London. He befriended Sir Moses Montefiore, the Jewish philanthropist, and travelled with him on missions to relieve persecuted communities abroad.

Why Thomas Is Called a Genius

The word must be used carefully here. Hodgkin made no theoretical breakthrough and founded no discipline. What he had was descriptive discrimination of a very high order: the ability to look at a set of cases that everyone else was filing under existing headings and to see that they constituted a separate thing. Almost anything can be made to fit an existing category, and the intellectual courage required to say *this is new* on the evidence of seven post-mortems, with no theory of cause and no instrument to confirm it, is easy to underrate. The judgement held up for two centuries of scrutiny, which is the only test that matters.

The counter-case is straightforward and Hodgkin would probably have conceded most of it. He did not know what the disease was, only that it was one. He could not distinguish it from tuberculosis of the lymph nodes, which some of his cases may in fact have been. He failed to persuade anyone in his lifetime, partly because he was a poor advocate for his own work and partly because he had made himself professionally marginal. He owes his eponym to Wilks's generosity as much as to his own paper. But the paper was right, and the readiness to place a marginalised colonised people, an enslaved African and an unexplained swollen gland in the same category — things the establishment had decided not to look at — is recognisably one habit of mind rather than two.

Legacy

He was one of the three great men of Guy's, alongside Thomas Addison, in a generation that gave clinical medicine several of its permanent names. He never held the senior appointment his ability warranted. Travelling with Montefiore to Palestine in 1866, Hodgkin contracted dysentery and died at Jaffa on 4 April, aged 67, and was buried there — an English Quaker in a Levantine grave, still on the road for somebody else's cause. His name is spoken every day in oncology wards by people who have no idea he ever had one.

Achievements

• Fields: anatomical pathology