Hutchinson, Jonathan (1828–1913)
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KeywordsWerner Syndrome Melanocytic Nevus Mycobacterium Leprae Congenital Syphilis Tertiary Syphilis
Sir Jonathan Hutchinson
Date, Country, and City of Birth
July 23, 1828, Selby, Yorkshire, England
Date and City of Death
June 26, 1913, Haslemere, Surrey, England
History of Life
Jonathan Hutchinson was born as the second son of a cloth-trading Quaker family of 12 in Selby, Yorkshire. His father was a rich flax merchant. He was educated with his parents’ religious convictions and initially planned a career as a medical missionary. However, in 1848 he became an apprentice to Caleb Williams, an apothecary and surgeon of York, then becoming a student of the York Medical School. In later life, he acknowledged his indebtedness with Thomas Laycock (1812–1876), who was a lecturer in clinical medicine at York for 5 years before moving to Edinburgh as professor of physics.
He received his professional qualification from London Bartholomew’s Hospital in 1850, where he came under the influence of the famous pathologist James Paget (1814–1899), choosing a carrier of surgeon, and qualified with the licentiate of the Society of Apothecaries and the membership of the Royal College of Surgeons in 1850. In 1851 he studied ophthalmology at Moorfields and became ophthalmologist at the London Ophthalmic Hospital. He then worked at the Lock Hospital as venereologist, at the City of London Chest Hospital as physician, at the London and Metropolitan Hospitals as general surgeon, at the London Hospital as surgeon from 1859 to 1883, and at the Blackfriars Hospital for Diseases of the Skin as dermatologist since 1867 and finally becoming senior surgeon. Although Hutchinson practiced as a surgeon, he was in effect a consultant generalist with a main interest in surgery, but important activity in dermatology, syphilology, ophthalmology, and neurology. He produced a huge amount of publications. In addition to contributions to medical journals and to some books, he published from 1878 onward five volumes entitled Illustrations of Clinical Surgery, containing personal case reports, and from 1889 to 1900 the Archives of Surgery, in quarterly numbers (up to 11 volumes), written entirely by Hutchinson himself as a means by which he could publish whatever he wanted to put on record. For a brief period, he was also the editor of The British Medical Journal.
Hutchinson’s clinical collection of illustrations was so vast that both the Royal College of Physicians and of Surgeons refused it, for lack of space; however, after his death the collection was acquired by the Johns Hopkins Medical School through Sir William Osler (1849–1919). In writing on the importance of postgraduate study in 1900, Osler stated – “When anything turns up which is an anomaly or peculiar, anything upon which the textbooks are silent and the systems and cyclopedias are dumb, I tell my students to turn to the volumes of Mr. Hutchinson’s Archives of Surgery as, if it is not mentioned in them, it surely is something very much out of the common.”
During his carrier Hutchinson was elected a fellow of the Royal College of Surgeons in 1862, and at various times, he was president of the Hunterian Society, the Pathological Society, the Ophthalmological Society, the Neurological Society, and the College of Surgeons itself. Elected a fellow of the Royal Society in 1882, and as member of Royal Commissions concerning provision against smallpox and leprosy, Hutchinson had an impressive career.
In July 1856, Jonathan married Jane West, a woman of similar Yorkshire background. Their marriage lasted 29 years and produced 10 children. By the 1880s, Hutchinson acquired a large estate, Inval, near Haslemere, Surrey, where he established a country home for his family, and eventually he provided accommodation for large numbers of his and his wife’s relatives. Hutchinson himself lived in his London house at 15 Cavendish Square during the working week, visiting Haslemere when pressure of work permitted. He decided to open an Educational Museum in outbuildings on his farm for popular instruction in natural history, which is still open nowadays (www.haslemeremuseum.co.uk) (Fig. 1). There, he not only put natural objects on display but lectured on a huge variety of topics. Sample subjects included “The Thickness of the Earth’s Crust,” “The Lives of the English Poets,” “Tuberculosis and Leprosy,” and “The Earliest Traces of Man.” This latter topic caused some controversy with fundamentalist church views clashing with his Darwinian evolutionary ideas.
Jonathan Hutchinson died on 23 June 1913, at the age of 85.
Main Achievements to Medicine/Pathology
Hutchinson was an exceptionally astute clinical observer and made numerous original observations, most notably in the area of congenital syphilis and skin diseases. Given that venereal diseases, skin diseases in general, and eye diseases were relegated to the surgeon in British medicine of the nineteenth century, Hutchinson made important contribution in any of these fields. Combining his faith and his experiences of life in London, he came strongly to believe that the study of sexual diseases was vital to promote good health in the poorer sections of society. He was a mentor and collaborator of pioneer neurologist John Hughlings Jackson (1835–1911), giving contributions also to neurology. For instance, he recognized that the pupil of the eye on the side of the lesion was reflectively fixed and widely dilated as a result of a lesion in the central nervous system (third nerve lesion), whereas the other pupil contracts. This sign is now recognized as “Hutchinson’s pupil.” There are many medical eponyms related to his observations, the most famous among them is probably the “Hutchinson triad.” It refers to the signs of congenital syphilis: the combination of “Hutchinson’s teeth,” interstitial keratosis, and deafness due to lesions of the eight’s cranial nerve. “Hutchinson’s teeth,” in turn, refers to the tooth abnormality seen in congenital syphilis, characterized by pegged, lateral incisors and notched central incisors along the cutting edge, giving the permanent incisors a screwdriver-like shape. His description of these stigmata was published in 1858, when he was 30. With regard to syphilis, there are two more eponymous. The “Hutchinson mask” indicates the paresthesia in tabes dorsalis, also known as syphilitic myelopathy, a neurological manifestation of tertiary syphilis. The “Hutchinson patch,” finally, refers to the salmon-colored area in the cornea seen in syphilitic keratitis.
In the field of dermatology, Hutchinson made many other important contributions. A well-known eponym is “Hutchinson’s sign.” First described by him in 1886, the sign includes pigmentation of the periungual skin in association with longitudinal melanonychia. Its presence should raise the suspicion of nail bed melanoma; however, it can also be found in melanocytic nevi of the nail bed.
In the same 1886, Hutchinson reported a syndrome known as “Hutchinson-Gilford progeria” (HGPS), then named also “Werner syndrome” and “progeria of the adult.” In that report, a patient with congenital absence of the hair and appendages was described. Nine years later, the English surgeon Hastings Gilford (1861–1941) presented the second case. This syndrome is characterized by premature, rapid aging commencing shortly after birth. Symptoms include micrognathia, craniofacial disproportion, alopecia, and prominent eye and scalp veins. The prognosis is rather poor because of progressive arteriosclerosis of the coronary and cerebrovascular arteries.
In 1892, Hutchinson described pigmented spots (“freckles”), particularly in older people, with progressive radial growth. Sometimes he noticed changes in the shape of, what he named, “an epitheliomatous or sarcomatous growth.” Hutchinson’s description and concept is now recognized as lentigo maligna. He was the first to describe this clinical entity in several reports. The eponymous “Hutchinson’s freckle” refers to macule with irregular pigmentation which is a precancerous condition occurring chiefly during middle and old age.
Finally, another famous description of Hutchinson is “Mortimer’s malady” (sarcoidosis). In January 1869 a 58-year-old coal-wharf worker attended Jonathan Hutchinson at the Blackfriars Hospital for Skin Diseases complaining of purple skin plaques, which had gradually developed over the preceding 2 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. Hutchinson did not understand this clinical picture and therefore, typically, named the disease after his patient “Mortimer.” He described a systemic benign form of sarcoidosis, being considered the first recognition of the disease, although it is more commonly associated with Cæsar Peter Møller Boeck (1845–1917), a Norwegian dermatologist who provided in 1899 a comprehensive description of skin changes along with general lymph node destruction associated with sarcoidosis.