Thread by @THilalMD

“Hodgkin’s disease” led to the earliest classification of lymphomas, which still stands today! If a lymphoma is not a Hodgkin’s then it’s a non-Hodgkin’s. Much has been written about the history of Hodgkin’s lymphoma. Here is a short visual walkthrough. #lymsm

Thomas Hodgkin, born on August 17 1798, was raised in a devout Quaker family. Because of his religion, he was unable to study medicine in England, which required people to be part of the Church of England.

Instead, he was allowed to rotate at Guy’s and met Sir Ashley Cooper who advices him to go to Edinburgh, Scotland. University of Edinburgh (pictured) was considered to be the best in the region.

Side note: Charles Darwin studied medicine at the University of Edinburgh a few years after Hodgkin completed his training, but he found medicine to be dull and did not like surgery. He never completed his training and did not get a medical degree.

In 1821, Hodgkin went to Paris, considered the center of medicine in the 18th century, and studied under Laennec (who developed the first stethoscope). Laennec inspired him to bring the stethoscope to England. He met Baron von Humboldt, whom he described “the hero of my youth”.

While in Edinburgh, he wrote about the spleen - “On the Uses of the Spleen” and suggested that the spleen was a reservoir for portal blood, enlarged in many disease and shrunken with hemorrhage. He graduated in 1823, his thesis on the relationship of lymph nodes with the spleen.

He returned to London in 1825, and joined the staff of Guy’s Hospital. Among them was Richard Bright (of Bright’s disease) and Thomas Addison (of Addison’s disease).

His official title at Guy’s was “Inspector of the Dead” 💀 and “Curator of the Museum”. Around the same time, he met Abraham Montefiore, a Jewish philanthropist who was suffering from tuberculosis. He struck a lifelong friendship with his brother Moses Montefiore (more later)

During his time at Guy’s Hospital, from 1825 to 1837, he described the Key-Hodgkin murmur, a diastolic aortic regurgitation murmur in 1827. It is his only other eponymous condition that is seldom used nowadays.

His famous paper after which the disease is named was published in 1832. It described 7 cases of patients who died and had painless lymph node and splenic enlargement.

The paper was not widely recognized when first published. Richard Bright alluded to his work in his paper on lymphatic disease, “Observations on Abdominal Tumors and Intumescence” in 1838, but it was not until 20 years later that his name would be associated with it.

Samuel Wilks, in 1856, independently described a similar disease of painless lymph node enlargement and officially coined the term “Hodgkin’s disease” after being told about Hodgkin’s work by Bright.

Interestingly, Hodgkin himself noted that a disease of similar description has been reported by Malpighi, an Italian physician, in 1666 (1668 in some reports), leaving one to wonder about a world in which Hodgkin’s lymphoma is called Malpighi’s lymphoma 😬

In 1877, Wilks published “Historical Notes on Bright’s Disease, Addison’s Disease, and Hodgkin’s Disease”, referring to the men as the “Three Greats” of Guy’s Hospital. He also chronicled the history of Guy’s Hospital.

Soon thereafter, the first microscopic descriptions of Hodgkin’s disease were made in 1872 by Theodor Langhans (of Langhans giant cells), wherein he describes multinucleated giant cells (in German). These were also described by Greenfield (in English) in 1878.

In 1892 and 1902, Carl Sternberg and Dorothy Reed independently described the Reed-Sternberg cell. Reed, at the age of 28 🤯, disproved the common perception that Hodgkin’s disease was a subtype of tuberculosis.

Back to Hodgkin. Aside from medicine, was an advocate for indigenous people and wrote about colonial influences on their lands. He wrote passionately against slavery and for population health. In 1837, because of his opinions, he was not accepted as assistant physician at Guy’s.

He quit Guy’s thereafter, and found the Aborigines’ Protection Society. His relationship with Sir Moses Montefiore influenced him to travel between 1857 to 1866 to many parts of the world where he advocated for public health measures.

During his last trip to Jaffa, he fell ill with dysentery and died. He was buried in Jaffa. The obelisk erected at the burial site reads “Humani nihil a se alienum putabit” (nothing human was foreign to him)

Ironically, almost 100 years after his original paper, histology specimens from the 7 cases reported by Hodgkin were examined, and only 3 of the 7 were found to have Hodgkin’s disease 😧. The remaining cases were tuberculosis, syphilis, and non-Hodgkin’s lymphoma.

Hodgkin’s lymphoma was one of the earliest cancers to be treated with radiation therapy after the discovery of roentgen rays in 1895.

In the 1960s, advanced Hodgkin’s lymphoma became the first “metastatic” cancer to be cured by combination chemotherapy developed by @DeVitaDoctor at the NIH (the fact that I can tag him on Twitter is amazing).

Almost 200 years after the first description, Hodgkin’s lymphoma remains an elusive and poorly understood malignancy. Despite this, it is one of the most curable cancers, even in advanced stages. /fin

The biography of Henry Kaplan and Hodgkin’s Disease, which I have not read, I am told is a great reference as well.

More reading and references:
- ncbi.nlm.nih.gov/pmc/articles/P…
- ncbi.nlm.nih.gov/m/pubmed/63817…
- jamanetwork.com/journals/jama/…