Jonathan Hutchinson

Biography

• Born July 23, 1828 in Selby, Yorkshire
• 1849 – York School of Medicine and Surgery, graduating medicine from Bartholomew’s, London
• 1850 – MRCS, LSA
• 1882 – FRS
• 1883 – Retired from London Hospital becoming emeritus professor of surgery
• 1908 – Knighthood
• Honorary degrees from the Universities of Glasgow, Cambridge, Edinburgh, Oxford, Dublin and Leeds
• Died June 23, 1913 in Haslemere, Surrey

Medical Eponyms

Hutchinson’s style of writing was unique.

• He favoured the use of memorable descriptive terms such as ‘ground glass’ cornea of congenital syphilis and the ‘apple jelly’ nodule of lupus vulgaris;
• In conditions which he did not understand, he used the patients name e.g. Mortimer malady (sarcoidosis) so as not to prejudice subsequent thought and investigation of a newly recognized condition;
• He strongly believed in the use of illustrations his short, lucid clinical descriptions. These were hand drawn mostly by Edwin Burgess and Mabel Green

Hutchinson teeth (1858): The term ‘Hutchinsonian’ teeth is descriptive of a particular developmental abnormality of the upper central incisors of the permanent dentition. At a meeting of the Pathological Society of London, Hutchinson drew attention to the deformity in A Report on the Effects of Infantile Syphilis in Marring the Development of the Teeth. Most of his cases were in patients attending the Royal Ophthalmic Hospital with interstitial keratitis and in all cases a clear history of a syphilitic infection was obtained.

Five years later, Hutchinson (1863) clarified his criteria for diagnosis:

The central upper incisors of the second set are the test teeth…In syphilitic patients, these teeth are usually short and narrow, with a broad, vertical notch in their edges and their corners rounded off. If the question be put, are teeth of the type described pathognomonic of hereditary taint? I answer unreservedly, that when well characterised, I believe they are.

Hutchinson 1863: 204

Hutchinson triad of congenital syphilis: the combination of Hutchinson’s teeth, interstitial keratosis, and deafness due to lesions of the eight cranial nerve.

Hutchinson angioma (1889) [aka Angioma serpiginosum (AS)] rare, naevoid skin disorder with benign vascular proliferation characterized by non-purpuric violaceous to red punctate lesions on an erythematous base. The vascular ectasies are usually compressible red or purple punctate lesions, arranged in a serpiginous pattern.

First described by Hutchinson publishing ‘A peculiar form of serpiginous and infective naevoid disease.’ in 1889

Hutchinson freckle (lentigo maligna; Hutchinson melanotic freckle)

• Hutchinson J. Senile freckles [Cases III-VI]. Archives of Surgery, 1892; 3: 317-322

First descriptions (…probably)

Temporal arteritis (Horton disease). The first definite description of this condition is credited to Hutchinson in 1890. In his article on a peculiar form of thrombotic arteritis of the aged, he recounts his observations of a man almost 80 years old who developed tender red streaks on both sides of his scalp. Hutchinson recognized these as inflamed swollen superficial temporal arteries.

I was asked to see him because he had “red streaks on his head” which were painful and prevented his wearing his hat. The “red streaks” proved to be his temporal arteries which… were inflamed and swollen. Pulsation could be feebly detected in the affected vessel, but it finally ceased; the redness then subsided, and the vessels were left impervious cords. The old gentleman lived, I believe, several years after this without any other manifestation of arterial disease”

Hutchinson 1890

Bayard Taylor Horton (1895-1980) et al in 1932 and 1934 presented 2 cases in greater detail including the symptoms of headache and jaw stiffness; and microscopic evaluation of the affected arteries. They coined the term temporal arteritis.

Peutz-Jegher Syndrome (1896): Hutchinson illustrated the pigmentation of and about the lips and on the buccal mucosa in twin 9-year old girls in his article on ‘Pigmentation of lip and mouth’. [Archives of Surgery, 1896; 7: 290]. McKusick reported in 1952 that one of the twins was later proved to have polyposis of the small intestine.

Notable quotables

Hutchinson chose his own epitaph “A man of hope and forward-looking mind.”

Major Publications

• Hutchinson J. Report on the effects of infantile syphilis in marring the development of the teeth. Transactions of the Pathological Society of London, 1858; 9: 449-456. [Hutchinson teeth]
• Hutchinson J. A clinical memoir on certain diseases of the eye and ear, consequent on inherited syphilis. 1863
• Hutchinson J. A descriptive catalogue of the New Sydenham Society’s Atlas of portraits of diseases of the skin. 1869 [Part II]
• Hutchinson J. Illustrations of clinical surgery. 1875
• Hutchinson J. On syphilis as an imitator. 1879
• Hutchinson J. The pedigree of disease; being six lectures on temperament, idiosyncrasy and diathesis, delivered in the theatre of the Royal College of Surgeons. 1881
• Hutchinson J. Syphilis. 1887
• Hutchinson J. Diseases of the arteries. I. On a peculiar form of thrombotic arteritis of the aged which is sometimes productive of gangrene (with plate). Archives of Surgery, 1889; 1: 323-.325 [Horton disease; temporal arteritis]
• Hutchinson J. Addresses and papers of Sir Jonathan Hutchinson (1869-1893). 1894 [Volume II]
• Hutchinson J. Senile Freckles. Archives of Surgery, 1891; 2: 85 and 1892; 3: 319-322 [Hutchinson freckle; Lentigo Maligna]
• Hutchinson J. A smaller atlas of illustrations of clinical surgery. 1895
• Hutchinson J. Pigmentation of lip and mouth. Archives of Surgery, 1896; 7: 290. [Plate CXLI] [Peutz-Jeghers syndrome]
• Hutchinson J. Syphilis. 1909

Archives of Surgery (1889-1900)

It may seem almost a work of presumption to begin the issue of a Journal to which I purpose, with but very few exceptions, to be the sole contributor. The fact is, that I have a very large store of clinical material, much of which is carefully edited and ready for the press.

Hutchinson, Archives of Surgery. 1889; Vol I

References

Biography

• Wales AE. Sir Jonathan Hutchinson, 1828-1913. Br J Vener Dis. 1963;39(2):67-86.Schoenberg BS, Schoenberg DG. Eponym: the name’s the same: the eponyms of Sir Jonathan Hutchinson. South Med J. 1977;70(8):993-994.
• Jackson R. Hutchinson’s Archives of Surgery revisited. Arch Dermatol. 1977;113(7):961-964.
• King DF. The man behind the eponym. Sir Jonathan Hutchinson. An obstinate genius. Am J Dermatopathol. 1987;9(1):74-75.
• van Ruth S, Toonstra J. Eponyms of Sir Jonathan Hutchinson. Int J Dermatol. 2008;47(7):754-758.

Eponymous terms

• Horton BT, Magath TB, Brown GE. An undescribed form of arteritis of the temporal vessels. Proceedings of the staff meetings of the Mayo Clinic. 1932; 7: 700-701
• Horton BT, Magath TB, Brown GE. Arteritis of the temporal vessels, previously undescribed form. Arch Int Med. 1934;53(3):400-409.
• McKusick VA: The clinical observations of Jonathan Hutchinson. Am J Syph Gon Ven Dis 1952; 36: 101-126
• Costello MJ, Fisher SB, DeFoe CP. Melanotic Freckle: Lentigo Maligna. AMA Arch Derm. 1959;80(6):753-771
• Scadding JG. The eponymy of sarcoidosis. J R Soc Med. 1981;74(2):147-157.