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Sir Jonathan Hutchinson (1828 - 1913) Prepared by: Dr P Curnow, 2000

Claim to Fame: Hutchinson's Melanotic Freckle

Hutchinson's Melanotic Freckle: (lentigo maligna) is a malignant proliferation of melanocytes within the epidermis and is one of four recognized subtypes of malignant melanoma (superficial spreading, nodular and acral lentiginous melanoma being the other three). It is a slowly enlarging melanoma with the classic features of asymmetry, border irregularity and variation of colour, and is generally seen in older people and over heavily sun-exposed body sites, usually the face. It may remain confined to the epidermis while slowly enlarging for a number of years, but may eventually invade the dermis to become a lentigo maligna melanoma with the same capacity to metastasize as other melanomas. Lentigo maligna melanoma represent 5 - 15% of all invasive melanomas.

Paper:

1. Hutchinson, J. Senile pigment changes. Arch Surg 3: 319-320, 1892

2. Hutchinson, J. Lentigo-melanosis. Arch Surg 5: 253-255, 1894

(Image opposite from Hutchinson, J.: Senile freckles. Arch Surg 5: Plate CVI, 1894)

Background:

Sir Jonathon Hutchinson was born in 1828 in Selby, Yorkshire. After matriculation, he commenced medical studies at the York School of Medicine and Surgery before pursuing further training at St. Bartholomew's Hospital. Here he was trained by Paget and obtained his MRCS in 1850. His first appointment was Surgeon at Blackfriars Hospital for Diseases of the Skin and at the Metropolitan Hospital, where he began a prolific career spanning five decades. His documentation of original clinical observations and postulations on disease causation set him aside as a key contributor to dermatology and medicine in general, with his name persisting in more eponyms today than any other.

Hutchinson's name is used in the following medical contexts:

Hutchinson's Triad: The triad of interstitial keratitis, Hutchinson's teeth and eighth-nerve deafness seen in congenital syphilis;

Hutchinson's Teeth: Peg-shaped, notched, permanent upper central incisors seen in congenital syphilis;

Hutchinson's Sign: The presence of vesicles due to herpes zoster over the tip of the nose (corresponding to the external nasal branch of the ophthalmic branch of the fifth cranial nerve and signifying an increased risk of ocular complications and blindness);

Hutchinson-Gilford syndrome: The eponym associated with progeria;

Hutchinson-Boeck syndrome: The eponym associated with sarcoidosis;

Hutchinson's Pupil: The presence of a dilated pupil on the side of an extradural haemorrhage;

Hutchinson's Potato Tumour: Carotid body tumour;

Hutchinson's Disease: Angioma serpiginosum.

Hutchinson developed a special interest in syphilis, as did many of the founding fathers of dermatology during the nineteenth century, and is said to have seen more than one million patients with this disease over his lifetime. His paper in 1858 on interstitial keratitis in congenital syphilis was regarded as ground breaking, and the triad of features associated with congenital syphilis bears his name (see above). His interest in dermatology was reflected in his membership of the Dermatological Society of London, and he trained many dermatologists during his lifetime. In 1860 he became Assistant Surgeon to the London Hospital and in 1863 to Moorfields Eye Hospital, after completing studies in ophthalmology. He was elected FRCS in 1862 and Professor of Surgery at the Royal College of Surgeons in 1879. His writing of the 10 volume "Archives of Surgery" over 14 years from 1885 was a culmination of his surgical experience.

Hutchinson was a Quaker and known to his contempories as a tall, solemn man devoid of a sense of humour, who was totally obstinate in his convictions, even in the face of irrefutable evidence to the contrary: for example, he believed that leprosy was due to eating decaying fish, even though Hansen's description of the mycobacterium leprae bacillus had already provided a scientific answer for this disease. He had an encyclopaedic knowledge of medicine and was a renowned educator in areas as diverse as surgery, ophthalmology, neurology and dermatology. His incisive descriptions of disease included lentigo maligna, keratoacanthoma, sarcoid, progeria, angioma serpiginosum and the pigmented macules seen in the Peutz-Jegher syndrome, and he was the first to recognise the carcinogenic effects of chronic arsenic exposure. He was also the first to operate successfully on a child with life threatening intussusception

Hutchinson was knighted in 1908 for distinguished service to medicine.

References.

Friday King D. The Man Behind The Eponym. Am. J. Dermpath, 9(1): 74-75. 1987

Rook et al. Textbook of Dermatology. Blackwell Sciences 1998, pp 1742-46.

BG Firkin and JA Whitworth. Dictionary of Medical Eponyms. Parthenon Publishers 1987.

J Lowie. Medical Eponyms: Who was Coude? Pitman Publishing Limited, 1982.

Clemmensen O. Hutchinson's freckle. Am J Dermatopathol 1982; 4:425-8.