The influence of Jonathon Hutchinson

From Archibald Watson’s surgical diary 1882–1883

Archibald Watson began his postgraduate training in London at a time when English surgeon Sir Jonathon Hutchinson (1828–1913) was coming to the end of his career.

Hutchinson, described in Plarr’s Lives of the Fellows as “one of the great medical geniuses of his time”, was Hunterian Professor of Surgery and Pathology at the Royal College of Surgeons from 1879 to 1882. 1 Mentored by Sir James Paget, he trained as an Ophthalmologist at Moorfields Hospital but his interests were very broad and included skin diseases, gout, haemorrhages, leprosy and syphilis. In 1876, his seminal work on syphilis described a triad of signs that indicated congenital syphilis.

6/2/82 (page 35) Man (23? W) Atrophine

In the early 1880s, syphilis was treated by arsenic or mercury used either in its elemental form or in a compound such as mercurous chloride (calomel). From 1884, bismuth salts, which were less toxic than mercury, were also used to treat syphilis. Jonathon Hutchinson disliked arsenic, which he felt was carcinogenic, and for early syphilis he advocated two to three years administration of metallic mercury by mouth. In 1882, Archibald Watson observed several of Hutchinson’s cases of syphilis.

“Syphilitic iritis? – never delay with atrophine in rheumatic much less syphilitic iritis to tear tags of adhesions – 2grms to ounce every 4 hours (sometimes 4 grs to ounce every 10 minutes on seeing a bad case at first)!!! (Hulke always 4gr and 1oz) – of course treat constitutionally at same time ie push the mercury – H asked him last week the first time I saw this pat – have you a chance? Yes –)

“I was always told iritis was a very late symptom – here any way it looks like an early one”

English physician William Heberden first described Nodi Digitorum in the late 1700s. Consisting of bony outgrowths at the distal interphalangeal joints, Heberden noted that the disease process was distinct from gout. In June 1883, Watson records that Jonathon Hutchinson dealt with a possible case of the disease. However, given the patient’s age and history, the diagnosis was not straightforward.

“Haberdeen’s [sic] nodi digitorum extremely rare in young people – this boy’s knees and elbows are also enlarged

“Diagnosis (nothing else one can think of - tendency to rheumatic gout in subject having had rickets)

“The ends of the fingers were not curved downwards (as in grande cucheron) but if anything backwards – at the same time this boy has severe flat foot on left side”

In the 1870s, Lister’s student H.O. Macy of Boston introduced kangaroo tendons for suturing and by the 1880s they were used by Hutchinson and many of his contemporaries. 2 There are several references to the use of kangaroo tendons in Watson’s diaries. They include Frederick Marsh’s operation in 1883:

“Subject in youth of Pots[sic] disease – tie with kangaroo tendon in two places and cut artery between ligation – it can then contract & retract”

In 1913, Hutchinson wrote a glowing endorsement of kangaroo sutures:

“On the whole my experience with kangaroo tendon has been so satisfactory that I do not wish to find any better material. It is very strong, less slippery and easier to tie securely than catgut, the strands can be readily made of the required size (I think the tendency is to use it too thick), it can be preserved an indefinite time in a strong antiseptic solution, it is well tolerated by the tissues, in fact it becomes a living fibrous structure.”

4.VI.83 (page 64) Boy 14

Jonathon Hutchinson was an exceptional surgeon whose varied interests matched the inveterate curiosity of his student, Archibald Watson.

Elizabeth Milford, RACS Archivist

Marsh popl. Aneurism (page 83) 21.VI.83 in man 45

REFERENCES

1. Plarrs Lives of the Fellows of the Royal College of Surgeons can be found online at https://livesonline.rcseng.ac.uk/client/en_GB/lives 2. Kangaroo tendons from Watson’s archive are on display in the College Museum.