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| Clinical Sign Revisited | |
| Hutchinson and the conundrum of signs attributed to him | |
| Vinod Arora
Department of Medicine, Lady Hardinge Medical College & associated hospitals, New Delhi-110001, India.
Introduction In day to day life as a medical student one often comes across the name Hutchinson being associated with a number of clinical signs such as Hutchinson pupil, Hutchinson teeth, Hutchinson triad and many more. Have we ever thought that whether it is the same person credited with number of signs after his name or there are number of persons with number of signs against their names. As we scanned a number of books, journals and surfed the web for the signs with name Hutchinson associated with them we found that it is a single person who has been credited with the various signs. He was Sir Jonathan Hutchinson (1828-1913), an Englishman, born and brought up in Yorkshire, England. He was popularly known as an amalgamated multispecialist of the field of medicine- he was a surgeon, pathologist, venereologist and ophthalmologist [1]. An attempt is being made to throw light on the life of Sir Hutchinson, one of the greats that medicine has seen; and the various signs and symptoms credited against his name will be discussed. Sir Jonathan Hutchinson, after his schooling from a local school in Yorkshire, was apprenticed to Caleb Williams, an apothecary and surgeon for five years. He entered St. Bartholomew’s hospital where he studied surgery under the mentorship of Sir James Paget, became a member of Royal College of Surgeons in 1850 and was awarded fellowship in the year 1862 [2]. He also studied ophthalmology for 12 months at Moorfields Institute and practiced at London Ophthalmic Hospital [3]. Owing to his intense activities in the different specialities of medicine, he was associated with a number of medical societies such as Hunterian Society, Royal College of Surgeons, Sydenham Society, Royal Medical and Chirurgical Society [2,4]. Works The work of Sir Jonathan Hutchinson in the field of medicine is an unflagging pursuit of excellence. He has been credited with the publication of more than 1200 articles and had produced quarterly archives of surgery from the period of 1890 to 1900. Sir Jonathan Hutchinson’s name has been credited with the following entities in the field of medicine. He had a special attachment for the field of ophthalmology where he has been entitled with the Hutchinson sign which refers to that the skin lesion on tip of the nose precedes the development of the ophthalmic herpes zoster because of the common innervation of eye and the tip of the nose by nasociliary nerve [5] and Hutchinson pupil which states that pupil on the side of intracranial mass lesion is dilated and unreactive owing to the compression of the oculomotor nerve of the same side. In one of the studies, predictive value of the Hutchinson sign predicting ocular involvement was determined to be 66% and patients with Hutchinson sign are twice as likely to develop intraocular complications [6]. He has been entitled with a number of contributions in the field of dermatology and venereology where he described chieropompholyx (Hutchinson dehidrosis) which refers to chronic hand and foot dermatitis, Hutchinson angioma refers to minute vascular ectasia arranged in serpiginous fashion and Hutchinson prurigo, also known as Hutchinson summer prurigo, is an eruption of nodular urticarial like lesions on parts of body exposed to sun. Hutchinson melanoma known as lentigo maligna refers to collection of malignant cells that does not grow invasive (slow growing melanoma) [7]. Hutchinson’s work was pioneering in the field of syphilis where he described Hutchinson teeth, a sign of congenital syphilis, in which teeth are smaller and incisor teeth are notched and Hutchinson mask in relation with tabes dorsalis in which face feels as if covered with cobweb or mask. Hutchinson teeth form part of Hutchinson triad which includes interstitial keratitis (also known as Hutchinson patch), eighth nerve palsy in addition to Hutchinson teeth [8,9]. Hutchinson disease (Mortimers disease) now
popularly known as sarcoidosis is a rare autoimmune
disease affecting usually the lungs [10]. Hutchinson–Gilford Progeria Syndrome, popularly
known as progeria syndrome, is an extremely rare
genetic condition caused by point mutuation in He was also the founder of London polyclinic or
postgraduate institute of medicine and was founder
of the Haslemere museum. On his death in 1913 he
had filled the chair of almost all important medical
societies in England and had been honoured by knighthood and by honorary degrees by reputed In the modern era of medicine, wherein we have innumerable sophisticated tools and techniques and the medical practitioner is inclined to rely heavily on investigative modalities, it is pertinent to learn and emulate Sir Jonathan Hutchinson who relying on his basic clinical skills has shown the importance of clinical methods in medicine. Clinical medicine and eliciting clinical signs is an art and knowing the interpretation of the same in order to arrive at a diagnosis is being relegated to the background in today’s medical practice. Sir Johnathan Hutchinson and the conundrum of signs attributed to him encourages us to still rely heavily on clinical medicine and use the investigative modalities as an adjunct. References
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