Sjögren, Henrik Samuel Conrad (1899–1986)
KeywordsDoctoral Thesis Lacrimal Gland Karolinska Institute American Rheumatism Association Sicca Syndrome
Sjögren, Henrik Samuel Conrad
Sjögren, Henrik Samuel Conrad (Swedish)
Date, City, and Country of Birth
July 23, 1899, Köping (Lake Mälaren), Sweden
Date and City of Death
September 17, 1986, Lund
History of Life
Henrik Sjögren was the son of a merchant; his surname, however, is from his mother. He completed the gymnasium school in Västerås on Lake Mälaren, west of Stockholm, in 1918. Immediately after his military service, he started his studies of medicine at Karolinska Institutet in Stockholm. His brother, Walter, had also studied medicine there, but he had died by the pandemic grippe of 1918–1919. During his studies, Henrik worked as transcriber in pathology. In 1922, he graduated as a medical licentiate, and in 1925 he became assistant surgeon at the Eye Clinic of Seraphim Hospital in Stockholm, Sweden’s first modern hospital. In 1927, he received his medical legitimation, and the next four years he worked in the ophthalmologic department of the Karolinska Institute. In 1928, he married Maria Hellgren, herself a medical student and daughter of a known ophthalmologist in Stockholm. In the autumn of 1929, both of them were sent to Jönköping in the province of Småland, South Sweden, in order to examine Swedish immigrants from Ukraine who had settled in this region. A lot of them suffered from trachoma. Here Sjögren observed patients with xerophthalmia, and became interested in this condition. In the following year, Sjögren saw his first patient with xerophthalmia, xerostomia, sweat hyposecretion and arthritis, and realized that this syndrome was not known among his colleagues. From 1931 to 1935, he worked at Sabbatsberg Hospital in Stockholm. In the Pathological Institute of the latter, headed by Prof. Dr. H. Bergstrand, he performed the microscopical investigations for his doctoral thesis. In 1933, he defended his thesis at Karolinska Institute about keratoconjunctivitis sicca, a term ha had coined himself. He wrote his thesis in German, which was at the prewar time widely used as the international language of science and letters in Sweden.
From 1936 Sjögren worked as a physician and from 1938 as the head of the newly established department of ophthalmology at the county hospital in Jönköping Here he worked on the technique of cornea grafting. At that time, Jönköping did not yet have a university; thus, after his doctoral thesis, most of Sjögren’s career was formally nonacademic. Until 1953, he was the only full-time ophthalmologist at the department, thus his workload was quite high. Based on their correspondence and own clinical observations, the Australian ophthalmologist Bruce Hamilton (1901–1968) translated Sjögren’s thesis into English and published it in Australia in 1943. In 1951, when the English version of a follow-up article by Sjögren was published, he was invited to Australia by Hamilton to give a lecture at the Hobart University in Tasmania. For Sjögren this became a trip eastward around the globe passing Egypt, India, Singapore, and from Australia through New Zealand, Hawaii, and the continental USA. In this way, Sjögren and the sicca syndrome became more known, especially in Anglophone countries. To this contributed also the fact that he attended some 20 international congresses during his career. Only in 1957, Sjögren became an associate professor (docent) in ophthalmology at the University of Gothenburg. In 1961 he was awarded the title of honorary professor. In 1966, he held a presentation at the first congress of the European Society of Pathology in Warsaw. After his retirement in 1967, he moved to Lund, Sweden’s then southernmost university city.
During his whole life, Sjögren was interested in music. He frequently played piano and was also able to play violin, flute, and accordion. He also composed small pieces of music and was very much interested in history and languages. Besides Swedish, he spoke German, French, and English, and he studied Latin, Esperanto, and Russian.
Sjögren received a series of awards both from Sweden and from abroad. Already on his 1951 trip, he became an honorary member of the Australian Royal College of Ophthalmologists and of the Ophthalmological Society of Wellington, New Zealand. Later on, he was awarded the honorary memberships of the American Rheumatism Association (1970), of the Royal College of Physicians and Surgeons (1976), and of the Swedish Rheumatological Society (1976). He was also a member of the Humanistic Society of Jönköping and of the Alliance Française.
Main Achievements to Medicine/Pathology
Sjögren described the syndrome of keratoconjunctivitis sicca, a term coined by himself in his doctoral thesis of 1933. It is based on the history of 19 female patients, predominantly associated with postmenopausal age and arthritis, and contains 56 histological pictures. He concludes that this disease does not only affect the eyes and the lacrimal glands but also the salivary glands and the laryngeal glands. The glands show an inflammatory round cell infiltration and show in the course of the disease a progressive destruction of glandular parenchyma with replacement by connective tissue.
Keratitis filamentosa, a part of Sjögren’s syndrome, had already been described by the German ophthalmologist Theodor Leber (1840–1917) in 1882. In 1888, a few cases of xerostomia, including affection of the lacrimal glands, were published by Hadden, Hutchinson, and Fischer. In 1892, the German-Polish-Austrian surgeon Johann von Mikulicz-Radecki (1850–1905) had described a syndrome which is generally considered as being identical with Sjögren’s syndrome. The case included round cell infiltration and acinar atrophy in the enlarged parotid and lacrimal glands. Therefore, the term Mikulicz-Sjögren syndrome has sometimes been used. In 1925, the French dermatologist Henri Gougerot (1881–1955) also described three cases of this syndrome. Since then, at least in the Francophone part of the world, over decades, the term syndrome de Gougerot was used. Today, even there it is now called after Sjögren, and only occasionally as Gougerot-Sjögren.
In his thesis, Sjögren also provides an extensive historical overview on the description of keratitis filiformis associated with reduced lacrimal function, naming Stock (1924), Schöninger (1924), Mulock Hower (1927) (according to Sjögren he was the first in mentioning the frequent association of keratitis filamentosa with arthritis), Betsch, Isakowitz, Scheerer, and Albrich – the latter mentioning enlarged parotid and sublingual glands – (all, each one separately, 1928), Vogt (1930), Hauer (1931), and Wissmann (1932). Surprisingly, neither Mikulicz-Radecki nor Gougerot are mentioned in Sjögren’s doctoral thesis.
According to Murube (2010), the term Sjögren’s syndrome may first have been proposed in 1936 by Stephan von Grosz, assistant in ophthalmology at the University of Budapest.
The autoimmune character of Sjögren’s syndrome has been elucidated in the early 1960s. Sjögren accepted it and wrote about it but did not deliver any fundamentally new contribution himself on that aspect of the disease.
Books and Publications
Sjögren, H. (1933). Zur Kenntnis der Keratoconjunctivitis sicca (Keratitis filiformis bei Hypofunktion der Tränendrüsen). Doctoral thesis, Karolinska Institutet, Stockholm. Also in: Acta ophthalmologica. Supplementum, 0065–1451. Stockholm.
Sjögren, H. (1943). A new conception of keratoconjunctivitis sicca: Keratitis filiformis in hypofunction of the lachrymal glands. Glebe, N.S. Wales, Australia. [English translation of S.’s doctoral thesis]
Sjögren, H. (1951). Some problems concerning keratoconjunctivitis sicca and the sicca-syndrome. Acta ophthalmologica, 29(1), 33–47. [Swedish version: 1949, French version: 1950; contains a larger cohort of patients than in 1933]
Sjögren, H. (1971). Zur Kenntnis der Keratoconjunctivitis sicca. VIII. Übersicht – Ätiologie [For the knowledge of keratoconjunctivitis sicca. VIII. Overview – etiology]. Acta ophthalmologica, 49(5), 779–789.
Murube, J. (2010). Henrik Sjögren, 1899–1986. The Ocular Surface, 8(1), 2–7. [bibliography, also a main source for this article].