Kate Elizabeth Shipman
Department of Clinical Biochemistry, Heart of England Foundation Trust, Birmingham, UK (Fall 2014)
Department of Clinical Biochemistry, Heart of England Foundation Trust, Birmingham, UK
Department of Medicine, University of Birmingham, UK (Fall 2014)
|Thomas Addison (1793-1860)|
In his time Thomas Addison was considered a giant of medicine, one who pioneered exacting scientific diagnosis by history and observation. He was a brilliant diagnostician, but also an unconventional maverick, and his name is still attached to the two diseases he brilliantly described, pernicious anemia and adrenal insufficiency.1,2
Thomas Addison spent his early years with his siblings and parents in Northumberland “born to humble parents … near Newcastle, about 1793.”1 The family supported his education by sending him first to the local school, then to grammar school: “His father was a grocer and flour-dealer; but … must have been a man of enlarged views, for he not only gave his son the best elementary education within his reach, but he aspired to start him in life on a much higher social level than his own.”2 So dedicated was he to his studies that by the end of his schooling “His familiarity with Latin was … exemplified by a habit of taking down lecture-notes in that language.”1 Though Latin was taught widely during this period it was remarkable to be so fluent. He read medicine in Edinburgh (1812-1815), his thesis being on syphilis “De Siphilide.”1
He was a prime example of a social phenomenon that was becoming common in his time with one’s natal social class no longer considered to confine one in perpetuity.2 “Dr Addison belonged to that class of men … who, by their abilities and energy, have raised themselves from the lower ranks of society to the more exalted positions in their respective callings.”2Greenhow remarks how “Fortunately, his father had the means, as well as the desire, to afford his son every possible advantage.”2
Medical training and career
With a rather remarkable set of fellow students, “Addison, Bright, Hodgkin,”3 his formal university education was complete after three years. This was typical with clinical studies being provided by hospitals and clinics directly for which he traveled to London becoming “house-surgeon” at the “Lock Hospital”2 to study syphilis. Then he trained in dermatology in “Hatton Garden … with the celebrated Bateman, and thus became so great a proficient in skin-disease as to acquire the acknowledgement … that after the death of the great dermatologist his mantle had fallen upon Addison.”1
To complete his medical training Addison “entered … Guy’s Hospital, and … was raised to be a member of the medical staff of that institution”2 and was awarded “the chair of Materia Medica”1 in 1827. This was remarkable as “It was not easy in those days to overcome the prevailing ingrained prejudice that unless a man has been originally a pupil of the hospital he was not fairly eligible to the duties of its offices. Addison’s may be cited, indeed, as one of the earliest (if not the first) instances of those traditional trammels being broken through.”1
Lecture courses for students at that time were staged at different hospitals and selected independently. Addison’s lectures were universally recognized as excellent in that “so great was the attendance that his lecture-fees must have amounted to £700 or £800 a year.”1 In recognition of Addison’s talents he soon became a fellow of the Royal College of the Physicians in 1838 one year after “he received the appointment of physician … and … (was) selected as the colleague of … Dr. Bright in the duties of the chair of Medicine.”1
Personality and environment
The discoveries of his later career could be argued to stem from his personality; “He never reasoned from a half-discovered fact, but would remain at the bedside, with a dogged determination to track out the disease to its very source for a period which constantly wearied his class and his attendant friends.”1 He was rather shy, which was often perceived by others as “rudeness.”1 He also “devoted less attention”4 to treating patients for “Without accusing Addison of a meditated neglect of therapeutics, we fancy that we can trace the dallying with remedies which has been the characteristic of more recent times”1 as “For with him accurate ‘diagnosis’ was the great, and too often the ultimate, object.”1 This was not unusual there being a lack of efficacious treatments available at the time. His work was mainly observational but also involved postmortem studies.
Discoveries and other work
Addison was investigating “a very remarkable form of general anaemia, occurring without any discoverable cause whatsoever”2 when he described a series of eleven patients who were found to have pathological changes in both suprarenal glands that were independent of the “idiopathic anæmia“1 (pernicious/Addison’s anemia) that he was studying. Published in his monograph “On the Constitutional and Local Effects of Disease of the Suprarenal Capsule” he described “a peculiar change of the color in the skin, occurring in connection with a diseased condition of the suprarenal capsules.”5 As the existence of the adrenal glands was not known and the disease rare, his monograph was viewed with much skepticism and refused for publication. Trousseau however confirmed “supra-renal failure” and named it Addison’s disease.6
His fame became international; “He was called upon to make a professional visit to one of the Rothchilds in Paris, and here he was feted by the leading medical men of the French capital.”6
Another notable publication was ‘‘Elements of Practice of Medicine” with Richard Bright (London, 1839) which “From the high estimation in which this work was held it must be a matter of regret that one volume only was published. Now that both these widely-known authors have departed from their labours, it cannot be harmful to assert (what was then generally known) that the greater portion of the work was from the pen of Dr. Addison.”1 Addison also wrote “An Essay upon the Operation of Poisonous Agents” in 1829 and “Observations on the Disorders of Females connected with Uterine Irritation” in 1830.
Addison’s death was reported in the Brighton Herald June 30, 1860. “Dr. Addison … committed suicide. … He was 72 years of age, and laboured under the form of insanity called melancholia” much to the grief of his family, students and colleagues. He was a giant born during a time that permitted giants, and he achieved immortality “by indomitable perseverance in the pursuit of one object of study; making it, as it were, the one day-dream and night-dream of his existence.”1
- Addison TW, Wilks S, and Daldy TM. ‘A collection of the Published Writings of the Late Thomas Addison, M.D’ (London, New Sydenham Society, 1868).
- Greenhow EH. On Addison`s Disease, being the Croonian Lectures for 1875. (Greenhow’s Lectures on Addison’s Disease, London, 1875).
- C. M. Brooks. Thomas Addison, 1794-1860 (Newcastle Medical Journal, Volume 27, Headley Bros., 1963).
- Payne JF. Joseph Frank Payne. Addison, Thomas1885. Dictionary of National Biography, Volume 1 (London: Smith, Elder & Co, 1885-1900).
- Addison T. On the Constitutional and Local Effects of Disease of the Suprarenal Capsule (London: Samuel Highley, 1855).
- Pallister G. Addison, M.D., F.R.C.P. (1795-1860) (Newcastle upon Tyne: G Pallister, 1975).
KATE ELIZABETH SHIPMAN, BMBCh, MRCP, is a trainee chemical pathologist at the Heart of England Foundation Trust in Birmingham, UK. Her interests include metabolic disease, medical history, and the development of analytical science.
SUDARSHAN RAMACHANDRAN, PhD, FRCPath, is a consultant chemical pathologist at the Heart of England Foundation Trust in Birmingham, UK. He is currently interested in metabolic disease, medical history, and techniques to establish cardiovascular disease risk.