Dr. Thomas Addison 1795-1860: Agitating the Whole Medical World

By Margaret R. O’Leary, MD

Dr. Thomas Addison (17951860): Agitating the Whole Medical World presents Dr. Addisons life story, considers his reception during his lifetime, and recognizes his profound contributions to modern medicine. Dr. Addison weathered five years of scorching criticism from peers for asserting that the adrenal glands were essential to life and that diseased adrenal glands could darken a white persons skin to mulatto hues. History validated his discoveries, which led other investigators to isolate and identify epinephrine, the adrenocortical steroids, and even vitamin B12.

• Language: English
• Publisher: iUniverse
• Release date: Nov 15, 2013
• ISBN: 9781491707715

Margaret R. O’Leary, MD

Margaret R. O’Leary, MD, earned her medical degree from the George Washington University School of Medicine and her MBA degree from Benedictine University in Lisle, Illinois. She is the author of many publications that include books on the histories of medicine, science, religion, society, and war. Dr. O’Leary currently resides in Fairway, Kansas.

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DR. THOMAS ADDISON 1795–1860

A GITATING THE WHOLE MEDICAL WORLD

Copyright © 2013, 2014 Margaret R. O’Leary, MD.

All rights reserved. No part of this book may be used or reproduced by any means, graphic, electronic, or mechanical, including photocopying, recording, taping or by any information storage retrieval system without the written permission of the publisher except in the case of brief quotations embodied in critical articles and reviews.

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ISBN: 978-1-4917-0770-8 (sc)

ISBN: 978-1-4917-0772-2 (hc)

ISBN: 978-1-4917-0771-5 (e)

Library of Congress Control Number: 2013917338

iUniverse rev. date: 09/24/2014

CONTENTS

Preface

Acknowledgment

Introduction

Chapter 1 Early Northumberland Childhood, 1795–1801

Chapter 2 Formal Education In Northumberland, 1801–1812

Chapter 3 University Of Edinburgh Medical School, 1812–1815

Chapter 4 London Lock Hospital And Carey Street Public Dispensary, 1815–1820

Chapter 5 Guy’s Hospital, 1824–1829

Chapter 6 Guy’s Hospital, 1830–1839

Chapter 7 Guy’s Hospital, 1840–1848

Chapter 8 Guy’s Hospital, 1849–1855

Chapter 9 On Disease Of The Suprarenal Capsules, 1855–1859

Chapter 10 Addison’s Final Year Of Life, 1859–1860

Chapter 11 Aftermath Of Addison’s Death, 1861–1865

Chapter 12 What Addison Wrought: The History Of Addison’s Disease, 1866–Circa 1950

Chapter 13 What Addison Wrought: The History Of Addison’s Anemia, 1855–Circa 1970

Chapter 14 Bearing Addison’s Disease: A Physician And A Politician

Bibliography

About The Author

LIST OF MAPS

Northumberland, North East England

Hadrian’s Wall, Northern England

Long Benton, Northumberland

London, 1806

LIST OF IMAGES

Thomas Addison (1795–1860)

Long Benton, Northumberland

The Royal Grammar School of Newcastle, Northumberland, 1810

Edinburgh Castle, 1831

Richard Bright (1789–1858)

College of Physicians of London

Engraving of Guy’s Hospital circa 1800

Engraving of Guy’s Hospital circa 1725

Hunterian Theater of Anatomy

Golding Bird (1814–1854)

René-Théophile-Hyacinthe Laënnec (1781–1826)

René-Théophile-Hyacinthe Laënnec at Necker Hospital, 1816

Postero-anterio projection of normal anatomy of human suprarenal capsules

Smoky, dingy skin discoloration of Addison’s disease

Jonathan Hutchinson (1828–1913)

Charles Edward Brown-Séquard (1817–1894)

Armand Trousseau (1801–1867)

Left axilla showing the discoloration of Addison’s disease

Addison’s disease skin discoloration pattern of Mr. S

Thomas Addison near the end of his life

Austin Flint Sr. (1812–1886)

Jacques Raphaël Lépine (1840–1919)

Samuel Fenwick (1821–1902)

4516.pngImage%20A%20copy.jpg4526.png

Thomas Addison (1795–1860). Wellcome Library, London.

PREFACE

Patients sometimes take for granted the healing adjuncts that save their lives. One patient, for example, developed painless circular skin lesions on her upper extremities, diagnosed as benign granuloma annulare and treated with subcutaneous adrenocortical steroids for cosmetic reasons. The patient subsequently developed hypertension, anemia, a creatinemia of 4 mg/dl (as opposed to the normal 0.5–1 mg/dl), fever, chills, and subungual splinter hemorrhages. Her condition worsened. A renal radionuclide scan showed low renal function, and a transthoracic echocardiography suggested an aortic valve abnormality consistent with endocarditis. Despite receipt of intravenous antibiotics for five days, the patient’s creatinine and blood urea nitrogen (BUN) levels climbed to high levels (i.e., greater than 10 mg/dl and 100 mg/dl, respectively, as opposed to normal levels of 6–20 mg/dl). A transesophogeal echocardiogram was normal. A renal biopsy showed diffuse noncaseating interstitial granulomatosis consistent with sarcoidosis, a multisystem disease of unknown etiology. A chest x-ray and computerized axial tomography of the patient’s thorax and abdomen were normal. Antibiotics were stopped and high-dose intravenous adrenocortical steroids begun. The patient improved rapidly and went home on the twelfth day of hospitalization. During the subsequent two months, her renal function nearly normalized on a tapering course of oral adrenocortical steroids. The patient returned to full-time work five months after her acute illness.

The patient described above is the author of the book before you now. The adrenocortical steroids that I received were only one of many necessary healing adjuncts that saved my life; however, their history and that of the adrenal glands piqued my curiosity, leading me to Thomas Addison, MD (1795–1860), the first person to realize that the tiny adrenal glands and the adrenocortical steroids secreted by them make life possible.

Dr. Thomas Addison, 1795–1860: Agitating the Whole Medical World is the first full-length biography of Dr. Addison’s life and work. The book also establishes the link between Dr. Addison’s original discoveries and the research of subsequent medical scientists who discovered treatments for Addison’s disease and Addison’s anemia (pernicious anemia). The last chapter of this book presents the history of two individuals who personally bore the awful weight of Addison’s disease.

I have rewritten this revised edition of Dr. Thomas Addison, 1795–1860: Agitating the Whole Medical World (2014) to conform to the writing and document preparation standards of The Chicago Manual of Style.

Margaret R. O’Leary, MD

Fairway, Kansas

April 4, 2014

ACKNOWLEDGMENT

I am grateful for the assistance of M. Ward, administrator, Wellcome Images, the Wellcome Trust, London; D. Hirst, curator, John Martin Rare Book Room, the University of Iowa Libraries, Iowa City, Iowa; and Kansas artist C. Sutherland, who drew the maps. B. Hauxwell shared stories about his ancestors and contributed information that improved the accuracy of the book. Editor S. Disbrow provided valuable guidance in working out the kinks of the first edition of this book.

INTRODUCTION

Sixty-four-year-old Thomas Addison, MD, knew that he was acutely ill. He had served thirty-six years as a physician, teacher, and medical officer at Guy’s Hospital and Guy’s Hospital Medical and Surgical School (henceforth, Guy’s Hospital Medical School) in London. The world of medicine knew his name and his discoveries. However, in 1859, four years after publishing his revolutionary ideas about the mysterious suprarenal capsules, or adrenal glands, Addison developed an unshakable despondency. For the first time in his life, he sought a long rest from his professional responsibilities.

Growing more melancholic and distracted every day, Addison was unable to complete even his limited teaching assignment for the winter medical-school term 1859–1860. In mid-March 1860, he wrote a letter to his students, thanking them for their concern during his many trying years devoted to Guy’s Hospital and to Guy’s Hospital Medical School. He explained that his breakdown in health had scared him from the anxieties, responsibilities, and excitement of the profession.¹ He said that he did not know whether his condition was temporary or permanent but hoped to get better and return to his students in the classroom and to his patients on the hospital wards. Addison accepted the institution’s governors’ and administrations’ accolades and a formal appointment as a consulting physician to Guy’s Hospital. His wife, Elizabeth, took him to their home in Brighton, Sussex, on England’s breezy south shore, to take in the fresh sea air in hopes of effecting a cure. Instead of improving, Addison’s depression worsened.

On June 20, 1860, Addison sustained severe head injuries following a suicide attempt and died of his head trauma ten days later. His passing went almost unnoticed. His wife took his remains to Lanercost parish church in Cumberland, North West England. A few local friends and family attended his burial beneath an ancient yew tree near his uncle Samuel Addison, a physician, and a dozen other Addison ancestors.

The profession of medicine had been Addison’s life. He did not marry until his fifties. He insisted on a university medical education rather than a surgery apprenticeship in Edinburgh. He resolved to become a physician instead of either a surgeon or an apothecary. After finishing medical school in Edinburgh, he left both Northern England and Scotland to seek his professional fortune in septic London. Everywhere there, diseases suffocated life as medical practitioners mostly watched, helpless.

In London, Addison nurtured every opportunity to advance his understanding of valid medical theories and practices. He eventually obtained an assistant physiciancy at Guy’s Hospital in South London at a critical time in its magnificent history. He slowly climbed its professional ladder through hard work, perseverance, and an intense devotion to the profession of medicine.

Addison was tall and had a high forehead; dark hair and eyes; bushy eyebrows; long side-whiskers; a fine, determined mouth; and a strong jaw. His features belonged to a powerful mind that showed no trace of any kind of sentiment.² He was self-confident. He moved gracefully. He was proud, pompous, shrewd, and sagacious, with the sterling hard qualities of true professional honesty.³ He disdained puffery and grandstanding. He owned the English language. With it, he enchanted his rapt students with a paced, purposeful lecture opening followed by dramatic ebbs and flows of his voice, filling the classroom air with polished, powerful, and grandiloquent sentences. His enemies declared him a blustering bundle of loquacity⁴ but could never diminish him as a teacher, for he had no rival in Britain. Students flocked to Guy’s Hospital Medical School because Addison taught there.

His commanding and formal exterior notwithstanding, Addison was a modest and kindly man who understood and accepted human fallibility in all but himself. He taught students about human frailty. For example, Addison cautioned his students that most people resisted new ideas even when society benefitted from them. People, he continued, were not too willing to admit the merits of a great discovery. First, they said that the discovery was not true. Then, if the discovery was found to be true, they said that it was of no value. If the discovery was found to be true and valuable, they said that it was already known.

Addison weathered vitriolic verbal and written assaults from certain peers when he announced his discovery that the mysterious suprarenal capsules were necessary to life and that diseased suprarenal capsules could cause a white person’s skin to darken to mulatto hues. Outspoken critics decried Addison’s effrontery in suggesting a life-giving function for the little yellow bodies sitting atop each kidney. Surely, they said, Addison was wrong.

However, Addison was not wrong. Subsequent medical science validated his discoveries. Addison’s original propositions led to the discovery of life-saving medicines, such as epinephrine, the adrenocortical steroids, and even vitamin B12. Addison himself did not discover these life-saving substances, but he made their discovery possible by first discovering adrenal insufficiency, also known as Addison’s disease, and by rediscovering pernicious anemia, also known as Addison’s anemia. Few medical men or women can rival Addison’s contributions to modern medical science and patient care.

Introduction Notes

¹. Samuel Wilks and Thomas Daldy, eds., A Collection of the Published Writings of the Late Thomas Addison, MD, Physician to Guy’s Hospital (London: New Society, 1868): xvi–xvii.

². Dr. Addison, in Samuel Wilks and George Thomas Bettany, Biographical History of Guy’s Hospital (London: Warwick House, 1892): 229.

³. Ibid., 231.

⁴. Pencillings of Eminent Medical Men, Medical Times 9 (October 6, 1843–March 30, 1844): 108.

CHAPTER 1

EARLY NORTHUMBERLAND CHILDHOOD, 1795–1801

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Thomas Addison was born in October 1775 ¹ in an upstairs room of his parents’ grocery store in Long Benton (Longbenton) village of Northumberland County.², ³, ⁴ Two-thousand-square-mile Northumberland is so far north and east in England that it abuts Scotland, inhabits the same north latitude as Copenhagen, and qualifies as the coldest county in England. Northumberland receives less rain than does Cumberland County to its west because of the intervening North Pennine uplands, which form the backbone and the main watershed of England’s northern reaches. However, any weather that Northumberland might escape from the west is made up for by the terrible wrath of the North Sea, which sends ferocious gales from the east and northeast that shred the Northumberland coastline every year during September and October. Northumberland’s vast, barren, windswept moors culminate on rounded or scarped crests with elevations less than three thousand feet and, from there, tumble in heaps to the coastal plain. The moors’ topsoil above around six hundred feet is so acidic (pH 2–4) that only bracken, heather, sphagnum, and coarse grasses dare to grow. This reality is happy news for the hardy black-faced Northumberland sheep that relish the rubbly flora and, in their turn, provide Northumbrians with their meat, wool, and hides. Few humans call the stark Northumberland moors their home.⁵, ⁶ ,⁷ ,⁸

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Map of Northumberland.

Northumberland’s main city, Newcastle (Newcastle upon Tyne), lies in the southeast corner of the county on the north shore of Northumberland’s main river, the Tyne.⁹ The Romans founded Newcastle in AD 122 as a fort and bridge to anchor the original eastern terminus of Hadrian’s Wall. The Romans built their fort and bridge at this particular spot because of the ease of crossing the Tyne on foot at low tide and the presence of a hundred-foot north shoreline rock outcropping on which to secure the fort’s foundation (the Tyne was much wider in earlier days).¹⁰ Later, the Romans extended Hadrian’s Wall eastward to Wallsend, making Newcastle the second fort on the line.¹¹ Emperor Hadrian, who reigned from AD 117 to 138, built the wall to protect the transverse road across the island, along which the garrison, supplies, and communications moved in either direction during peaceful times and attacks by northern raiders.¹² The remnants of Hadrian’s Wall, with characteristic Roman directness, still bestride the seventy-mile waist of England between Wallsend on the Tyne and Bowness on the Solway.

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Map of Hadrian’s Wall.

Hadrian’s Wall follows the Tyne River both upstream (to the west) and downstream (to the east). From Newcastle, the wall passes westward through an interruption in the upland moors called Tyne Gap to reach Hexham, which marks the approximate halfway point between Tynemouth and Carlisle. Hadrian’s Wall eventually picks up and follows the westward-flowing Irthing River through Lanercost parish in Cumberland, which was the rural homeland of Thomas Addison’s paternal ancestors. The two-story stone house on the Addison’s family freehold estate on the northern bluff overlooking the Irthing river in Lanercost parish was built, at least in part, from stones recovered from Hadrian’s Wall, just a stone’s throw away.¹³, ¹⁴ Reuse of the wall’s freestone blocks was common practice in former days; even the Lanercost parish church contains many of them.¹⁵

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Lanercost parish church (formerly the church of Lanercost Priory), Cumberland, North West England

Back in Northumberland, the Tyne River at one time ran more than eight miles eastward from Newcastle to the North Sea, crossing a channel that varied in width and depth, thus causing the tides to move more rapidly in some places than others. Within the first mile downstream of Newcastle, the river was an open stream but then coursed through several windings before opening onto a broad and deep channel called the Long Reach. From there, the river formed a large basin that extended nearly the whole length of Shields, at the west end of which the tide spread over extensive flats known as Jarrow Slake. The rocky submerged channels of the Tyne River in the windings could be so perilous to navigate that wary collier ship captains docked near Newcastle waited for high tide (ten feet above low tide) to pass downstream unimpeded.

By the turn of the nineteenth century, the shores of the Tyne were beginning to wear the black and busy look of an industrial region. Between Lemington, about four miles upstream from Newcastle, and Shields, about seven miles downstream, collieries, factories, foundries, forges, glass manufacturers, refineries, gunpowder works, chemical works, shipbuilding yards, and breweries sprouted along the river’s shores.¹⁶ Long Benton village, still fairly rural, watched the hardening north shore from a safer perch a couple miles north of the river. Long Benton descended from the barons of Morpeth to the earl of Carlisle, who, in 1800, sold it to the Brandlings and Browns.¹⁶

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Map locating Long Benton north of the Tyne river.

The once-abundant coal deposits of the southeast corner of Northumberland, part of the so-called Great Northern Coalfield, shaped its history. The coal came to the attention of the earliest Northumberland inhabitants when North Sea coal outcroppings, denuded by the howling winds and pummeling surf, hurled pebbles or lumps of coal in large quantities onto the shore. The Romans, the monks of Tynemouth priory, and the lords of castles and manors in ancient and medieval Northumberland only reluctantly burned this sea-coal to heat their buildings and to cook their food because of its acrid smoke and smell. As long as wood was plentiful, people ignored the abundance of coal in their region, whose fertile Tyne River Valley bottomlands they instead turned over to agriculture.¹⁷

However, as the English felled their finite forests, sea-coal’s star rose as a substitute source of fuel, particularly during the reign of Elizabeth I, queen of England and Ireland, who reigned from 1558 to 1603. She dismantled the first cartel of Newcastle coal owners, known as the Society of Free Hosts,¹⁸ which, upon procuring a monopoly of the Tyne coal trade, regulated and fixed the price at which coal was to be sold in the London market. Elizabeth I signed a royal charter in 1600 that made her the absolute mistress of the coal trade on the Tyne while levying a crown tax on each Newcastle chaldron ¹⁹ of coal produced. From 1600 on, the Newcastle coal industry rapidly developed. During the seventeenth century, Northumberland coal ceased to carry the prefix sea.¹⁷

Thomas Addison’s devoted parents were Joseph Addison (1756–1823) and Sarah Shaw (1760–1841),²⁰ whose families were Cumberland yeomen ²¹ and Northumberland grocers, respectively. Joseph was the second son of Jonah Addison (1719–1804)²² and Mary Barnfather (1728–1806),²³ who owned and farmed the freehold estate called Banks House ²⁴ in Lanercost parish, Cumberland. Many Addison kin had prospered in Cumberland over the previous several centuries.²⁵ Cumberland yeomen, known for their independence, reserve, and work ethic, occupied the tier between the tenant farmers and the small landed gentry in the social hierarchy. One of their most distinctive traits was the high value they placed on the education of their children and the effort they exerted to place their noninheriting children in commercial occupations or professional positions. The Cumberland yeomen constituted a landed middle class, and at one time were very numerous, and not less politically influential, in Cumberland, noted Henry G. Lonsdale.²⁶

Joseph Addison grew up at Banks House to become a strong, independent, and naturally skilled farmer. However, as Jonah and Mary’s second-born son, Joseph had to seek his fortune elsewhere because only his older brother, John (1755–1814), was destined to inherit the family estate, in conformity with the English tradition of male primogeniture.²⁷ Given their ardent yeomen values, Jonah and Mary Addison groomed Joseph for a career in commerce and Samuel (1765–1799), their youngest son, for a career in medicine. Sometime during the 1770s, Joseph Addison left Lanercost parish for Newcastle to seek his fortune in the region’s booming coal industry. Joseph also probably had a trade interest ²¹ in Newcastle, possibly working as a wholesale merchant transporting and selling fresh produce, grains, wool, meat, and hides produced in the agricultural regions of western Northumbria and Cumberland in the Newcastle marketplace. There was always a market for these items among the burgeoning population of workers around Newcastle. For example, data from the mid-nineteenth century from the town of Hexham, which Joseph passed each time he oscillated between Newcastle and Lanercost, indicated that wholesalers purchased immense quantities of vegetables, four thousand quarters of wheat, one thousand quarters of barley, and two thousand quarters of rye, which they then transported to the Newcastle marketplace for sale.²⁸

Colliery ²⁹ jobs were plentiful in the coal region of Northumberland when Joseph sought one, in part because of the capital infused by a coal cartel called the Limitation of the Vend.¹⁷ Joseph Addison apparently worked as a colliery engineer,³¹ also known as a foreman enginewright. His job probably entailed management of the joiners, fitters, smiths, masons, enginemen, and other mechanics, or each trade’s department foreman. The engineer kept a wage book, showing each shift worked by the mechanics, and their wages per fortnight. He had responsible charge of the engines, boilers, ropes, and all machinery, and made the written report of their condition. Sometimes he kept an account of all materials received, and what department used, acting a storekeeper.³², ³³

It is unknown how Joseph Addison and Sarah Shaw met. On February 21, 1793, at the relatively seasoned ages of thirty-eight and thirty-four, respectively, Joseph and Sarah wed in the Benton parish church (previously called St. Andrew’s Church and renamed Saint Bartholomew’s in 1791 ³⁴), which stood in a valley about one-fourth mile north of Long Benton village. They chose this inconvenient site perhaps to accommodate the Anglicans of Killingworth village to the north of Long Benton, or perhaps it was impossible to obtain a burying ground in [Long Benton] village, in consequence of the rock approaching so near the surface.³⁵ Joseph left the coal industry for the retail grocery business with Sarah, who had inherited her father’s Long Benton grocery store.

In 1792, Joseph and Sarah Addison and their fellow parishioners (a population of about 5,500) welcomed Reverend John Squarey Clapp (1757–1830) as their new vicar.³⁶, ³⁷, ³⁸ Reverend Clapp was born in Bickleigh, near Newton St. Cyres in Devon County, South West England. He earned baccalaureate and master’s degrees at Balliol College, Oxford, and served as the Latin master of Lostwithiel Grammar School in Cornwall, among other positions, before moving to Northumberland.³⁹ Balliol College acquired Benton parish in about 1340, when Philip Somervyll of Wykenore, owner of the parish, bequeathed the lands as an ecclesiastical benefice to the college. In 1341, Richard de Bury (1287–1345), bishop of the diocese of Durham, constituted the Long Benton church as a perpetual vicarage, as detailed elsewhere.⁴⁰ Thus, the masters of Balliol College were Clapp’s patron and bore some responsibility for the perpetual upkeep of the Long Benton church, which included, in the late eighteenth century, helping to save the church from sinking further into the ground because of coal extraction deep beneath the foundation.⁴¹, ⁴²

In 1794, thirty-seven-year-old Clapp married twenty-four-year-old Susan Stukes Hoblyn (1770–1858) of Newlyn East parish, Cornwall, with whom he had four children between 1795 and 1800: John Charles, Eleanor Murray, William Murray, and Ann Jane. The Addison boys grew up with the Clapp boys. The Clapp family lived in the well-appointed, rambling two-story brick vicarage complete with a garden, well, and stable, which stood in the center of the village next to the Black Bull Inn, itself across the street from the Addison family’s grocery store.⁴³ Reverend Clapp represented the intellectual elite of his era and early recognized Thomas Addison’s intellectual gifts and drive, as well as his need to plan for a career unassociated with his parents’ grocery business. Reverend Clapp was an important mentor and touchstone for young Thomas Addison.

Thomas and John frequently accompanied their parents to visit their Addison relatives at Banks House in Cumberland. Construction of the Military Road along the east–west route in the mid-eighteenth century somewhat eased the rigors of travel for the Addison family.⁴⁴ Thomas immensely enjoyed these trips and regarded Banks House as his true Addisonian homestead and Cumberland as his true English homeland. One observer noted, By the accident of his birth, [Thomas Addison] was a Northumbrian, though no one can call into question his Cumberland blood and origin.²

Chapter 1 Notes

¹. Thomas Addison was christened on October 11, 1795. England and Wales Christening Records, 1530–1906 (Long Benton, England, 1670–1845), 1469110.

². Thomas Addison, in Henry G. Lonsdale, The Worthies of Cumberland 4 (London: George Routledge and Sons, 1873): 241.

³. William Hale-White, Thomas Addison, MD, Guy’s Hospital Reports 76 (1926): 254–255.

⁴. The ancient name of Northumberland was Northumbria. After the departure of the