The Quest for Cortisone

Chapter 1. Addison and His Disease

9 Chapter 1 Addison and his Disease It is of the highest importance in the art of detection to be able to recognize out of a number of facts which are incidental and which vital. Otherwise your energy and attention must be dissipated instead of being concentrated. —sherLoCK hoLMes, “The ADVenTure of The reiGATe sQuire” At two o’clock the afternoon dinner bell rang. Dr. Thomas Addison was ambling through the well-manicured garden outside his home, accompanied as always by two watchful “companions.” unfortunately, the thought of english cuisine again was more than his fragile psyche could handle today; he suddenly broke away from his attendants and hurled himself over a dwarf-wall, diving headfirst onto the stone pavement nine feet below.1 The impact shattered his forehead, driving jagged fragments of skull deep into the underlying gray matter. The brain damage was massive and irreparable. Dr. Addison never regained consciousness and, according to the Brighton Herald, died at 1:00 a.m. on June 29, 1860. his body was returned to his family home in Cumberland, and he was buried in the priory churchyard in Lancaster Abbey on July 5.2 Why would a man who had grown up eating haggis kill himself rather than face another home-cooked meal?3 Two reasons. first, Addison was depressed.4 in the mid-1800s clinical depression was poorly understood, largely untreatable, and frequently lethal. Mental illnesses were enigmas (sigmund freud, the father of psychoanalysis, was only four years old at the time of Addison’s death). The modern discipline 10| Chapter 1 of “psychiatry” didn’t exist yet. Those around him merely accepted that Addison had for many years suffered from a form of insanity called melancholia , which they believed was caused by overwork of the brain.5 During the winter of 1859–60 his condition worsened, forcing him to retire from clinical and teaching responsibilities at Guy’s hospital in London. Addison retreated from his London home in Berkley square and relocated to Brighton, where his family hoped the seashore would restore his faculties . unfortunately, his depression worsened. After a couple of halfhearted attempts at suicide, his wife and stepson hired two bodyguards, Abraham Quilter and John J. Medcraft, to prevent any further attempts.6 it wasn’t money well spent, as these were the very attendants Addison eluded on his way to fatal humpty-dumptification. The second reason for choosing death over dinner may have been physical illness. for months Addison had been experiencing abdominal pain, weight loss, and bouts of jaundice—ailments that have led to speculation that he was suffering from gallstones or even cancer of the pancreas.7 his aversion to food—a symptom commonly seen in conjunction with certain malignancies of the digestive system—might have reflected something more sinister than the body’s natural response to english cuisine. Thomas Addison was born in october 1795 in Long Benton, a rural village of northumberland near the scotland border. his parents, sarah and Joseph Addison, ran a grocery and flour business.8 As a youth he attended various schools in newcastle-upon-Tyne. his father wanted him to become a lawyer, but Addison decided to become a physician. in 1812 he entered the university of edinburgh Medical school.9 he was proficient at Latin, having mastered it in grammar school, and he prided himself on his ability to take lecture notes in that language.10 in 1815 he completed a doctoral thesis provocatively entitled “Concerning syphilis and Mercury” and subsequently received his MD degree.11 Medical and surgical therapeutics in nineteenth-century scotland were embarrassingly primitive, yet in certain areas of biological science— particularly the discipline known as physiology—rapid advancements were being made. Many long-standing mysteries concerning bodily functions were suddenly yielding to the investigations of medical detectives like Addison.12 Addison left edinburgh and moved to skinner street in the snow hill region of London, becoming a “house surgeon” at Lock hospital13 and Addison and His Disease| 11 beginning a short affiliation with st. George’s hospital.14 After dabbling as a practicing physician, first at the Carey street Dispensary and later at the royal infirmary for Women and Children, he entered Guy’s hospital as a “physician pupil” on December 13, 1817, at which time he paid 22 pounds for the privilege of becoming a “perpetual student.” his performance must have been satisfactory; in 1824 he was invited to...