Thomas Addison

The English physician Thomas Addison (1793-1860), one of a famous group of physicians at Guy's Hospital, London, was the first to describe a disease of the endocrine glands and the type of anemia now known as Addison's disease.

Thomas Addison was born in April 1793 at Long Benton near Newcastle-upon-Tyne. His father, Joseph Addison, was a grocer and flour dealer. Thomas studied medicine at the University of Edinburgh and took his doctorate in medicine in 1815. He then held various posts in London hospitals, and in 1819 he was admitted a licentiate of the Royal College of Physicians of London. Although now a fully qualified physician, he entered as a student at Guy's Hospital about 1820. In 1824 he was appointed assistant physician to that hospital and in 1837 full physician. An acute clinical observer and a brilliant teacher, he did much to create the fame of the medical school at Guy's.

Addison's medical writings were not numerous but very important. In 1829, in collaboration with John Morgan, he published the first work on toxicology in English. Much of his work—including his important observations on pneumonia, pulmonary tuberculosis, and fatty liver—appeared in the Guy's Hospital Reports. He gave the first description of appendicitis in his and Richard Bright's The Elements of the Practice of Medicine (vol. 1, 1839), most of which was written by Addison.

In 1849 Addison read to a London medical society a paper on anemia with disease of the suprarenal bodies. This type of anemia was unlike the anemias then known (it was always fatal) and at autopsy Addison had sometimes found disease of the suprarenals. The paper passed unnoticed. After further investigation Addison published in 1855 his classic work On the Constitutional and Local Effects of Disease of the Supra-renal Capsules, in which he described Addisonian (pernicious) anemia and Addison's disease.

Addisonian Anemia

This disease is described in the short introduction to the book. He gave a general description of this anemia, on which he had been lecturing since 1843. It occurred in persons past middle age and was almost always fatal. As he did not know its cause, he called it "idiopathic anaemia."

Addison's clinical description of this anemia is, so far as it goes, a classic, and hence it is often called Addisonian anemia. But in his time little was known about the microscopical examination of the blood, and he therefore did not know about the characteristic blood picture. These and some other features were first described in 1872 by Anton Biermer of Zurich, who called the disease "pernicious anaemia." Outside the English-speaking world it is often called Biermer's anemia. The discovery in the period 1925-1930 of the cause of the disease and of satisfactory methods of treatment completely changed the outlook, and the term "pernicious" is now no longer appropriate.

Addison's Disease

The whole of the text of Addison's book is devoted to his description of a new disease characterized by "anaemia, general languor and debility, remarkable feebleness of the heart's action, irritability of the stomach, and a peculiar change of colour in the skin, occurring in connection with a diseased condition of the 'supra-renal capsules."'The excellence of his clinical description of the disease, and its priority, has never been doubted, and his account of the peculiar bronze color of the skin is outstanding. He described 11 cases, with an autopsy in each. In each he found a lesion in the suprarenal glands, and three-quarters of these lesions were due to tuberculosis.

Before Addison wrote, nothing whatever was known about either the function or the diseases of the suprarenal glands, and his book makes clear that one of its main objects was to stimulate others to investigate their function. But important scientific investigations of these glands, leading to the discovery of adrenaline (epinephrine) and cortisone and other steroids, were not begun until the end of the 19th century. By 1855 no disease of any other endocrine gland had been discovered, and Addison was therefore the founder of clinical endocrinology.

Later Life

Addison's interests all centered in Guy's Hospital, and he paid little attention to private practice. In the late 1850s his health began to decline, and in the hope of effecting an improvement he resigned his hospital posts early in 1860 and moved to Brighton. He died there on June 29, 1860.

Further Reading on Thomas Addison

There is an excellent biography of Addison by Sir Samuel Wilks, his former pupil and successor at Guy's Hospital, in A Collection of the Published Writings of the Late Thomas Addison, M.D., edited by Wilks and Daldy (1868). Some additional details are in W. Munk, Roll of the Royal College of Physicians of London, vol. 3 (1878). For a discussion of later work on the adrenals see C. Singer and E. A. Underwood, A Short History of Medicine (1962).

Additional Biography Sources

Pallister, George., Thomas Addison, M.D., F.R.C.P. (1795-1860), Newcastle upon Tyne: The Author, 1975.

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