Operative dexterity, as was natural, arrived more quickly at perfection than did medical treatment. In fact, no one will pretend that medicine has yet travelled far, in comparison with its future achievements, when physiology, pathology, and therapeutics shall have become more complete. Thomas Addison is a specimen of the physicians of genius who have adorned this century. He is known as the discoverer of a disease which bears his name; but his true fame rests upon his practical talent in diagnosing disease.
Dr. Lonsdale, in his volume of “Worthies of Cumberland,” issued in 1873, shows that Addison sprang from the ranks of the yeomanry of Cumberland, and that his forefathers resided during the Commonwealth at “The Banks,” in the parish of Lanercost. Thomas Addison, born in 1636, and Mary his wife, have left their initials carved on an old oaken settle still preserved at The Banks, inscribed with the injunction, “When God doth thee in store, remember thou the poor.” One of his descendants was a Samuel Addison, who became a doctor of medicine, but died at the age of thirty-four. Thomas Addison, a nephew of his, was born in April 1793, at Longbenton, near Newcastle-on-Tyne, where his father was in business, though he retained his farm at The Banks, where his wife lived for the most part. Young Addison clung greatly to the ancestral home, and many years afterwards assembled his wedding guests there. It is on the very site where the Romans encamped during the building of the wall to the Solway Firth; it overlooks the medieval Priory of Lanercost; near by is Naworth, the old Border castle of “Belted Will Howard.”
Thomas Addison was educated at the Newcastle grammar-school under the Rev. E. Moises, and there became a masterly Latin scholar, so that he afterwards took his lecture notes in Latin at Edinburgh. He went direct from school to Edinburgh University, declining to enter as a pupil with an Edinburgh doctor, as his father desired. He was no ordinary student. Independent in thought and action, he was soon recognised by the Royal Medical Society, and made one of its presidents in 1814, an honour which Marshall Hall, and Richard Bright his subsequent colleague, also attained about that time. A striking fact it is that three of the first names of great English physicians of this century should be Edinburgh students, and Presidents of the same Medical Society there. But as yet the London medical schools were only in embryo.
Addison took his M.D. degree in 1815, and afterwards, it is believed, visited the Continental schools; but of this there is no certain evidence. He soon settled in London, in Skinner Street, Snow Hill, in one of the so-called haunted houses. He knew but one man, an old fellow-student, in London. Yet he received nearly sixty guineas in his first year of practice, a very considerable success. He became House Surgeon to the Lock Hospital; then Physician to the General Dispensary, where he studied skin diseases with Bateman. This appointment he held for eight years, and it was of essential service to him. He manifested a keen eye for generic distinctions and individual varieties, and might probably have succeeded to Bateman’s position in regard to skin diseases. But he was not to be made into a specialist. As Dr. Lonsdale says, “with Addison the investigation of any disease meant the full exercise of his abilities till he had mastered it, and having done this, he could not rest till he broke up fresh ground for tillage.” He dreaded becoming a specialist; it savoured of quackery. He always held that the true physician must understand surgery well; and that the good surgeon must know the principles of medicine.
In 1819 or 1820 commenced Addison’s association with Guy’s. He early attracted the attention of the energetic and discerning treasurer, Mr. Harrison, then the beneficent despot of Guy’s, and was by him appointed Assistant-Physician in 1824. This was a victory for unconventional procedure, for it had always been the custom to appoint men at Guy’s who had been original pupils, and not to receive men who were already qualified and in practice into the charmed circle. It was soon evident that a great practical physician had joined the hospital staff, and he was further recognised in 1827 by receiving the lectureship of Materia Medica. Here his attractive powers were made evident by the large classes he drew around him, at a period when medical students entered for individual courses of lectures, and did not as a rule take the whole of their instruction at one school. He must have received between £700 and £800 from these lectures in some years. Men felt that he was the man to sustain and increase the fame of Guy’s.
In 1829 Dr. Addison published, in conjunction with John Morgan, Surgeon to Guy’s, an essay on “The Operation of Poisonous Agents on the Living Body.” Strange to say, this was the first serious investigation in England into the phenomena of general poisoning. The authors believed that a direct influence on the nerve filaments distributed to the blood-vessels accounts for the rapid effects of some of them. In 1830, Addison published a pamphlet on some disorders of females, vigorously combating some received notions, and objecting to the system of depletion. In concluding a lengthy lecture to his class on this subject, he showed the sentiments which animated him by the following remarks: “Gentlemen, if you require an apology for detaining you so long, I find ample material for that apology in the lively interest in which we must all feel in the comfort and happiness of the other sex, doomed as they are, both by the decrees of Providence and by human institutions, to drink deep of the bitter cup of suffering. Whatever may be her lot in this world, we, as men, must at least acknowledge that, whilst Infinite Power gave us being, Infinite Mercy gave us women.”
In 1837 Addison was elected full Physician to the Hospital, and was appointed joint-lecturer with Dr. Bright on Medicine. About this time he commenced with his colleague the “Elements of the Practice of Medicine,” of which the first volume only appeared, chiefly written by Addison. It was most highly valued, but neither author could be induced to complete it. Valuable monographs in number came from his rich experience: two on Pneumonia in 1837 and 1843; Observations on the Anatomy of the Lungs in 1840; the Pathology of Phthisis, 1845, in which he laid down the principle that inflammation constitutes the first instrument of destruction in every form of phthisis. This early advocacy of a doctrine which has thrown much light on this disease was strongly opposed by the physicians of his day, and stamped Addison as a powerful innovator. He was much impressed by Laennec’s views, and acquired very great power of diagnosing from auscultation of the chest. Yet, candid ever in confessing ignorance, he read a paper before Guy’s Physical Society in 1846, “On the Difficulties and Fallacies attending Physical Diagnosis of Diseases of the Chest.” Among other subjects, he dealt with Diseases of the Liver, Affections of the Skin, Disorders of the Brain connected with Diseased Kidneys, and “the Influence of Electricity as a Remedy in certain Convulsive and Spasmodic Diseases,” in every case bringing together facts hitherto disconnected, and contributing markedly to advance medicine as a science.
The achievement of Dr. Addison, however, which has attracted most general notice, is his discovery of a disease of the supra-renal capsules, the small organs adjacent to the kidneys, whose function has not yet been satisfactorily ascertained. We are told that in one case, which had baffled all investigation, Addison was called in, and after careful enquiry, stated positively that the patient suffered from a disease of these organs, which would before long prove fatal. This opinion was received with polite incredulity, but it was justified by the result, and the supra-renal capsules were the only organs that were found diseased. This extraordinary diagnosis was soon noised abroad, and on the Continent brought Addison more honour than in England. Trousseau in France was cordially supported in naming it “la Maladie d’Addison” (Addison’s disease), a name which it will long retain. But the disease was not discovered in this apparently sudden and striking manner, but was the result of observations carried on for many years, in which his powers of deduction from a few cases and imperfect data were most strikingly evidenced. The disease occurs rarely, and very few hints or materials for comparison were available. A form of wasting disease without any apparent organic injury had been again and again observed—bloodlessness, extreme prostration, and various shades of alteration in the colour of the skin, being prominent symptoms. A certain bronzing of the integument was, and still is, an inexplicable concomitant, and no light was thrown upon it till Addison, carefully examining the organs of a deceased patient, when no other disease could be detected, discovered signs of malady in the supra-renal capsules. He identified the disease, and though he did not absolutely mark it out from all others, he gave a very perfect account of the symptoms in the cases which he had met with, and showed that no other disease could be connected with them—indeed no other disease of these capsules has been discovered.
As a teacher Addison was impressive and popular. His interest in his class was genuine and unfeigned; he was eager to draw out the talents of his students. Among his pupils were Dr. Golding Bird, too early called from his brilliant career, Sir William Gull, Dr. Wilks, and many others of note. His clinical teaching in the wards was especially superior. He could most vividly illustrate on the patient, and most clearly define and demonstrate his disease. He disliked anything like interference with his methods by others, and sometimes showed it somewhat brusquely. Once when he had been away from his wards for a few days, a colleague had seen reason to change his treatment of a case of pleurisy. On Addison’s return, he at once inquired the reason, and was told that the physician in charge believed the case to be one of pneumonia and solidification of the lung. “Ah indeed!” said Addison, “give me a trocar;” and he immediately plunged the little instrument into the chest, and drew off a few ounces of fluid, proving the accuracy of his own diagnosis. He wasted no time in considering or discussing probabilities; he was certain, and he proved that he was right.
Dr. Wilks’ view of Addison’s character, in the collected edition of his works published by the New Sydenham Society, 1868, is so pertinent that it must find a place in any adequate account of Addison:—