Addison, Thomas

(b. Long Benton, England, ca. April 1793; d. Brighton, England, 29 June 1860)

medicine.

Although the birth date generally assigned to Thomas Addison is April 1793, the tablet in Guy’s Hospital Chapel in London and that in Lanercost Abbey in Cumberland, where he is buried, state that he died on 29 June 1860, at the age of sixty-eight, The Long Benton church baptismal register has the following entry: “1795, Oct. 11. Thomas s. of Joseph and Sarah Addison, Lg. Benton.” The same register gives 13 April 1794 as the baptismal date of John, the second son of Joseph and Sarah Addison Since its is unlikely that if Thomas had been bon in 1793 his baptism would have been deferred until after that of his younger brother, it is reasonable to believe that in the course of transcription a five has become a three, as hale white suggested

Addison married Elizabeth Catherine Hauxwell at Lanercost church in September 1847 They were childless, although she had two children by her first marriage

Addison was first sent to school near Long Benton, and then went to a grammar school at Newcastle-onTyne. He learned Latin so well that he made notes in that language and spoke it fluently. His father had wished him to become a lawyer, but in 1812 he entered the University of Edinburgh as a medical student. He graduated in 1815, at the age of twenty-two, as a Doctor of Medicine. The title of his thesis was“De syphilide et hydrargyro” (“Concerning Syphilis and Mercury”). Guy’s Medical School book records his entrance: “Dec. 13, 1817, from Edinburgh, T. Addison, M.D., paid £22-Is. t o be a perpetual Physician’s Pupil.”.

Addison became house surgeon at Lock Hospital in London in 1815 and was appointed assistant physician to Guy’s Hospital on 14 January 1824. He became lecturer on materia medica three years later. He was joint lecturer on medicine with Richard Bright in 1835, and in 1837 he became physician to Guy’s Hospital. In 1840 Bright retired from the lectureship, and Addison became sole lecturer. He held this position until either 1854 or 1855. He obtained his licentiateship in the Royal College of Physicians on 22 December 1819 and was elected a fellow on 4 July 1838.

Addison’s numerous clinical studies include works on the clinical signs of fatty liver 1836 appendicitis (1839) pneumonia (1843) phthisis (1845) and xanthoma (1851) In 1849 he described Addison anemia before meeting of the South London Medical Society: “For a long period I had from time do time met with a remarkable from of general anemiua...” His clinical findings fit with both vitamin B₁₂ and folic acid deficiency states. One feature peculiar to Vitamin B₁₂ deficiency is “... the bulkiness of the general frame and the obesity often present, a most striking contrast”..

In the absence of a separate formal report it is not surprising that the world overlooked this excellent description of pernicious anemia. That description, good as its was, was quite overshadowed by Addison’s spectacular discovery of the disturbance of the supra-renal capsules In 1855 in a paper entitled “On the Constitutional and Local Effects of Disease of the Suprarenal Capsules,” he described what is now known as Addison’s disease, a condition characterized by progressive anemia, bronze skin pigmentation, severe weakness, and low blood pressure. It is now known that in Addison’s disease the blood sodium and chloride are lowered, potassium and nitrogen are increased, and there is a diminution in the blood volume. The intravenous administration of a physiologic solution of sodium chloride helps the patient to recover from these conditions. This work laid the foundation for modern endocrinology.

At Guy’s Hospital both conditions became increasingly familiar and were recorded separately from time to time in Guy’s Hospital Reports, but elsewhere Addison’s description of anemia was forgotten until his pupils Samuel Wilks and Thomas Daldy published his collected work and made it clear that Addison had described the disease in 1849, although A. Biermer reported it as a new disease in 1872.

In 1839 Bright and Addison published Elements of Practical Medicine. Only Volume I (two volumes were planned) appeared, and the work is incomplete and very rare.

Probably the best evaluation of Addison comes from Wilks, who said: “The personal power which he possessed was the secret of his position, much superior to what Bright could ever claim, and equal, if not greater, than that of Sir Astley Cooper.”

On 7 July 1860 the Medical Times and Gazette published a notice of Addison’s death on 29 June 1860, but neither Lancet nor the British Medical Journal recorded it

BIBLIOGRAPHY

I. Original Works. Addison’s writings include “Observations on Fatty Degeneration of the Liver.” in Guy’s Hospital Reports, 1st Series, 1 (1836), 476–485; Elements of the Practice of Medicine (London, 1839), written with Richard Bright: “Observations on the Anatomy of the Lungs” (1840), in his Collected Writings (London, 1868), pp. 1–6; “Observations on Pneumonia and Its Consequences,” in Guy’s Hospital Reports, 2nd Series, 1 (1843), 365–402; “On the Pathology of Phthisis,” ibid., 3 (1845), 1–38: “Disease Chronic Suprarenal Insufficiency, Usually due to Tuberculosis of Suprarenal Capsule. 1st Announcement,” in London Medical Gazette, n.s. 43 (1849), 517–518, reprinted in his Collected Writings (London, 1868), pp. 209–239, and Medical Classics, 2 (1937), 239–244; “On a Certain Affection of the Skin, Vitiligoidea—a. plana. b. tuberosa, With Remarks,” in Guy’s Hospital Reports, 2nd Series, 7 (1851), 265–276, written with William Gull; On the Constitutional and Local Effects of Disease of the Suprarenal Capsules (London, 1855), also in Medical Classics, 2 (1937), 244–280; and A Collection of the Published Writings of the Late Thomas Addison, Samuel Wilks and Thomas M. Daldy, eds. (London, 1868).

II. Secondary Literature. More on Addison and his work may be found in Thomas Bateman, in The Roll of the Royal College of Physicians of London, 2nd ed. (London, 1878), III, 19–22; A. Biermer, “Form von progressiver perniciöser Anämie,” in Korresp.-Bl. schweizer Årtze, 2 (1872), 15; Herbert French, “Pernicious Anemia,” in Clifford Allbutt and Humphrey Davy Rolleston, eds., System of Medicine (London, 1909), V, 728–757; William Hale-White, “Biography by Sir William Hale-White,” in Guy’s Hospital Reports, 76 (July 1926), 253–279; Victor Herbert. “The Megaloblastic Anemias,” in Modern Medical Monographs (New York and London, 1959), p. 63; and E. R. Long, “Addison and His Discovery of Idiopathic Anemia,” in Annals of Medical History, 7 (1935), 130-132.

See also “Obituary,” in Medical Times and Gazette, 2 (1860), 20; and “Biography,” in The Roll of the Royal College of Physicians of London, 2nd ed. (London, 1878), III, 205.

John A. Benjamin

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

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 Sources

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

Thomas Addison

1793-1860

British physician for whom Addison's disease, a metabolic dysfunction of the adrenal glands, and Addison's (or pernicious) anemia are named. In 1855 Addison was the first to identify a set of symptoms that correlated to a disease of an endocrine gland.