Thomas Addison: 1793-1860

Addison’s passion for dermatology and his determination to diagnose difficult diseases resulted in the classification of two new conditions involving the adrenal glands.

Issue: September 2007

Thomas Addison’s claim to fame in medicine is his groundbreaking classification of two diseases involving the “suprarenal capsules,” or adrenal glands. However, during his lifetime, Addison received little or no acclaim within the medical field.

Thomas Addison

Courtesy of Gordon Museum Kings College London

Addison received no court appointments or honorary degrees, and the Royal Medical and Chirurgical Society is said to have refused to publish some of his papers, even after he had been its president. The monograph that described Addison’s disease was not mentioned in the British Medical Journal and only briefly mentioned in The Lancet, and neither of these journals published an obituary for Addison when he died.

In literature, the words used to describe him vary from withdrawn, unapproachable, austere, proud, haughty and severe to shy, nervous and timid.

Despite all this, Addison is considered by many to be one of the most well-known physicians of the 19th century, one of the founders of modern endocrinology and, together with Thomas Hodgkin and Richard Bright, one of the three “giants” of Guy’s Hospital in London.

Humble beginnings

Addison was born in 1793 (some sources list it as 1795) in Long Benton, New Castle-upon-Tyne, England. His father, Joseph Addison, was a grocer and flour dealer and strived to provide his son with greater opportunities than he had. During his elementary school education, Addison excelled at Latin and became so proficient that he is said to have spoken and taken notes in the language.

Although his father originally intended him to go into law, Addison graduated from the University of Edinburgh in 1815 with a medical degree earned with his thesis, “Concerning Syphilis and Mercury.”

After graduation, Addison moved to London, where he became a house surgeon at Lock Hospital and a pupil at the Public Dispensary. Here he learned from acclaimed dermatologist Thomas Bateman, who instilled in him a lasting interest in skin diseases and dermatology.

Around 1817, Addison became a pupil at Guy’s Hospital, where he would stay until his retirement in 1860. He became assistant physician in 1824 and a full physician in 1837, almost 20 years after he joined the hospital. During his time at Guy’s Hospital, Addison was an extremely popular lecturer on Materia Medica – the scientific study of medicinal drugs and their sources, preparation and use — and earned between £700 and £800 in lecture fees each year. His students both loved and feared him.

Addison was also “preoccupied with the challenge of clinical bedside diagnosis.” To further this endeavor, he helped instill pathologic teaching principles at Guy’s Hospital. Together with Bright, Addison helped organize a clinical ward in close connection with postmortem rooms. This allowed him to correlate physiological signs in life with the pathology found in autopsy.

In one biographical sketch it was said, “he never reasoned from a half discovered fact, but would remain at the bedside with a dogged determination to track out the disease to its very source for a period which often wearied his class and his attendant friends. To those who knew him best, his power of searching into the complex framework of the body and dragging the hidden malady to light appeared unrivaled, but that great object being accomplished, the same energetic power was not devoted to its alleviation or cure.”

It was for this reason that Addison never established a large private practice.

Contributions to medicine

Among Addison’s contributions to medicine is his description of appendicitis in his and Bright’s Elements of the Practice of Medicine, which is said to have been written mostly by Addison.

Addison is also credited as having discovered the pathology of pneumonia. He traced bronchial branches to their alveolar termination, where he discovered ‘pneuomonic deposits in the air cells.’ At the time, pneumonia was thought to be an interstitial pneumonitis. Addison was able to make major advances in the study of pneumonia by using French surgeon René Laennec’s invention, the stethoscope.

In 1849, Addison described a peculiar form of anemia in a lecture to the South London Medical Society. He called it idiopathic anemia. Patients with this form of anemia were weak or lethargic, had weak hearts and had sickly, gray colored skin. The disease occurred in middle age and was almost always fatal. Later that year, Addison published a short article in the London Medical Gazette: ‘Anaemia — disease of the suprarenal capsules in which the disease is not distinctly separated from a new form of anaemia.’ This condition was later known as pernicious anemia, or Addison’s anemia.

In 1855, Addison published his now famous monograph, On the Constitutional and Local Effects of Disease of the Suprarenal Capsules. In it he gave detailed records of 11 patients all of whom died with similar clinical symptoms. While investigating a peculiar form of anemia, Addison found pathological changes in both suprarenal glands that appeared to be independent of anemia. Patients were often weak, had irritable stomachs and a strange change in skin color. Upon autopsy, all patients had lesions on the suprarenal glands. His colleague, Bright, previously observed these symptoms in one of the patients but had not discovered the significance.

Addison’s work was widely debated and largely discounted; however, Armand Trousseau eventually recognized adrenal failure and gave the disease the eponym Addison’s disease.

In 1855, no disease of any other endocrine gland had been discovered. Further research into the adrenal glands, eventually leading to the discovery of adrenaline, did not begin until the end of the 19th century.

In 1860, Addison retired from Guy’s Hospital due to gallstones and jaundice. A few months later, Addison, who was believed to have struggled with depression throughout his life, committed suicide by throwing himself over a wall, landing on his head after a nine-foot fall.

In his memory, Joseph Towne created a statue of a bust that was placed in the pathology museum at Guy’s Hospital, and later a hall was named after Addison in the new portion of the hospital. – by Leah Lawrence

For more information:
Munk W. The roll of the Royal College of Physicians of London, Vol. 3 (1878). London.
Pearce JMS. Thomas Addison (1793-1860). J R Soc Med. 2004;97:297-300.
Løvås K, Husebye ES. Addison’s disease. Lancet. 2005;365:2058-2061.
Jeffcoate W. Thomas Addison: one of the three “giants” of Guy’s Hospital. Lancet. 2005;365:1989-1990.
Thomas Addison. Can Med Assoc J. 1927;17:108-109.
Jay V. Thomas Addison. Arch Pathol. 1999;123:190.