History of Addison`s Disease
By Charles Douglas Wehner

Beginning in about 1829, with one of Dr. Bright`s cases, Thomas Addison began to notice people dying with - or of - damage to their adrenal glands, or suprarenal capsules

He reported his discovery in a lecture Anaemia - Disease of the Supra-renal Capsules in 1849

He looked, so to speak, for an X-ray machine - before Roentgen`s discovery of 1895 there was no such thing - a means to look inside the human body and anticipate the death. This would allow treatment to be more specifically directed towards extending the victim`s life.

He thought he had found his X-ray machine in the form of a brown coloration of the skin. See the pigment, treat accordingly. One could say, the skin examination is an adrenal examination by proxy.

Addison discovered that there are white areas (vitiligo) sometimes - and his famous colleague Dr. Thomas Hodgkin found that hair growing from such white areas will also be white.

Having seen five cases of adrenal disease, and heard of six others, with a possible twelfth who refused an autopsy, Addison published a book in 1855.

Edward Headlam Greenhow met Addison, and determined to resolve the "with-or-of" question. Would adrenal damage kill?

At "God`s Hospice" (Hôtel-Dieu), Professor Trousseau delivered lectures on Addison`s disease, having seen a case in 1856. He also taught Louis Martineau at Paris university, Faculty of Medicine.

Before the Medico-Chirurgical Society, Addison confessed that his "X-ray machine" was unreliable. People had shown no pigmentation at all, and yet died with capsular disease.

In 1859, at the city hospital of Rotterdam, doctors F. J. J. Schmidt and Boogaard noticed pigment on the sites of Baender (belts or garters) and on the buttocks of a 16-year-old girl. These were the sites of pressure on the skin. The Addison pigment was revealing itself as pressure-sensitive.

In June 1860, Addison died and was buried at Lanercost Abbey, Cumberland.

In April 1862, Gaget, a blacksmith, was admitted to the Beaujon hospital. He had the disease, and blisters caused by flying sparks had affected the forearms. When healthy, these minor wounds healed white, but now that he was ill they healed pigmented. This is similar to Wehner`s insect bites. For those who show pigment, the X-ray machine could be refined by such added detail.

At Clermont-Ferrand, Professors Imbert-Gourbeyre and Laguille researched whether the ancient Greeks or Romans had previously seen such an illness. They speculated that a "black jaundice" was known, due to the liver. However, they found no prior knowledge of disease of the suprarenal capsules.

In 1862 Dr. Samuel Wilks wrote in Guy`s Hospital Reports of the twenty-five cases that had come to the notice of the hospital, supported by autopsy specimens, since Addison`s publication.

One patient in Wilks` list had been treated with brandy, just as one might treat the shock of hypothermia with brandy from a St. Bernard dog in the Swiss alps; another - Addison`s last case - was given effervescing medicine.

In 1863, Monsieur Martineau became M. le docteur Martineau with the publication of "de la maladie d`Addison", his thesis. He had collated facts such as the sensitivity of the skin-pigmentation to wounds or friction, the cases of people recovering only to relapse later (as hinted at in Addison`s book), and cases such as deep jaundice or silver-nitrate poisoning who were pigmented without adrenal damage.

Martineau warned that pregnancy - producing the pigmented "mask of pregnancy" - did not rule out Addison`s disease. He had a case of a woman with both pregnancy and Addison`s disease.

Addison believed that the outcome is always fatal. Martineau, however, quotes case XXXI, from Dr Thompson in the Medical Times and Gazette, of a woman of 33 who recovered. Also case LIV was an 18-year-old who recovered, saying that his cousin had also recovered.

Were these remissions or spontaneous cures? Wherever there are germs at work, the immune system may latch on, providing a complete cure. There is no room for absolutism in medicine. Equally, one should NEVER rely upon a rare spontaneous cure.

Lifelong follow-up studies are required in cases of alleged complete cure, for the very reason of intermittency. Without such information, one can only make a mental note to carry out such lifelong studies in future eventualities of suspected spontaneous cure.

Martineau`s plates of Gaget and of a woman with jaundice are exaggerated. Gaget`s eyes were described as "un beau bleu de ciel" (a beautiful sky-blue), and his hair as blond, turning to chestnut - yet the eyes, the hair and the skin are all rendered in charcoal black.

According to Martineau, on 12th April 1862, Dr. Frémy prescribed eau de Seltz with ice for Gaget. This is soda-water, from which Alka-Seltzer derives its name. A mild acid, carbonic acid, it mitigates gently against the gastric alkalinity. They did not know that, and even to this day this point is unknown by the profession.

For example, in the London Medical Gazette of 1849, Dr. Bouvier of the Beaujon described how he gave soda water against vomiting even in Cholera. It was Greenhow (below) who discovered the special importance of effervescing medicine in Addison`s disease.

Martineau reached a surprising conclusion - Addison`s disease is a disease of those who die with capsular damage. The adrenal glands, or suprarenal capsules, are not essential to life. He was wrong.

In 1866, Greenhow published a survey of the whole of Europe from Rotterdam in the north to Lombardy in the south, from St. Petersburg (Russia) in the east to New York in the west. That`s thorough! He had found 128 cases who died of damaged capsules. So the glands are essential to life.

He also found 58 who died with - along with 10 Addison look-alikes who died without - capsular damage.

These figures cover a ten year research span, at a time when the disease was more common than it is today.

Thomas Addison`s last case is Greenhow 89; Gaget is Martineau case 1, Greenhow 145. Martineau`s pregnant case seems to be Greenhow 52.

Diagnosis - then as now - is fraught. There is no craving for salt. There is no adrenal crisis that causes automatic tintinabulation of the bells, informing the doctor of the urgency. No collapse. Nothing.

For over a decade, "experts" were convinced the disease did not exist.

Addison described a poisoned look. True. Blood poisoning. But it is sometimes chloride poisoning (skin cold, but complains of burning heat) - Greenhow; sometimes phosphate poisoning (felt as if legs restrained by cords) - Greenhow; sometimes potassium poisoning (paralysis and numbness of legs below the knees and of fingers) - Addison. It is chemical-imbalance poisoning. It is also forever changing.

The patient starts drooping (Greenhow p.9), but does not collapse. The blood at some time becomes thick (water loss). It may congeal early, allowing a merciful sudden death. More usually, circulation fails and gangrene sets in. The patient rots whilst fully conscious (Greenhow p.64). Consciousness is retained to the last (eg. Greenhow p.9). There is always a clot in the heart after death (Greenhow p. 62).

There is no X-ray machine in the blood - nothing that should not be there. It is just that the proportions are wrong. The anaemic blood is dried out, making it look un-anaemic. Greenhow was fooled into thinking there was no anaemia (p.63).

In 1875, Greenhow delivered the Croonian Lectures to the Pathological Society, and published another book - Addison`s Disease, being the Croonian Lectures for 1875. He said there was much too much emphasis on skin pigment - the unreliable X-ray - and not enough on symptoms. He also recommended effervescing medicine without knowing why

If you ate washing soda, you would get nausea and vomiting. That`s how an Addison sufferer feels. However, the success of Coca-Cola led to all manner of effervescing drinks arriving on the market since the days of Greenhow. Greenhow recommends effervescing medicine (1866, P.23). It is likely that most sufferers will accidentally have medicated themselves against nausea and vomiting by drinking modern drinks.

Diagnosis is an arithmetical exercise. Put harmless dyestuff in circulation. Measure the dye per cubic centimetre. Is the patient hypovolaemic? Measure the sodium - corrected for blood volume. Is the patient hyponatraemic? Measure the pH. Is there acidosis? Measure the potassium - corrected for blood volume. Is the patient hyperkalaemic?

The division of the molar concentration of sodium by the molar concentration of potassium yields a useful figure. It conveniently cancels the hypovolaemia factor, so no dyestuff test is needed - but quantites must be molar, such as millimols per litre. In dogs, healthy is about 28, whilst 27 downwards is suspected Addison, and below 23 is said to be certain Addison. It should be the same with humans. Try the test with a healthy control for reference.

Such harmless and reliable methods were not - and are not known. The disease has been stuck with the 19th century reputation of the bronzing disease, and is known only by rumour.

If the patient dies, there will be germs in the adrenals - tuberculosis, or in AIDS the cytomegalovirus. If there are not, the cause will be STEROID MISUSE, either from black-market drugs or irresponsible doctoring.

Doctors should test suspected addicts for fluoro-complexes in the blood. If they deny taking drugs, but the signs are there, their symptoms will not enter the record-books as true Addison`s disease. Do not be deceived by the fluoro-steroids in the birth pill, however.

Greenhow discovered about 330 cases by the time he gave the Croonian Lectures for 1875. That would make about 400 documented cases in the whole of Europe when tuberculosis was common, for the nineteenth century.

The International Medical Congress of 1881 had a lecture by Greenhow (on this site). They still had not discovered that the action of the adrenals was chemical, and tended to the opinion that the infection - usually tuberculosis - inflamed the adrenal nerves, thereby causing symptoms.

Thereafter, the declaring of TB to be a notifiable disease separated those with lung TB from the community, putting them in sanatoria. The Swiss tourist industry grew out of British people seeking the mountain air. TB was declining.

Then the biologist Louis Pasteur recommended giving milk a "fever". Just as a fever would weaken germs in the blood, so this pasteurising would weaken germs in the milk. TB declined more.

Another survey of Addison`s disease was published in spain in 1949. La Enfermedad de Addison - Estudio de 400 casos, por Gregorio M. J. Fernandez Noguera; Madrid: Espasa-Calpe 1949, in the Wellcome Library, London. A novelty is the retrospective diagnosis of a case at the Escorial monastery in 1577.

The book then cites Tadeusz Reichstein`s use of deoxycorticosterone in the treatment of the condition. It also gives details of deoxycorticosterone toxicity, citing a case of a patient who died of bleeding in the brain due to the thinning of blood-vessels by steroids.

A study of potassium uptake and excretion then leads to the advice to avoid potassium-rich foods. Pages 150 and 151 have tables of foods that are meagre, medium and high in potassium.

There were no TABLES of the alleged 400 case-reports used.

Then cows were tuberculin tested. Only cows that had never been exposed to TB were allowed to deliver unpasteurised milk to the public. This was known as TT milk.

Then in the 1950s and 1960s, a huge vaccination initiative in Europe gave Bacillus Calmette-Guerrin or "BCG" to the children at school. Tuberculosis almost vanished in the industrialised world.

Addison`s disease will have declined pro-rata. That is to say, there may have been only one thousandth as many cases in the late twentieth century as in the nineteenth - zero-point-four in the whole of Europe. That means just one or at most two.

Worldwide, however, the advances were not so clear. The worldwide incidence of the disease might be as it was in 19th century Europe - about one uncomplicated case in ten to twenty million of the population.

Bear in mind that although some people survive for years, most die within less than a year of the onset. Thus the recorded cases for a given century are not the statistic on those who were alive at the same time. For example, Ann Roots had been dead for over twenty years (18 August 1829 - Addison p22) before James Wootten was admitted to Guy`s hospital (6 February 1850 - Addison p9).

Meanwhile, from the late 1950s onwards, steroids were spreading throughout the world. Glucocorticoids cause atrophy of the zona fasciculata of the adrenal glands. The victim may be psychologically addicted ("he likes the buzz") but also physically addicted ("he lives on steroids").

The ACTH stimulation test arrived. This proves the absence of a zona fasciculata, and by doing so proves that the patient is dead. When a dead patient walks into a surgery, alarm bells should sound. How can a dead man live, if not from a pill-bottle?

And when through clumsiness, mineral steroids are taken in place of sugar steroids, the patient experiences a pathological craving for salt.

The only sensible tests are pH when the patient complains of a burning heat despite the skin being cold; the molar Na/K test and the Greenhow blister test (in Greenhow`s 1866 book). There simply have not been enough genuine cases for study for better diagnostics to be developed.

The Mayo Clinic`s Robinson-Kepler-Power test for water retention is non-destructive and of use in sodium crisis. The insulin-tolerance and the metapyrapone (metapyrone) tests are liable to kill the patient.

In the year 2001, at the University Clinic in Berlin, events were to lead to what may be the first-ever CERTAIN diagnosis. A Pakistani who had a history of lung tuberculosis arrived in the hospital with nausea and vomiting.

Blood tests revealed high ACTH and low cortisol. As tuberculosis of the adrenals was suspected, ultrasound images were made. These showed "knobbly" adrenals. However, when the patient was subjected to computer tomography, the calcification stopped the X-rays, showing clear bright patches - an UNEQUIVOCAL diagnosis.

After the author discovered this image and obtained permission from Professor Wermke to publish, a correspondent pointed out that there were other examples of calcification shown on X-Rays and on CT-scans after they became available in circa 1980. Academic proof authorised for publication was not yet available in January 2003.

The search for an X-ray had reached its conclusion. The means to diagnose without guesswork had been demonstrated.

Human anatomy has not altered since the nineteenth century, but the steroid market has arrived to cloud the picture. That is why early reference works are so vital. The statistics tell all.

© 2001 Charles Douglas Wehner.
Use freely but do not plagiarise.