54 FIELDING. H. GAKRISOJN 



ance, in 1855, of what we must now regard as the principal milestone in 

 the history df the subject, the monograph "On the Constitutional and 

 Local Effects of Disease of the Suprarenal Capsules," a quarto of forty- 

 three pages by Thomas Addison, senior physician at Guy's Hospital, Lon- 

 don. In the history of medicine, this work was destined to have an immor- 

 tality of its own. In the very opening lines of his preface Addison clearly 

 states, for the first time, the true paths by which, as subsequent experience 

 has proved, the problems of these mysterious glandular structures have 

 been best approached and attacked: 



"If Pathology be to disease what Physiology is to health, it appears reasonable 

 to conclude, that, in any given structure or organ, the laws of the former will be as 

 fixed and significant as those of the latter; and that the peculiar characters of any 

 structure or organ may be as certainly recognized in the phenomena of disease as in 

 the phenomena of health. When investigating the pathology of the lungs I was led, 

 by the results of inflammation affecting the lung tissue, to infer, contrary to general 

 belief, that the lining of the air cells was not identical and continuous with that of 

 the bronchi; and microscopic investigation has since demonstrated in a very striking 

 manner the correctness of that inference an inference, be it observed, drawn entirely 

 from the indications furnished by pathology. Although pathology, therefore, as a 

 branch of medical science, is necessarily founded on physiology, questions may never- 

 theless arise regarding the true character of a structure or organ, to which occasionally 

 the pathologist may be able to return a more satisfactory and decisive reply than the 

 physiologist these two branches of medical knowledge being thus found mutually to 

 advance and illustrate each other. Indeed, as regards the functions of individual 

 organs, the mutual aids of these two branches of knowledge are probably much more 

 nearly balanced than many may be disposed to admit; for, in estimating them, we 

 are very apt to forget how large an amount of our present physiological knowledge 

 respecting the functions of these organs has been the immediate result of casual ob- 

 servations made on the effects of disease. Most of the important organs of the body, 

 however, are so amenable to direct observation and experiment, that in respect to them 

 the modern physiologist may fairly lay claim to a large preponderance of importance, 

 not only in establishing the solid foundation, but in raising and greatly strengthening 

 the superstructure of a rational pathology." 



Thus did Addison set forth the fact that Nature herself is sometimes 

 the physiologist's best vivisector, even as Billroth and the followers of 

 Marion Sims elucidated the pathology of the abdominal and pelvic viscera 

 by making "autopsies in vivo." 



On March 15, 1840, Addison read a paper before the South London 

 Medical Society, in which lie described the symptoms of what is now 

 styled pernicious anemia, cases in which the whole surface of the body 

 "bears some resemblance to a bad wax figure." Only three of the cases 

 came to autopsy, but "m all of them uus found a diseased condition 

 of flic, suprarenal capsules." Was this a mere coincidence? Addison in- 

 quires. 



"Making every allowance for the bias and prejudice inseparable from the hope 

 or vanity of an original discovery, he confessed he felt it very difficult to be per- 

 suaded that it was so. On the contrary, he could not help entertaining a very strong 

 impression that these hitherto mysterious bodies the suprarenal capsules may be 

 either directly or indirectly concerned in sanguification; and that a diseased condition 

 them, functional or structural, may interfere with the proper elaboration of the 

 generally, or of the red particles more especially. . . . Indeed, not only had he 

 i' anemia in question occasionally occurring in connection with purpura, but 



