There is something quite endearing in the sight of a collection of the world`s finest thinkers struggling to understand a problem that has since been solved. They are doing their best - they care.

Martineau, in his thesis of 1863 had described a gland:

Perhaps it was his own description, perhaps that of his great tutors - the professors Trousseau and Nélaton - but it was completely right.

Then he took a wrong turn. Just as a blow to the solar plexus can launch a pulse into the nervous system which stops the heart; just as hanging - which when properly performed simply pinches the spinal cord - launches such a pulse; just as electricity can kill; so surely the festering infection around the solar plexus causes an Addison death. Death is a neurosis - a mechanical disturbance of the nerves. Even Thomas Addison had said that it was possible.

This became the official view right across Europe.

On page 18, Dr. NOEL GUENEAU DE MUSSY even brings symptoms of another endocrine disease - Grave`s (or Basedow`s) syndrome, or exophthalmic goitre - under the heading of mechanical neurosis.

They struggle to bring skin pigmentation and nerve damage into the same orbit.

Today we know that the action of the adrenal glands is chemical. Within a few years of the 1881 conference, extracts of the adrenals and then of the skin of the adrenals - the rind or cortex - were discovered to have physiological action. Cortisine was one such extract. In the early Thirties, Dr. Karl-Theodor Bluth found that Cortisine had between four hundred and four thousand components, of which one is Cortisone.

The top active layer of the cortex is the zona glomerulosa. If you are shocked, either by acid in the blood or by being present at an event like September 11th, you gasp. This is because the liver makes angiotensin 1 to clear the blood of acid (carbon dioxide) and enrich it with oxygen - for fight or flight.

If the acidosis is chloracidosis, you cannot breath out the hydrochloric acid. The lungs turn the angiotensin 1 into angiotensin 2, which goes to the glomerulosa to generate aldosterone.

If your glomerulosa is damaged, you have no choice but to gasp some more. This explains the symptoms of gasping and sighing of Addison`s disease.

In a healthy person, however, the aldosterone will be made. This in turn will recall sodium from the bladder, and pull it in from the digestion. This sodium will neutralise the blood acid. It is only when the blood is "calling" for sodium due to high aldosterone and the diet is too lean in sodium that you develop a craving for salt.

As you run into the blazing building to save lives, or flee to save your own life, you burn up energy. This makes you hot. Sweat must be carried through the skin by the sodium ion-pump, and aldosterone must be present to take sodium straight back in.

But before you decide on vigorous action, you do not want to be poisoned by the aldosterone produced by the shock, so you block off the adrenal glands by closing the adrenal muscle around the adrenal vein. This is an unconscious reflex action. Most people live their entire lives unaware of the existence of the adrenal muscle. The muscle only opens again when you start to exercise.

Simultaneously, from the basophile cells of the adenohypophysis in the pituitary comes ACTH - the adreno-cortico-tropic hormone. This goes to the middle active layer of the adrenal cortex - to the zona fasciculata - to make hydrocortisone.

Hydrocortisone enables you to metabolise sugar - a process of cold combustion - whilst fighting or fleeing the drama. The synthesis is a comparatively slow process, so ACTH is released before you have had time to think about the drama, but the closing of the adrenal muscle prevents overdose.

When you are actually running, not only is the adrenal muscle open, but the flexing at the waist is "pumping" the steroids out of the glands - increasing the energy boost. Those with Addison`s disease tend to walk without flexing at the waist - particularly when the causative infection flares up. They need to conserve hydrocortisone.

Heaviness of limbs is due to the inability to metabolise sugar.

Dizziness is due to loss of sodium leading to circulatory collapse - just like a person sweating in a hot desert.

There is a third layer - the zona reticularis - but, as people have been kept alive on aldosterone and hydro-cortisone alone, it seems that this layer is not essential to life. It makes protein hormones like androsterone.

The adrenal muscle is not essential to life, because if the aldosterone and hydro-cortisone pile up in the adrenal gland due to a blockage of the adrenal vein, ACTH and Angiotensin 2 will rise until the steroids overdose the surrounding capillaries. This leads to varicosity in those capillaries. But once the varicose veins have formed, the ACTH and Angiotensin decline again. It creates a bypass to the blocked vein, and is self-limiting.

The raw materials for steroid production are ergosterol and cholesterol - fatty substances - in pods or "liposomes" on the adrenal cortex.

Autopsies keep reporting that the lesions are "oily" - presumably the last vestiges of the liposomes. What Greenhow and the other experts did not know was that if there are the slightest flakes of surviving cortex, bathed in the waxy contents of the liposomes, they can still produce steroids.

From what was said above, it should be clear that the physical structure of the glands, whilst ideally kept intact, is not as essential to life as the chemical properties of those tissues.

TB germs invade. The colony grows. Lymphocytes try to overpower the infection. They fail. Pea-sized cheesy tubercles develop. Nature tries to isolate them, by the rapid growth of greyish, translucent fibrous coatings. Some particles inside the pod manage to break out and start new colonies. The structure of the glands is disrupted - and yet the chemical synthesis continues.

Eventually, the cholesterol- gathering mechanism fails. Healthy flakes of tissue would make steroid, but they are isolated from the raw materials by intervening tubercles and fibre. Production then falls below a life-sustaining level.

The victim is obliged to reduce his energy consumption, and to reduce his perspiration. In winter, shivering would use up too much energy - leading to hypoglycaemic shock. In summer, loss of sodium in the sweat leads to hypovolaemic shock. Only spring and autumn are comfortable.

The victim learns to seek out the quiet places, and to avoid any dramas as might lead to over-production of ACTH. However, the appearance of being "unflappable" is just an illusion. There is an unconscious reflex in argument-prone people to look for the physiological signs of stress. They wage war on a person until they see him "sweat". Faced with an Addison sufferer, who constantly battles to remain calm, they become even more enraged. These needless problems in society are an ever-present hazard.

If a person survives for long, it is possible that a new factor enters - a virus. Viruses are extremely small, and can penetrate places where bacteria cannot go. But first, they must evade the immune system. It is possible that bacteria-eating virus particles (bacteriophages) ultimately break into the tubercles and reduce them to a creamy, puriform fluid - as so often reported for old infections.

The rising levels of stress hormone ACTH - which is related to sun-tan hormone MSH - cause a deepening of skin colour in some patients, particularly where the skin is mechanically disturbed.

By the time of the International Medical Congress of 1881, the old chemistry of phlogiston and the like was becoming replaced by the new chemistry of oxygen. It is true that oxygen was known - for example, in 1847, London Medical Gazette, Dr. J. Black described ether as made up of carbon, oxygen and hydrogen. However, in 1849, ibid, doctors such as Bouvier in Paris were giving dephlogisticating treatment.

Note the two references to oxydation and (cellular) division by Professor Semmola on page 16. This is modern. The pamphlets of Mendeleev were circulating, but were slow to gain acceptance.

We begin with Greenhow - the King of Remissions - who prolonged so many lives, describing the disease to perfection but delivering a totally wrong account of how the nervous system might explain the pigmentation. He calls, however, for careful study - because he is not so arrogant as to assume his theories are right.

Professor Semmola of Naples describes the "animal heat" - the metabolism - as fading. Correct. He compares it with an oil stove. There is plenty of oil, and the wick is not used up. Addison, in his book, described people as dying with plenty of fat reserves. Semmola suggests that if it neither the wick nor the oil, it must be the control mechanism that turns down the heat. The control mechanism is the nervous system. Plausible, but WRONG. It is the loss of the as yet undiscovered hydro-cortisone - the metabolism is cold combustion, combustion without flame, and that requires additional reagents like hydro-cortisone.

Dr. Noel Gueneau de Mussy of Paris likens the plexus of nerves to another brain. But they are motor neurons for the control of such things as the adrenal muscle - not the gnosisceptors or sensory nerves. The signals are incoming to the adrenals. He did not know that.

Dr. Zuelzer of Berlin makes a major contribution with his observations on the impairment of renal mineral elimination. Possibly a diagnostic tool.

Professor Paget of Cambridge defends the story reported by Greenhow of a patient with tuberculosis of the spleen, and extensive damage to the entire structure of nerves, and many of the pigmentary signs of Addison`s disease - yet without any damage to the glands. Today we can ask whether the ACTH levels went sky-high, causing pigment, and why?

Professor Gairdner of Glasgow raises the subject of vitiligo in Addison`s disease. Is this a separate species of the condition?

Dr. Matterson of York also believes the nervous theory of Addison`s disease. He then speaks of a patient whose condition resembles Addison`s disease, who seems to have recovered. Yet remissions can sometimes go on for years. It was too early to consider the patient cured. Only after death from another cause, and thorough autopsy, can one confirm that this was not Addison`s disease.

And finally, JACK THE RIPPER. He murdered prostitutes in Whitechapel in 1889. He also DISCOVERED Addison`s disease - and Addison STOLE what is known as "the idea". Is there no limit to Sir William Withey Gull`s talents?

The truth is more mundane. He was a good doctor. He was usually right, but sometimes wrong.

There was a cholera outbreak in London in 1848, and a Cholera Committee was set up under Dr. William Baly (of "Negro-skin" infamy) and William Gull.

A doctor had written:

Baly and Gull were not accredited with the conquest of cholera, but their questions contained the answer. There was an outbreak in central London. The only other outbreak was a lady and her maid in Hampstead. Both had died.

Baly and Gull wrote in 1851: