Chemistry was primitive in those days. Greenhow speaks of the Sesquichloride of iron, which is FeCl1½. Surely he means Ferric Chloride, which today is known as Trichloride of iron. However, the prescription - and that of Citrate of iron - is utterly brilliant. Pernicious anaemia is of the Iron-retaining kind; Addison`s disease anaemia is of the Iron-losing kind. Thus, Addison sufferers need iron.

He says his patients got better on his medication, got worse when they stopped taking it and got better again when he reinstated it (p.37). Of course! Greenhow was highly competent and his book is a gem.

The influence of the Four (or Five) Essences and other mumbo-jumbo like blistering is still there. A patient had abscesses on both hypochondria. These are soft areas below (hypo) the ribs (chondria) where black (melan) bile (colic) is formed, causing sadness. These glands do not exist, and today we speak of a hypochondriac as someone who suffers from a "sickness" which does not exist. In those days, however, the hypochondriac region meant below the ribs.

Greenhow neither endorses nor challenges such traditional medical faux-pas - he just presses ahead in the style of a modern scientist, adhering to facts. Even the spelling has changed. Addison`s arcane opake has become a modern opaque.

Tantallising is this spectacle of a great thinker struggling to understand the glands, not knowing that their action is chemical. Hormones were unknown. He postulates a perversion of function - not knowing that Klinefelter, Conn`s, Cushings`s and many other syndromes do indeed come under this category. With faultless logic he decides that true Addison`s disease is a destruction of function (p.22) by tuberculosis. It is a panpenia, a more-or-less uniform deficiency of hormone, without skew.

Then, without modern chemical knowledge, he takes a wrong logical step. He assumes that cancer causes destruction. Today, however, we would recognise in case 25 (in the tables) the presence of masculinising adrenal hyperplasia due to a hormone-producing tumour that killed a three-year-old girl. A perversion, ahead of the destruction.

Despite his exquisite precision, Greenhow fails to find that it is the cortex or rind of the adrenal glands, and not the body or medulla that is essential to life.

At the bottom of P.50 and top of p.51 he states that Addison was wrong. Cancer cannot produce the classic Addison panpenia symptoms. It can in theory - metastases can come from anywhere and have any properties, but Greenhow`s statistical facts show that such a condition would be improbably rare. Greenhow was a competent and unpretentious statistician.

Again he says Addison was wrong. There is no anaemia (p. 63). He did not know that the patient loses sodium, whilst retaining chloride - resulting in every nerve being pickled in acid. Patients died moaning as if in pain, and case 50 died screaming. That sodium loss leads to water loss, so that the blood becomes thick (haemoconcentration).

Concentrated blood is not plentiful blood, so there is anaemia. From sheer agony, intensified by the neuroactivity of ACTH, the patient passes from full consciousness to death by the thick blood stopping the heart with a clot (middle of p.62).

Case 142 (greenhow/table46.htm) states "skin cool, but patient complains of burning heat". This is the chloracidosis - hydrochloric acid in the blood, which can be measured by a simple pH test today.

Another facile "theory" was that the cadaverous odour was linked to "Negro-skin" (case 130). Greenhow does not agree, but has to mention the prevailing theory if only to dismiss it.

The blood becomes too thick to circulate the skin. The tissue in contact with the bedding aches, having "pins and needles" when turning over restores the blood. If the patient does not move, the tissue will die and rot. So Greenhow`s speculation (top of p.64) is correct.

Had Greenhow thought to turn the patients over, he would have found gangrene. By the time he delivered the Croonian Lectures of 1875, he still had not resolved the question.

Decomposition products from the rotting flesh will greatly curtail any chance of recovery, so they all died soon after.

The author came back from extremis in 1979 by a method that is published here in case it is of help to anybody in trouble. Firstly, you prop yourself up with cushions. Not too high (the "tingle-tongue" of low blood-pressure) nor too low (the "banging" in the head of high). Then you splay your legs wide - to get good turning-moment from the minimum of energy. Then you rock.

You will feel the ache of circulatory arrest in the tissue alternating with the "formication" (pins and needles). Meditate on a boring word such as "OM" so as to remove all interesting thoughts from your head, such as might keep you awake thinking.

Focus your feelings on drowsiness, and still rocking, fall asleep through all the pain. Energy consumption is about ten times less in sleep, so if you fall asleep you are in with a chance.

In the morning, as you wake, you pass through the "twilight" phase. The bladder will suddenly fill, forcing you out of bed. Don`t let this happen! Repeat the boring mantra. Force yourself back to sleep. Stretch your sleep from eight to ten to twelve hours or more.

When the filling of the bladder forces you up, spend the whole day lying in bed or sitting. Don`t waste a single calorie. In the course of a week or a month, your strength may return.

That crisis had been triggered five or six months earlier by running for one minute for a train at Konz-Karthaus (Germany). Compare case 110 (greenhow/table34.htm). That case also - by coincidence - was a "Charles W.".

Remarkably, Greenhow spotted that sometimes the patient suffers from vertigo. In reality, the patient sometimes loses his balancing mechanism and learns to balance by eyesight. Today, we speak of "vertigo" when the room spins after you turn your head. But here we have loss, not disturbance of balance - a subtle point. Perhaps as the blood congeals, so does the fluid in the semi-circular canals of the balancing mechanism. It is dizziness without vertigo. Nevertheless, it was brilliantly observed.

A separate form of dizziness - without vertigo - is caused by the low blood-pressure. He reports this frequently, as dizziness on standing up.

The frequent references to yawning (bottom p. 8; bottom p. 35) depict a yawning reflex. The patient is not sleepy. Exhausted, yes; sleepy, no.

At the bottom of P. 26, Greenhow observes that "The pupils of his eyes are large, and act sluggishly under the stimulus of light". This agrees with a diagnosis of Charles Wehner by a German doctor - "Die Pupillenreflexe waren träg". Elbow and knee reflexes are poor, and disappear - followed by pupil reflex - as extremis approaches, unless a premature blood-clot intervenes.

Autoimmune disease - the excuse of modern doctors who kill their patients by cutting off steroids abruptly - is absent from the catalogue of cases. Signs of infection or cancer were always present. Whole "capsules" were missing - eaten up by germs, but the selective removal of the cortex by "autoimmune antibodies" never featured.

The homeostatic feedback loop throws him completely! How can homeostasis be maintained in the face of massive damage, only to collapse abruptly? Today we understand feedback principles. Greenhow did discover, however, that with careful nursing patients can be brought back into homeostasis - into remission. Vide inter alia pp. 16, 22, 34.

It was his perception that remissions are possible - that after a near-death experience such as the circulatory collapse described above a sufferer such as Charles Wehner can recover enough to live for years - that sets Greenhow apart. Greenhow sought and mastered the means to extend the lives of his patients. More could not be expected of any man.

Mock his superstitious trust in effervescing medicine (p.37). Then think. In Addison`s disease, the digestion goes alkaline. Soda water is a mild acid. So it helps to control the alkaline ulcers. Wow!

Another survival tip - avoid drinking milk, as it causes Milk-and-Alkali-Tetany. Butter and cheese are fairly OK - although the fat may cause problems. It is the phosphate in the whey that causes cramps.

On page 26, a patient (C. S., aged 32) complains of the "...extension of the legs .... restrained by cords situated between the flanks and the groin". Yes - the tendons! Tetany pulls the tendons, which is Trousseau`s sign.

Although there was microscopy, germs had not been identified yet. Greenhow is building a theory that could be described as follows: Tuberculosis flows around the body, and if there is a minor injury near the adrenal glands it forms a colony there. This leads to the infection known as Addison`s disease.

Dr Burdon Sanderson denies that the adrenal decay is due to tuberculosis (footnote, P. 11). This throws Greenhow - yet he still persists in speaking of a tuberculous (tuberculosis-like) condition. You cannot fool Greenhow.

See the notes on pages 10 and 11 for the microscopy technique. They used acetic acid prior to the discovery of staining. Dye-stuffs also led logically to antibiotics. Without such modern aids, there was little they could do to arrest the disease.

As with Addison`s book, it pre-dates the arrival on the market of steroids. All cases are genuine. There is no Sudden Steroid Withdrawal Syndrome, nor is there any craving for salt due to Sudden Steroid Prescription Change - disasters of the modern world. Therefore it is the true picture.

Having Thomas Addison`s book and Edward Greenhow`s book side-by-side in your library gives you about as much as was ever discovered about the clinical picture. Only a true Addison sufferer will know more. Modern science, however, has created an endocrine picture that is sometimes correct and sometimes flawed by drug mis-use.

On page 61, Greenhow enters into a detailed study of the pigment, not knowing it is a sun-tan. He has been misled by poor scientists who claimed to have found the special pigment in the blood or in the spleen. Greenhow is no fool, and is slowly disregarding these ideas.

Dr Balthazar Foster sent a PHOTOGRAPH to Greenhow. How MODERN! It is not in the book. Where is it now? Has it faded?

Unlike the Addison book, this one had a couple of misprints. They were not always corrected. In both cases, Charles Wehner sought to make an exact copy, not an edition of the book - to preserve it for posterity as it is and make it available to a wider audience. The danger of adding typographical errors was foremost in mind, and it is hoped that there are no more. However, the limitations of the Internet impose typesetting restrictions.

The headings of the table in page 56 were printed sideways. This is possible with lead type in a galley, but is as yet not available in internet Hypertext.

The word abscess was sometimes printed abcess. When the spelling in the book was found to differ from the transcript, it was necessary to correct all occurrences to their correct spelling to save time. Dr. Thompson was once called Dr. Thomson. This remains uncorrected, as either spelling is plausible.

A dashed line was added to demarcate the footnotes, because the Mosaic browser did not respond to all font swaps.

At the back of the book are Greenhow`s tables of medical cases, which were printed sideways. It is often possible to command the printer-driver to print in landscape, rather than portrait mode, if you want paper copy. Selecting VIEW and then the smallest font on INTERNET EXPLORER should make the tables fit A4 or Foolscap paper. Otherwise, download and edit with WORD or similar. The text pages may be correct if text size is medium.

The original pages were 5½ by 8¾ inches, or 14 by 22 centimetres, double-edge justified. Text was ten point. Pages headed On Addison`s Disease (with lower case), and the tables, had no heading. It is a standard requirement for Internet pages to have a heading, so lower case denotes the added headings.

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Further reading in the British Library

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