The Wilks Report

Guy's Hospital Reports SERIES 3 VOL 8, 1862

Introduced by Charles Douglas Wehner

After Addison`s publication, cases began to be reported in ever growing numbers.

These were the days when tuberculosis was widespread. Addison`s disease is in fact Adrenal Tuberculosis, but this was unknown. The softened tubercles looked so unlike lung tubercles.

Even the simple fact that the adrenal glands are chemical in their action was only discovered in the twentieth century - so the action of steroids in softening the tubercles, and so disguising their nature was not known.

Samuel Wilks M.D. - later Sir Samuel Wilks - was a collaborator of Addison. After the death of Addison in 1860, the job of examining specimens from all over the country - with a view to confirming or denying the diagnosis of Addison`s disease - fell to him.

He was therefore well placed to see many cases of adrenal tubercle softened down by steroids - the typical outcome. He then took issue with Addison over his inclusion of cases of adrenal sepsis and of adrenal cancer in his book.

Even though the disease proper ALWAYS presents softened tubercles - and can be defined as a disease entity in its own right, the inclusion of other forms of destruction of the adrenals in Addison`s book was not strictly wrong.

This inclusion had, after all, revealed an outlook that was later to be vindicated - that the destruction of the adrenal glands by whatever means is ALWAYS FATAL.

The long-term survival with totally destroyed adrenal glands is due to the disrupted tissue continuing its chemical synthesis until the raw materials, cholesterol and similar, run out. Wilks also seems to have been misled by the vivisection experiments of Dr. Brown-Sequard in France, which suggested that some animals survived adrenal extirpation.

We now know that ALL cases of destruction are fatal, and that the recoveries cited were not cures but remissions.

However, it should be borne in mind that different causes have different histories, and it is only in the classic condition that the set of clinical symptoms is almost identical in all cases.