Book Review: Finding Sanity: John Cade, lithium and the taming of bipolar disorder
Greg De Moore and Ann Westmore; Allen and Unwin, 2016
This recently published biography will be of interest to many readers of The Quarterly.
It outlines the story of a remarkable Australian, John Cade, who made a singular medical discovery that provided the first effective medication for a mental illness.
The authors are Greg De Moore, a Melbourne trained psychiatrist who is now Associate Professor of Psychiatry at Westmead Hospital, and Ann Westmore, an Honorary Fellow in the School of Population and Global Health at the University of Melbourne who had previously written a PhD thesis on the topic of psychiatry in mid twentieth century Victoria.
John Cade (1912-1980) was born in Horsham, Victoria, the son of Dr David Cade, a general practitioner from nearby Murtoa. After service with the AAMC during the Great War, David Cade joined the Victorian Mental Hygiene Department and successively became the Medical Superintendent at the Sunbury, Beechworth and Mont Park hospitals. Hence John grew up in the grounds of various mental hospitals.
John Cade graduated in medicine from the University of Melbourne in 1934, and after several house positions, chose psychiatry as his specialty. In late 1936 he joined the Mental Hygiene Department, and was appointed medical officer at Mont Park Mental Hospital. He enlisted in the AIF in July 1940, was posted to the 2/9th Field Ambulance, and left for Singapore in February 1941. After the fall of Singapore he was a prisoner of war in Changi between February 1942 and September 1945. During his time in Changi he became aware of the effect that dietary deficiencies had on health and well being.
After the war he returned to the Mental Hygiene Department and took up a position at the Bundoora Repatriation Hospital. In 1952 he became Superintendent and Dean of the Clinical School at Royal Park Psychiatric Hospital, a position he held until his retirement in 1977. Many former Melbourne students would well remember the series of Saturday morning lectures given at Royal Park by this humble man.
Cade was State chairman (1963-1980) and national president (1969-1970) of the Royal Australian and New Zealand College of Psychiatrists, and a member of the Medical Board of Victoria (1970-1980). In 1976 he became one of the first recipients of the award of Officer of the Order of Australia (AO).
Further to his experiences in Changi, John Cade became convinced that a deficiency or excess of elements could affect bodies and minds. He established a laboratory in an unused kitchen at the Bundoora Repatriation Hospital in 1946, and began to inject urine from patients into the abdomens of guinea pigs; he noted that these guinea pigs died faster than those guinea pigs injected with urine from healthy persons. Cade surmised that uric acid was acting as a toxin, and so added lithium urate to increase its water solubility. This addition led to decreased toxicity, but also had a remarkably calming effect on the guinea pigs. He then ingested lithium to ensure that there were no harmful effects on humans.
Cade then undertook a small scale trial of lithium on ten patients with chronic or recurring mania, six patients with dementia praecox (now known as schizophrenia), and three patients with melancholia. The calming effect on these patients was such that he concluded that mania was caused by a deficiency of lithium. His paper reporting on the results, ‘Lithium salts in the treatment of psychotic mania’, was published in the Medical Journal of Australia in September 1949. In 2004 Ann Gregory, Deputy Editor, reported that, according to data from the Institute for Scientific Information, this paper was the most cited article ever published in the Medical Journal of Australia.
The use of lithium was quickly taken up, but with mixed results as there was only a small margin between its therapeutic effect and significant toxicity, that often resulting in death. Lithium revolutionized the treatment of manic-depressive disorders from the 1960s onwards, once safer treatment regimens were devised, and toxicity avoided.
He published no further research on lithium.
An incidental background to this story is that of institutional psychiatric care in the twentieth century. In the absence of anything but gross interventions such as insulin therapy or ECT, the mainstay of treatment for most patients was incarceration in a very large lunatic asylum.
This biography also highlights the changes in the administration of institutional research and ethics. During his research, John Cade worked alone, and mostly in secret, not sharing his work or findings with colleagues until he published his results. He did not have recourse to, nor have to be responsible to, an ethics committee, a research committee, or an animal ethics committee, or need for informed patient consent, all of which would now be required.
Dr Robert Grogan
Cade, JFJ: Lithium salts in the treatment of psychotic mania; Med J Aust 1949; 36 (2); 349-352;
Ironside, Wallace: Cade, John Frederick Joseph (1912–1980), Australian Dictionary of Biography, National Centre of Biography, Australian National University, http://adb.anu.edu.au/biography/cade-john-frederick-joseph-9657/text17037, published first in hardcopy 1993, accessed online 13 December 2016;
Gregory, AT: Jewels in the crown: The Medical Journal of Australia’s 10 most-cited articles; Med J Aust 2004; 181 (1): 9-12;
The Royal Australian and New Zealand College of Psychiatrists website: Presidents.
Last Updated on Wednesday, 12 April 2017 16:53