John Cade

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For other people named John Cade, see John Cade (disambiguation).

John Cade
Murtoa, Victoria, Australia
Died16 November 1980(1980-11-16) (aged 68)
Fitzroy, Victoria
, Australia
Occupation(s)psychiatrist; army medical officer; medical scientist; mental health practitioner; prisoner of war (Australian); public servant
SpouseEstana Evelyn Jean Charles
ChildrenJohn (1938), David (1940), Mary (1947), Peter (1948), Richard (1950)
ParentDr David & Ellen Cade

John Frederick Joseph Cade AO[1][2][3] (18 January 1912 – 16 November 1980) was an Australian psychiatrist who in 1948 discovered the effects of lithium carbonate as a mood stabilizer in the treatment of bipolar disorder, then known as manic depression. At a time when the standard treatments for psychosis were electroconvulsive therapy and lobotomy, lithium had the distinction of being the first effective medication available to treat a mental illness.

Early life

John Cade was born in

Royal Children's Hospital before becoming severely ill with bilateral pneumococcal pneumonia. While he was convalescing, John fell in love with one of his nurses, Jean. They married in 1937.[4]

World War II

Like his father before him, Cade left his young family to fight for Australia in the Armed Forces in World War II. Cade was appointed

Fall of Singapore to Japan, he became a prisoner of war at Changi Prison from February 1942 to September 1945.[4]
During his imprisonment, he reportedly would observe some fellow inmates having strange, vacillating behaviour. He thought perhaps a toxin was affecting their brains and when it was eliminated through their urine, they lost their symptoms.

Discovery of the effect of lithium on mania

After the war, Cade recuperated very briefly in Heidelberg Hospital, then took up a position at Bundoora Repatriation Mental Hospital in Melbourne.[6] It was at an unused pantry in Bundoora that he conducted crude experiments which led to the discovery of lithium as a treatment of bipolar disorder. Since he had no sophisticated analytical equipment these experiments mostly consisted of injecting urine from mentally ill patients into the abdomen of guinea pigs. His early experiments suggested to him that the urine from manic patients was more toxic. There are 2 toxic substances in urine: urea and uric acid. He found urea was the same in both ill and healthy people. He started to work on uric acid. In order to do that, he made artificial solutions of uric acid. To make up different strengths of uric acid he needed to convert it into a substance that he could more easily manipulate. On its own uric acid would not dissolve in water. Then, in an effort to increase the water solubility of uric acid, lithium was added to make a solution of lithium urate. Cade found that in the guinea pigs injected with lithium carbonate solution, as a control solution, the guinea pigs were more restful.[7] His use of careful controls in his experiments revealed that the lithium-ion had a calming effect by itself, but even this finding may have been caused by the toxic effects of an excessive dose of lithium. After ingesting lithium himself to ensure its safety in humans,[4] Cade began a small-scale trial of lithium citrate and/or lithium carbonate on some of his patients diagnosed with mania, dementia præcox or melancholia, with outstanding results. The calming effect was so robust that Cade speculated that mania was caused by a deficiency in lithium.[7] He published these findings in the Medical Journal of Australia in a paper entitled 'Lithium salts in the treatment of psychotic excitement', published in 1949.[8]

While Cade's results appeared highly promising, side effects of lithium in some cases led to non-compliance. The toxicity of lithium led to several deaths of patients undergoing lithium treatment. The problem of toxicity was greatly reduced when suitable tests were developed to measure the lithium level in the blood. Moreover, as a naturally occurring chemical, lithium salt could not be patented, meaning that its manufacturing and sales were not considered commercially viable. These factors prevented its widespread adoption in psychiatry for some years, particularly in the United States, where its use was banned until 1970.[9]

Royal Park and RANZCP

John Cade acute unit at Royal Park Hospital circa 2003

In 1952 Cade was appointed Superintendent and Dean of the clinical school at

group therapy. Concerned at the number of alcohol-related cases, he supported voluntary admission to aid early detection and later proposed the use of large doses of thiamine in the treatment of alcoholism.[5] Cade served as the Superintendent at Royal Park until his retirement in 1977.[4]

He served as the federal president of the

Officer of the Order of Australia.[11] Dr. Cade remained humble about his chance discovery, describing himself as merely a gold prospector who happened to find a nugget. Finally, in July 2004, the Medical Journal of Australia reported that Cade's 1949 article, "Lithium salts in the treatment of psychotic excitement", was the number one most cited MJA article.[12]

Legacy

John Cade died of

The University of Queensland.[14] The RANZCP awards The John Cade Memorial Medal to a final year Victorian medical student following a special clinical examination at Monash University or the University of Melbourne each year.[15] The Faculty of Medicine at University of Melbourne also awards the John Cade Memorial Prize.[5]

Troubled Minds

In 2004, Film Australia and SBS screened the documentary Troubled Minds – The Lithium Revolution, a 60-minute documentary portraying John Cade's discovery of the use of Lithium in mental illness. The documentary received international recognition, winning the main prize at the International Vega Awards for Excellence in Scientific Broadcasting. Troubled Minds was also recognised locally with writer/director Dennis K. Smith winning the AWGIE Award for Best Documentary.[16]

See also

  • Lithium pharmacology

Notes

  1. ^ Some authors state Cade was born in Horsham, one of the larger towns in the Wimmera area. However other authors, notably Cade's son Jack Cade, state John Cade was born in Murtoa, a town 32 kilometres (20 mi) NE of Horsham.

References

  1. ^ De Moore, Greg; Westmore, Ann (2016). Finding sanity : John Cade, lithium and the taming of bipolar disorder. Crows Nest, NSW: News.com.au. p. 324.
  2. ^ Williams, Robyn (2016). Ockham's Razor Sunday 6 November 2016: Finding sanity. ABC Radio National.
  3. ^ Fanning, Ellen; McCullagh, Cassie (2016). Life Matters Wednesday 31 August 2016: Finding Sanity – John Cade and lithium. ABC Radio National.
  4. ^
    S2CID 7072182
    .
  5. ^
    ISSN 1833-7538
    . Retrieved 22 September 2008.
  6. ^ On Bundoora hospital, see the summaries by the Victorian Department of Health and Human Services and by Research Data Australia.
  7. ^
    PMID 10885180
    .
  8. PMID 10885180
    .
  9. PMID 19538681
    .
  10. ^ a b "NHMRC John Cade Fellowship Mental Health Research". NHMRC. Archived from the original on 8 April 2018. Retrieved 29 February 2016.
  11. ^ "It's an Honour – Officer of the Order of Australia". Retrieved 22 November 2008.
  12. ^ "100 Years of Australian Innovation – lithium for manic depression". Archived from the original on 19 July 2008. Retrieved 11 October 2008.
  13. ^ "Inner West Mental health Services". Department of Health. Retrieved 29 February 2016.
  14. ^ "NHMRC John Cade Fellowship in Mental Health Research for funding commencing in 2013" (PDF). NHMRC. Retrieved 29 February 2016.
  15. ^ "John Cade, AO". RANZCP. Retrieved 29 February 2016.
  16. ^ "2005 AWGIE Award Winners" (PDF). Australian Writers' Guild. Archived from the original (PDF) on 11 September 2009. Retrieved 22 September 2008.
  • Mitchell PB, Hadzi-Pavlovic D. John Cade and the discovery of lithium treatment for manic depressive illness. Medical Journal of Australia, 1999, 171: 262–264. and Ref. No. 00-0612 Bulletin of the World Health Organization, 2000, 78 (4)
  • Mitchell PB. On the 50th anniversary
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