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 For a considerable time dissensions had existed in the ministry; and these came to a crisis in April 1717, when those who had been the real chiefs passed into the ranks of the opposition. Townshend was dismissed, and Walpole anticipated dismissal by resignation. There was now formed, under the leadership of General Stanhope and Lord Sunderland, an administration which, as resting on court-influence, was nicknamed the “German ministry.” Sunderland, Addison’s former superior, became one of the two principal secretaries of state; and Addison himself was appointed as the other. His elevation to such a post had been contemplated on the accession of George I., and prevented, we are told, by his own refusal; and it is asserted, on the authority of Pope, that his acceptance now was owing only to the influence of his wife. Even if there is no ground, as there probably is not, for the allegation of Addison’s inefficiency in the details of business, his unfitness for such an office in such circumstances was undeniable and glaring. It was impossible that a government, whose secretary of state could not open his lips in debate, should long face an opposition headed by Robert Walpole. The decay of Addison’s health, too, was going on rapidly, being, we may readily conjecture, precipitated by anxiety, if no worse causes were at work. Ill-health was the reason assigned for retirement, in the letter of resignation which he laid before the king in March 1718, eleven months after his appointment. He received a pension of £1500 a year.

Not long afterwards the divisions in the Whig party alienated him from his oldest friend. The Peerage Bill, introduced in February 1719, was attacked, on behalf of the opposition, in a weekly paper called the Plebeian, written by Steele. Addison answered the attack in the Old Whig, and this bellum plusquam civile—as Johnson calls it—was continued, with increased acrimony, through two or three numbers. How Addison, who was dying, felt after this painful controversy we are not told directly; but the Old Whig was excluded from that posthumous collection of his works (1721–1726) for which his executor Tickell had received from him authority and directions. It is said that the quarrel in politics rested on an estrangement which had been growing for some years. According to a rather nebulous story, for which Johnson is the popular authority, Addison, or Addison’s lawyer, put an execution for £100 in Steele’s house by way of reading his friend a lesson on his extravagance. This well-meant interference seems to have been pardoned by Steele, but his letters show that he resented the favour shown to Tickell by Addison and his own neglect by the Whigs.

The disease under which Addison laboured appears to have been asthma. It became more violent after his retirement from office, and was now accompanied by dropsy. His deathbed was placid and resigned, and comforted by those religious hopes which he had so often suggested to others, and the value of which he is said, in an anecdote of doubtful authority, to have now inculcated in a parting interview with his step-son. He died at Holland House on the 17th of June 1719, six weeks after having completed his 47th year. His body, after lying in state, was interred in the Poets' Corner of Westminster Abbey.

ADDISON’S DISEASE, a constitutional affection manifesting itself in an exaggeration of the normal pigment of the skin, asthenia, irritability of the gastro-intestinal tract, and weakness and irregularity of the heart’s action: these symptoms being due to loss of function of the suprarenal glands. It is important to note, however, that Addison’s Disease may occur without pigmentation, and pigmentation without Addison’s Disease. The condition was first recognized by Dr Thomas Addison of Guy’s Hospital, who in 1855 published an important work on The Constitutional and Local Effects of Diseases of the Suprarenal Capsules. Sir Samuel Wilks worked zealously in obtaining recognition for these observations in England, and Brown-Sequard in France was stimulated by this paper to investigate the physiology of these glands. Dr Trousseau, many years later, first called the condition by Addison’s name. Dr Headlam Greenhow worked at the subject for many years and embodied his observations in the Croonian Lectures of 1875. But from this time on no further work was undertaken until the discovery of the treatment of myxoedema by thyroid extract, and the consequent researches into the physiology of the ductless glands. This stimulated renewed interest in the subject, and work was carried on in many countries. But it remained for Schafer and Oliver of University College, London, to demonstrate the internal secretion of the suprarenals, and its importance in normal metabolism, thereby confirming Addison’s original view that the disease was due to loss of function of these glands. They demonstrated that these glands contain a very powerful extract which produces toxic effects when administered to animals, and that an active principle “adrenalin” can be separated, which excites contraction of the small blood vessels and thus raises blood pressure. The latest views of this disease thus stand: (1) that it is entirely dependent on suprarenal disease, being the result of a diminution or absence of their internal secretion, or else of a perversion of their secretion; or (2) that it is of nervous origin, being the result of changes in or irritation of the large sympathetic plexuses in the abdomen; or else (3) that it is a combination of glandular inadequacy and sympathetic irritation.

The morbid anatomy shows (1) that in over 80% of the cases the changes in the suprarenals are those due to tuberculosis, usually beginning in the medulla and resulting in more or less caseation; and that this lesion is bilateral and usually secondary to tuberculous disease elsewhere, especially of the spinal column. In the remaining cases (2) simple atrophy has been noted, or (3) chronic interstitial inflammation which would lead to atrophy; and finally (4) an apparently normal condition of the glands, but the neighbouring sympathetic ganglia diseased or involved in a mass of fibrous tissue. Other morbid conditions of the suprarenals do not give rise to the symptoms of Addison’s Disease.

The onset of the disease is extremely insidious, a slow but increasing condition of weakness being complained of by the patient. There is a feeble and irregular action of the heart resulting in attacks of syncope which may prove fatal. Blood pressure is extremely low. From time to time there may be severe attacks of nausea, vomiting or diarrhoea. The best known symptom, but one which only occurs after the disease has made considerable progress, is a gradually increasing pigmentation of the skin, ranging from a bronzy yellow to brown or even occasionally black. This pigmentation shows itself (1) over exposed parts, as face and hands; (2) wherever pigment appears normally, as in the axillae and round the nipples; (3) wherever pressure is applied, as round the waist; and (4) occasionally on mucous membranes, as in the mouth.

The patient’s temperature is usually somewhat subnormal. The disease is found in males far more commonly than in females, and among the lower classes more than the upper. But this latter fact is probably due to poor nourishment and bad hygienic conditions rendering the poorer classes more susceptible to tuberculosis.

The diagnosis, certainly in the early stages of the disease, and often in the later, is by no means easy. Pigmentation of the skin occurs in many conditions—as in normal pregnancy, uterine fibroids, abdominal growths, certain cases of heart disease, exophthalmic goitre, &c., and after the prolonged use of certain drugs—as arsenic and silver. But the presence of a low blood pressure with weakness and irritability of the heart and some of the preceding symptoms render the diagnosis fairly certain. The latest researches on the subject tend to indicate a more certain diagnosis in the effect on the blood pressure of administering suprarenal extract, the blood pressure of the normal subject being unaffected thereby, that of the man suffering from suprarenal inadequacy being markedly raised. The disease is treated by promoting the general health in every possible way;