View source for John Cade

{{Short description|Australian psychiatrist (1912–1980)}}
{{other people}}
{{Use dmy dates|date=April 2023}}

{{Infobox person
| name   = John Cade
| honorific_suffix = [[Officer of the Order of Australia|AO]]
| image     =John Cade 1971 (cropped).jpg
| image_size     = 
| caption  = Cade in 1971
| birth_date  = {{birth date|df=yes|1912|1|18}}
| birth_place = [[Murtoa, Victoria]], Australia
| death_date  = {{death date and age|df=yes|1980|11|16|1912|1|18}}
| death_place = [[Fitzroy, Victoria]], Australia
| occupation     = psychiatrist; army medical officer; medical scientist; mental health practitioner; prisoner of war (Australian); public servant
| spouse         = Estana Evelyn Jean Charles
| parents        = Dr David & Ellen Cade
| children       = John (1938), David (1940), Mary (1947), Peter (1948), Richard (1950)}}
'''John Frederick Joseph Cade''' [[Order of Australia|AO]]<ref name="De_Moore">{{cite book
|last1=De Moore
|first1=Greg
|last2=Westmore
|first2=Ann
|year=2016
|title=Finding sanity : John Cade, lithium and the taming of bipolar disorder
|publisher=News.com.au
|url=http://www.news.com.au/lifestyle/health/mind/finding-sanity-how-an-australian-doctor-discovered-the-first-drug-to-treat-mental-illness/news-story/d94cb7b1425f20953133fc41ed22de31
|location=Crows Nest, NSW
|pages=324}}</ref><ref name="Williams">{{cite book
|last1=Williams
|first1=Robyn
|year=2016
|title=Ockham's Razor Sunday 6 November 2016: Finding sanity
|url=http://www.abc.net.au/radionational/programs/ockhamsrazor/finding-sanity/7987670
|publisher=ABC Radio National}}</ref><ref name="Fanning">{{cite book
|last1=Fanning
|first1=Ellen
|last2=McCullagh
|first2=Cassie
|year=2016
|title=Life Matters Wednesday 31 August 2016: Finding Sanity – John Cade and lithium
|url=http://www.abc.net.au/radionational/programs/lifematters/finding-sanity---john-cade-and-lithium/7800132
|publisher=ABC Radio National}}</ref> (18 January 1912 – 16 November 1980) was an Australian [[psychiatry|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 [[Murtoa, Victoria|Murtoa]],<ref group="nb">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 {{convert|32|km|mi|0}} NE of Horsham.</ref> in the [[Wimmera]] region of [[Victoria, Australia]].  John's father David was Murtoa's general practitioner.  Ellen, John's mother, and younger brothers David and Frank completed the family.  When John was a small boy, his father left for World War I and served in [[Gallipoli]] and [[Western Front (World War I)|France]].  On return from the war, his father suffered from '[[Shell shock|war-weariness]]' and had difficulty in continuing in general practice.  Therefore, his father sold the practice and accepted a position with the Mental Hygiene Department.  Over the next 25 years, Dr Cade Sr became medical superintendent at several Victorian mental hospitals, namely [[Sunbury Asylum|Sunbury]], [[Beechworth Asylum|Beechworth]] and [[Mont Park Asylum|Mont Park]].  John and his brothers spent many of their younger years living within the grounds of these institutions, which had a great bearing on John's later deep understanding of the needs of the mentally ill.<ref name="jack">{{cite journal
  | doi = 10.1080/j.1440-1614.1999.00624.x
  | last = Cade
  | first = Jack F.
  | title = John Frederick Joseph Cade: family memories on the occasion of the 50th anniversary of his discovery of the use of lithium in mania
  | journal = The Australian and New Zealand Journal of Psychiatry
  | volume = 33 
  | issue = 5
  | pages = 615–618
  | year = 1999
  | pmid = 10544983| s2cid = 7072182
 }}</ref> John was educated at [[Scotch College, Melbourne]], matriculating in 1928.  He then studied medicine at the [[University of Melbourne]], graduating at the age of 21 years with honours in all subjects.   He became a House Officer at [[St Vincent's Hospital, Melbourne|St Vincent's Hospital]] and then [[Royal Children's Hospital, Melbourne|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.<ref name="jack"/>

===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 [[Captain (land)|captain]], [[Australian Army Medical Corps]], [[Second Australian Imperial Force|A.I.F.]], on 1 July 1940 and posted to the 2nd/9th Field Ambulance.<ref name=adb/> Although trained as a psychiatrist, Dr. Cade served as a [[surgery|surgeon]] and departed for Singapore in 1941 on {{RMS|Queen Mary}}.  He was promoted to [[Major (rank)|major]] in September 1941.  After the [[Battle of Singapore|Fall of Singapore]] to Japan, he became a [[prisoner of war]] at [[Changi Prison]] from February 1942 to September 1945.<ref name="jack"/> 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.<ref>On Bundoora hospital, see the summaries by [https://www.findingrecords.dhhs.vic.gov.au/CollectionResultsPage/MontParkHospital the Victorian Department of Health and Human Services] and by [https://researchdata.edu.au/bundoora-repatriation-hospital-1933-1993/933242 Research Data Australia].</ref> 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 pig]]s. 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.<ref name="mja">{{cite journal|last=Cade|first=John FJ|author-link=John Cade|date=3 September 1949|title=Lithium salts in the treatment of psychotic excitement|journal=Medical Journal of Australia|volume=2|issue=36|pages=349–352|doi=10.1080/j.1440-1614.1999.06241.x|pmid=10885180|pmc=2560740}}</ref> 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,<ref name=jack/> Cade began a small-scale trial of lithium citrate and/or lithium carbonate on some of his patients diagnosed with [[mania]], [[schizophrenia|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.<ref name=mja/> 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.<ref>{{Cite journal|last=Cade|first=J. F.|date=2000|title=Lithium salts in the treatment of psychotic excitement. 1949.|journal=Bulletin of the World Health Organization|volume=78|issue=4|pages=518–520|issn=0042-9686|pmc=2560740|pmid=10885180}}</ref>

While Cade's results appeared highly promising, side effects of lithium in some cases led to non-compliance.  The [[lithium toxicity|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 [[patent]]ed, 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.<ref>{{cite journal | doi=10.1111/j.1399-5618.2009.00706.x | title=The history of lithium therapy | date=2009 | last1=Shorter | first1=Edward | journal=Bipolar Disorders | volume=11 | issue=Suppl 2 | pages=4–9 | pmid=19538681 | pmc=3712976 }}</ref>

==Royal Park and RANZCP==
[[Image:Royalparkjohncadeunit.jpg|thumb|right|250px|John Cade acute unit at [[Royal Park Hospital]] circa 2003]]
In 1952 Cade was appointed Superintendent and Dean of the clinical school at [[Royal Park Hospital]]. Two years later, at the request of the Mental Hygiene Authority which was planning to remodel [[Royal Park Hospital|Royal Park]], he visited Britain for six months to inspect psychiatric institutions. On his return, he introduced modern facilities and replaced the rather authoritarian approach to patient care with a lot more personal and informal style that included [[group therapy]]. Concerned at the number of alcohol-related cases, he supported [[wikt:voluntary|voluntary]] admission to aid early detection and later proposed the use of large doses of [[thiamine]] in the treatment of alcoholism.<ref name=adb>{{Australian Dictionary of Biography
|last=Ironside 
|first=Wallace 
|year=1993
|id=A130374b
|title= Cade, John Frederick Joseph (1912–1980)  
|access-date=22 September 2008 }}</ref> Cade served as the Superintendent at Royal Park until his retirement in 1977.<ref name=jack/>

He served as the federal president of the [[Royal Australian and New Zealand College of Psychiatrists]] in 1969–70, and also as the president for its [[Victoria (state)|Victoria]] branch from 1963 until his death in 1980. In the end, Dr. Cade's discovery did receive widespread acknowledgements and praise. For his contribution to psychiatry, he was awarded a Kittay International Award in 1974 (with [[Mogens Schou]] from Denmark), and he was invited to be a Distinguished Fellow of the [[American College of Psychiatrists]].<ref name="NHMRC">{{cite web |title=NHMRC John Cade Fellowship Mental Health Research |url=https://www.nhmrc.gov.au/grants-funding/directory-previous-nhmrc-grants/nhmrc-john-cade-fellowship-mental-health-research |archive-url=https://web.archive.org/web/20180408231558/https://www.nhmrc.gov.au/grants-funding/directory-previous-nhmrc-grants/nhmrc-john-cade-fellowship-mental-health-research |archive-date=2018-04-08 |access-date=29 February 2016 |publisher=NHMRC}}</ref> In 1976, Cade was one of the first to be made an [[Officer of the Order of Australia]].<ref>{{cite web
  | title = It's an Honour – Officer of the Order of Australia
  | url = https://honours.pmc.gov.au/honours/awards/883814
  | access-date = 22 November 2008}}</ref> 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.<ref>{{cite web|title=100 Years of Australian Innovation – lithium for manic depression |url=http://www.biotechnology-innovation.com.au/innovations/pharmaceuticals/manic_depression.html |access-date=11 October 2008 |url-status=dead |archive-url=https://web.archive.org/web/20080719084358/http://www.biotechnology-innovation.com.au/innovations/pharmaceuticals/manic_depression.html |archive-date=19 July 2008 }}</ref>

==Legacy==
John Cade died of [[oesophageal cancer]]<ref name=jack /> at [[Fitzroy, Victoria|Fitzroy]] on 16 November 1980, and is buried at Yan Yean Cemetery in [[Whittlesea, Victoria|Whittlesea]].<ref name=adb /> Recognition of Cade's pioneering work continued after his death.  The Adult Acute unit at Royal Park Hospital was named the "John Cade Unit" in recognition of Cade's long service to the hospital.  After Royal Park's closure, the newly opened Adult Acute Psychiatric Unit at [[Royal Melbourne Hospital]] was named "John Cade Adult Acute Inpatient Unit".<ref>{{cite web
 | url =http://www.health.vic.gov.au/mentalhealthservices/adult/inwest-a.htm
 | title =Inner West Mental health Services
 | publisher =Department of Health
 | access-date =29 February 2016
 | archive-date =28 February 2016
 | archive-url =https://web.archive.org/web/20160228224448/http://www.health.vic.gov.au/mentalhealthservices/adult/inwest-a.htm
 | url-status =dead
 }}</ref> In 1980 the first John Cade memorial lecture was delivered by [[Mogens Schou]] at the congress in Jerusalem of the Collegian International Psychopharmacologium.<ref name=adb /> In 2013 the [[National Health and Medical Research Council]] (NHMRC) offered two $750 000 per annum fellowships for mental health research, entitled the "NHMRC John Cade Fellowship in Mental Health Research".<ref name=NHMRC/> The Fellowship recipients were Professor Helen Christensen of the [[University of New South Wales]] and Professor John McGrath of [[The University of Queensland]].<ref>{{cite web
 | url =https://www.nhmrc.gov.au/_files_nhmrc/file/grants/funding/2013/nhmrc_john_cade_fellowship_mental_health_research_commencing_2013_130824.pdf
 | title =NHMRC John Cade Fellowship in Mental Health Research for funding commencing in 2013
 | publisher =NHMRC
 | access-date =29 February 2016}}</ref> The [[Royal Australian and New Zealand College of Psychiatrists|RANZCP]] awards The John Cade Memorial Medal to a final year [[Victoria (state)|Victorian]] medical student following a special clinical examination at [[Monash University]] or the [[University of Melbourne]] each year.<ref>{{cite web
 | url =https://www.ranzcp.org/About-us/About-the-College/Our-history/Presidents-of-the-College/John-Cade.aspx
 | title =John Cade, AO
 | publisher =RANZCP
 | access-date =29 February 2016}}</ref> The Faculty of Medicine at [[University of Melbourne]] also awards the John Cade Memorial Prize.<ref name=adb />

==Troubled Minds==
In 2004, [[Film Australia]] and [[Special Broadcasting Service|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.<ref>{{cite web|title=2005 AWGIE Award Winners |publisher=Australian Writers' Guild|url=http://www.awg.com.au/artman/uploads/awgie_2004_winners.pdf|access-date=22 September 2008|archive-url=https://web.archive.org/web/20090911230208/http://www.awg.com.au/artman/uploads/awgie_2004_winners.pdf|archive-date=11 September 2009}}</ref>

==See also==
*[[Lithium pharmacology]]

==Notes==
<references group="nb" />

==References==
{{Commons category}}
{{reflist}}
* 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

{{Bipolar disorder}}

{{Authority control}}

{{DEFAULTSORT:Cade, John}}
[[Category:1912 births]]
[[Category:1980 deaths]]
[[Category:Australian prisoners of war]]
[[Category:Bipolar disorder researchers]]
[[Category:Officers of the Order of Australia]]
[[Category:Psychiatrists from Melbourne]]
[[Category:People educated at Scotch College, Melbourne]]
[[Category:20th-century Australian medical doctors]]
[[Category:World War II prisoners of war held by Japan]]
[[Category:Military personnel from Victoria (state)]]
[[Category:Royal Australian Army Medical Corps officers]]
[[Category:Australian Army personnel of World War II]]