John Cade

Early life

John Cade was born in Murtoa, in the Wimmera region of Victoria, to father David, a general practitioner, and mother Ellen, with younger brothers David and Frank. When John was a small boy, his father served in World War I at Gallipoli and France, returning with 'war-weariness' that led him to sell his practice and join the Mental Hygiene Department. Over the next 25 years, Dr. Cade Sr. became medical superintendent at Sunbury, Beechworth, and Mont Park mental hospitals, and John spent many of his younger years living within the grounds of these institutions, which influenced his later understanding of the mentally ill.

He was educated at Scotch College, Melbourne, matriculating in 1928, then studied medicine at the University of Melbourne, graduating at age 21 with honours in all subjects. After house officer roles at St Vincent's Hospital and Royal Children's Hospital, he became severely ill with bilateral pneumococcal pneumonia. While convalescing, he fell in love with nurse Jean, marrying her in 1937. Like his father, Cade left his young family to fight in World War II, appointed captain in the Australian Army Medical Corps on 1 July 1940 and posted to the 2nd/9th Field Ambulance.

He served as a surgeon, was promoted to major in September 1941, and after the Fall of Singapore became a prisoner of war at Changi from February 1942 to September 1945. During imprisonment, he observed fellow inmates with strange, vacillating behavior and speculated that a toxin affecting their brains, when eliminated through urine, led to symptom loss.

Discovery of the effect of lithium on mania

After the war, Cade briefly recovered at Heidelberg Hospital before starting work at Melbourne’s Bundoora Repatriation Mental Hospital. There, in a disused pantry, he ran basic experiments, mainly injecting urine from psychiatric patients into guinea pigs. His early results hinted that urine from manic patients was more poisonous. He looked at two toxic components in urine—urea and uric acid—and discovered that urea levels were the same in both sick and healthy individuals.

To study uric acid, he created artificial solutions, adding lithium to make it dissolve in water, producing lithium urate. As a control, he gave guinea pigs lithium carbonate solution and noticed they became calmer, suggesting the lithium ion itself had a soothing effect, though this might have been from an overdose’s toxicity. After testing lithium on himself to check its safety, he ran a small trial of lithium citrate or carbonate on patients with mania, dementia præcox, or melancholia, getting remarkable results.

The calming effect was so strong that he thought mania might stem from a lithium shortage. He published his findings in 1949 in the Medical Journal of Australia in a paper called “Lithium salts in the treatment of psychotic excitement.” But side effects caused patients to stop taking it, and lithium poisoning killed several people, including one of his first patients. After that, Cade abandoned lithium use and ended his research on the element.

Royal Park and RANZCP

In 1952, John Cade became the superintendent and dean of the clinical school at Royal Park Hospital. Two years later, the Mental Hygiene Authority, planning to renovate Royal Park, sent him to Britain for six months to study psychiatric institutions. When he returned, he brought in modern facilities and swapped the old authoritarian style of patient care for a much more personal, informal approach that included group therapy. Worried by the high number of alcohol-related cases, he backed voluntary admission to catch problems early and later suggested using large doses of thiamine to treat alcoholism.

He remained Royal Park’s superintendent until retiring in 1977. Cade led the Royal Australian and New Zealand College of Psychiatrists as federal president in 1969–70 and served as president of its Victoria branch from 1963 until his death in 1980. For his psychiatric work, he shared a Kittay International Award in 1974 with Mogens Schou of Denmark, and was named a Distinguished Fellow of the American College of Psychiatrists. In 1976, he became one of the first Officers of the Order of Australia.

Cade stayed modest about his accidental discovery, calling himself just a gold prospector who stumbled on a nugget. In July 2004, the Medical Journal of Australia noted that his 1949 paper “Lithium salts in the treatment of psychotic excitement” was its most cited article ever.

Legacy

John Cade died of oesophageal cancer at Fitzroy on 16 November 1980 and is buried at Yan Yean Cemetery in Whittlesea. The Adult Acute unit at Royal Park Hospital was named the 'John Cade Unit', and after Royal Park's closure, the newly opened Adult Acute Psychiatric Unit at Royal Melbourne Hospital was named 'John Cade Adult Acute Inpatient Unit'.

In 1980, the first John Cade memorial lecture was delivered by Mogens Schou at the congress in Jerusalem of the Collegian International Psychopharmacologium. In 2013, the National Health and Medical Research Council offered two $750,000 per annum fellowships for mental health research, titled the 'NHMRC John Cade Fellowship in Mental Health Research'. The RANZCP awards the John Cade Memorial Medal to a final year Victorian medical student, and the Faculty of Medicine at University of Melbourne awards the John Cade Memorial Prize.

Did You Know?

• John Cade's father David served in Gallipoli and France during World War I and later became medical superintendent at several Victorian mental hospitals.
• One of Cade's first lithium-treated patients died of lithium toxicity, leading Cade to stop using lithium and end his research on the element.