William John Adie (1886–1935)
William John Adie is best known for his account of the tonic pupil, a physical finding of a dilated pupil that reacts poorly to light but better to accommodation. The reaction of the pupil is sluggish and is usually unilateral, most often seen in women, commonly with absent leg tendon reflexes.1,2 The pathology is now localised to the ciliary ganglion. The preserved response of the pupil to accommodation results from the higher percentage of fibres from the ciliary ganglion that innervate the iris for accommodation than for constriction to light.
Adie described 19 patients, 13 with absent tendon reflexes, and noted 44 reported cases of tonic pupil. In an exemplary clinical essay, he outlined four incomplete forms (the last would not now be accepted):
The complete form—typical tonic pupil and absence of reflexes
Incomplete forms: a) tonic pupil alone; b) atypical phase of the tonic pupil alone (iridoplegia; internal ophthalmoplegia); c) atypical phases of the tonic pupil with absent reflexes; and d) absent reflexes alone.
Adie did not claim originality, recognising descriptions from 1902. However, James Ware in 1813 and Hughlings Jackson in 1881 both provided convincing accounts;3 Gordon Holmes described the same disorder in 19314 but is surprisingly not acknowledged in Adie’s Brain paper.2
William John Adie was born in Geelong, west of Melbourne on the southern Australian coast. He was educated at Flinder’s School, but at the age of 13 had to leave in order to support the family, as his father had died in 1899. He worked as an office errand boy. One of his employers recognised his abilities and paid for his tuition. Thus he passed the examination for university entry. Dr Arthur South in Geelong inspired Adie to embark on a medical career, but medical school fees in Melbourne were high and an uncle paid for his £19 one way ticket to England. He obtained a scholarship that enabled him to read medicine at Edinburgh, where he graduated in 1911. He then visited German clinics and returned to the National Hospital, Queen Square, as house physician.
At the outbreak of world war one Adie joined the Northamptonshire Regiment and served as medical officer in France, where he took part in the retreat from Mons, although his regiment was annihilated. He was transferred to the Leicestershire Regiment and saw active service. In 1916 he was mentioned in despatches for saving a number of soldiers in one of the early gas attacks by improvising a mask of clothing soaked in urine. He subsequently took charge of the 7th General Hospital, and also acted as a consultant in the management of head injuries.5
After the war he became medical registrar at Charing Cross Hospital, London. In 1916 he married Lorraine Bonar; they had a daughter and a son. He was appointed to the staff of the National Hospital, Queens Square, and Moorfields Eye Hospital. His clinical acumen and diagnostic skill were soon evident; his teaching was also much in demand. With Macdonald Critchley he described in frontal lobe disease “a syndrome of forced grasping and groping”.6 He lucidly described narcolepsy,7 and wrote important papers on pituitary tumours and disseminated sclerosis. With James Collier, he wrote the section on neurology in Price’s Textbook of medicine, generally considered the finest general textbook account of neurology.
He earned several honours. The University of Edinburgh awarded him their gold medal and he was a founder of The Association of British Neurologists (ABN). The ABN was initiated at a meeting in the house of Gordon Holmes at 9 Wimpole Street, on 28 July 1932. Present were: WJ Adie, E Bramwell, EF Buzzard, H Cohen, JS Collier, DE Core, A Feiling, RG Gordon, JG Greenfield, G Hall, W Harris, W Johnson, FJ Nattrass, C Worster-Drought, SA Kinnier Wilson, and G Holmes.
Sadly, when aged 45 Adie developed angina and in 1935 was obliged to resign his post when only 48. He died from a myocardial infarct on 17 March 1935.
Adie was admired for his intelligence and powers of shrewd clinical observation. Above all, he was esteemed as a modest generous man loved by his students. He was a keen bird watcher and tennis player. In his native town, the youth who had accomplished so much on the other side of the world was not forgotten. The daily newspaper, Geelong Advertiser, headed a long obituary: “Geelong boy who made good in London”.