John Cade: Life and Career

John Frederick Joseph Cade (1912–1980) was an Australian psychiatrist who, working almost alone in a converted pantry at a repatriation hospital outside Melbourne, reported in 1949 that lithium salts calmed patients in the grip of mania. That short paper in the Medical Journal of Australia became the starting point of modern mood-stabilising treatment, and lithium — a simple element dissolved in many of the world’s spring waters — went on to become one of the most studied medicines in psychiatry. Before any of that, Cade was a country doctor’s son, a young asylum doctor, an army medical officer and, for three and a half years, a prisoner of war in Changi.

This page tells the story of the man rather than the experiment. It follows him from country Victoria through Scotch College and Melbourne’s medical school, into the state mental hospitals, through the fall of Singapore and captivity, back to the hospital at Bundoora, and on to a quarter of a century running Royal Park Psychiatric Hospital and teaching its students. It ends with the honours that came late, his own modest description of himself, his death in 1980 and the two modern biographies that have re-told his life. The 1949 discovery itself, the mineral he worked with and the research that followed each have their own page in this wing, linked under Connections.

Table of Contents

  1. A Doctor’s Son from Country Victoria
  2. Scotch College and Melbourne Medicine
  3. Mont Park and a Young Family
  4. Army Doctor and the Fall of Singapore
  5. Three and a Half Years in Changi
  6. Bundoora and the Pantry Laboratory
  7. Royal Park: Superintendent and Teacher
  8. Honours: the Kittay Award and the Order of Australia
  9. The ‘Enthusiastic Amateur’ and Mending the Mind
  10. Death, Memorials and Biographies
  11. Key Research Papers
  12. Connections

1. A Doctor’s Son from Country Victoria

John Cade was born on 18 January 1912 in the wheat country of western Victoria. The sources disagree on the exact town. The Australian Dictionary of Biography, in the entry written by the psychiatrist Wallace Ironside and published in 1993, gives his birthplace as Horsham; the Encyclopedia of Australian Science and several later accounts give Murtoa, a smaller town nearby. Both are rural centres of the Wimmera district, and the accounts agree that he began life as the son of a country general practitioner.

His father, David Duncan Cade, was a medical practitioner and his mother was Ellen Edwards. According to the Australian Dictionary of Biography, David Cade served in the First World War, commanded the 3rd Field Ambulance of the Australian Imperial Force and was awarded the Distinguished Service Order. A field ambulance was a mobile army medical unit that collected the wounded near the front and moved them back for treatment — a detail worth remembering, because his son would serve in a unit of exactly the same kind a generation later.

Medicine ran deep in the family. A reviewer of the 2016 biography Finding Sanity summarises the authors’ finding that doctors and chemists formed an unbroken line among Cade’s ancestors for nearly a century and a half. John Cade was born into that tradition, and followed it.

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2. Scotch College and Melbourne Medicine

Cade was educated at Scotch College in Melbourne, one of the city’s long-established schools, and went on to study medicine at the University of Melbourne. He took the degrees of Bachelor of Medicine and Bachelor of Surgery (MB BS) in 1934. Popular accounts of his life describe an outstanding student who graduated with honours across his subjects.

The date of his higher degree is one of the small puzzles in his record. The Australian Dictionary of Biography says he received the research degree of Doctor of Medicine (MD) in 1938; the Encyclopedia of Australian Science dates the MD to about 1954. The earlier date is the one given in the fuller biographical entry, but the difference has not been resolved in the sources consulted for this page.

After graduating he did the hospital residencies that young Australian doctors of the period served before choosing a field. The Australian Dictionary of Biography records him as a resident medical officer at St Vincent’s Hospital in Melbourne in 1935 and at the Children’s Hospital (later the Royal Children’s Hospital) in 1936. From there he turned to psychiatry, the field in which he would spend the rest of his career.

The psychiatry that Cade entered in the mid-1930s had very few effective physical treatments. Large state hospitals housed patients with severe mental illness for years or decades, and the tools available to their doctors were mostly custodial care, sedatives and, from the later 1930s, the new shock therapies. Against that background, the idea that a single chemical salt might settle a severe mood illness — the idea he would test a dozen years later — was genuinely new.

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3. Mont Park and a Young Family

Cade joined the Victorian Mental Hygiene Department and became a medical officer at Mont Park Mental Hospital, one of the large psychiatric hospitals on Melbourne’s northern edge. It was there that he gained his first long experience of patients with chronic psychosis, mania and severe depression — the people who would later fill the case notes of his 1949 paper.

In 1937 he married Estana Evelyn Jean Charles, known as Jean, who had trained as a nurse. The couple had five children: four sons and a daughter. One of the sons, Jack (J.F.) Cade, became a physician at the Royal Melbourne Hospital, and in 1999, for the fiftieth anniversary of the lithium paper, he published a set of family memories of his father in the Australian and New Zealand Journal of Psychiatry. That paper appears under his father’s name in some indexes because the initials are the same; it was written by the son.

Colleagues and family remembered Cade as a gentle man. A 1999 portrait by two psychiatrists, E. Chiu and R.M. Hegarty, collected anecdotes that, in their words, revealed a loyal, kind and curious person with a quiet spirituality, who valued the individuality of his patients and cared for his staff and his family. That picture of the man — curious, practical and attentive to the person in front of him — recurs in almost every account of his career.

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4. Army Doctor and the Fall of Singapore

When the Second World War came, Cade followed his father into army medicine. On 1 July 1940 he was appointed a captain in the Australian Army Medical Corps of the Australian Imperial Force and posted to the 2/9th Field Ambulance. The “2/” prefix marked units of the Second AIF, raised for this war, and a field ambulance did the same job his father’s unit had done in 1914–18: collecting, treating and evacuating the sick and wounded.

The unit was sent to Malaya. The Australian Dictionary of Biography records that Cade arrived in Singapore in February 1941 and was promoted to major in September 1941. For most of that year the garrison waited; then, in December 1941, Japanese forces invaded the Malay Peninsula and pushed south towards Singapore. The island fell in February 1942, and tens of thousands of British, Indian and Australian servicemen became prisoners of war. Cade was among them.

A medical officer in a field ambulance, he had spent the campaign caring for the injured. What followed was a different kind of medicine altogether: keeping men alive in captivity with almost no drugs, very little equipment and a diet that was inadequate in both quantity and quality.

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5. Three and a Half Years in Changi

From February 1942 until September 1945 Cade was held at Changi, the prisoner-of-war camp on the eastern end of Singapore island. Three and a half years is a long time to spend as a captive doctor, and the biographers treat those years as a turning point in his thinking.

According to Walter Brown’s 2019 biography, as summarised in the historian Douwe Draaisma’s review of it in Nature, Cade was put in charge of the camp’s psychiatric section. In the same account he began to notice links between missing nutrients and disease among his fellow prisoners — in particular the effects of a lack of B vitamins. Two of the classic deficiency diseases of the camps were beriberi, caused by a shortage of thiamine (vitamin B1) and producing nerve damage, swelling and heart failure, and pellagra, caused by a shortage of niacin (vitamin B3) and producing skin rash, diarrhoea and, in its severe form, mental confusion. A diet built largely on polished white rice, stripped of the outer layers where much of the thiamine sits, made both diseases common.

The lesson Cade carried from this is told in general terms by the biographers: that a disturbed mind could have a physical, chemical cause in the body, and that a single missing or excess substance could make a person ill in ways that looked psychiatric. Some popular retellings go further and claim that specific observations of prisoners gave him his later idea of a toxin in the urine of manic patients. That specific claim has not been traced to a primary source, and the careful statement is the biographers’ broader one — that his wartime experience shaped the way he thought about mental illness.

He was released when the war ended in 1945 and returned to Australia. He was demobilised from the army on 2 January 1946.

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6. Bundoora and the Pantry Laboratory

After demobilisation in 1946 he joined the Repatriation Mental Hospital at Bundoora, on Melbourne’s northern outskirts, a hospital for returned servicemen, as medical superintendent and psychiatrist. That is the date and role given by the Australian Dictionary of Biography, and it fits with the clinical work he did there in 1948. The Encyclopedia of Australian Science lists a Bundoora superintendency of 1950–1952, so the sources differ on exactly when the title applied; they agree that Bundoora is where the lithium work happened.

The hospital gave him patients, but almost nothing in the way of a laboratory. Draaisma’s review of Brown’s biography describes the work being done in an abandoned pantry on the hospital grounds, without sophisticated chemical analysis. Cade kept guinea pigs, collected urine samples from his patients and from healthy controls, and set out to test a hypothesis about mania with the simplest of means.

The experiments themselves — the guinea pigs, the role of urea and uric acid, the soluble lithium salt that seemed to calm the animals, and the later dispute over what that calm really meant — are described on the companion page Lithium Salts and Mania: Cade’s 1949 Discovery. In outline: lithium treatment of his first manic patient, recorded in his notes only by the initials W.B., began at Bundoora on 29 March 1948, and his report, “Lithium salts in the treatment of psychotic excitement”, appeared in the Medical Journal of Australia on 3 September 1949.

For a career, this was an unusual pattern. Cade was not a laboratory scientist, held no university research post and had no research grant. He was a hospital superintendent with clinical duties who did experiments on the side. Looking back, he insisted that the result was not luck: in a 1967 editorial, quoted by the historian Johan Schioldann, he called it “not an accidental discovery” but “the inevitable though unforeseen product of a hypothesis and of a series of experiments”.

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7. Royal Park: Superintendent and Teacher

In 1952 Cade became psychiatrist superintendent of Royal Park Psychiatric Hospital in Melbourne and dean of its clinical school, posts he held for twenty-five years, until 1977. As dean of the clinical school he was responsible for the teaching of the medical students and trainee doctors who passed through the hospital.

His standing in the profession grew through these years. He was a Foundation Fellow of the Australian and New Zealand College of Psychiatrists (later the Royal Australian and New Zealand College of Psychiatrists) in 1963 and served as its federal president in 1969–70. In 1970 he was made a Distinguished Fellow of the American Psychiatric Association, and from 1970 to 1980 he sat on the Medical Board of Victoria, the body that registered and disciplined the state’s doctors.

Meanwhile his discovery had travelled. In Denmark, Mogens Schou and his colleagues ran a controlled trial of lithium in mania published in 1954, and through the 1960s Schou and Poul Baastrup went on to study lithium as a preventive treatment. Schou later wrote about the early European lithium studies for the fiftieth anniversary of Cade’s paper, closing that account with his personal memories of Cade. The story of that later work is told on From Cade to Schou: Lithium’s Legacy and Later Research.

The psychiatrists N. Cole and G. Parker, writing in 2012, sketched Cade’s background, character and powers of observation and argued against his own description of himself as merely a clinician-administrator. Their title compares him to a prospector who found a gold nugget: someone who went looking, rather than someone who simply tripped over his find.

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8. Honours: the Kittay Award and the Order of Australia

Recognition came late but it came. In 1974 Cade shared the Kittay International Award, given by the Kittay Scientific Foundation, with Mogens Schou — a pairing that joined the man who first reported lithium’s effect in mania with the man who did most to test and establish it.

In 1976 he was appointed an Officer of the Order of Australia (AO). The Order had been founded only the year before, in 1975, and one popular account notes that he was among the first people appointed to it.

Taken together with his College presidency, his American fellowship and his seat on the Medical Board, these honours mark how far his reputation had travelled from the pantry at Bundoora. By the 1970s lithium was in use in many countries; the historian Edward Shorter notes that when the United States admitted it to the market in 1970, it became the fiftieth country to do so.

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9. The ‘Enthusiastic Amateur’ and Mending the Mind

Cade was famously modest about his own scientific credentials. In the Beattie-Smith Lecture he gave in 1951, as quoted by Johan Schioldann, he described himself as “an enthusiastic amateur, full of curiosity, with fair determination, golden opportunities, inadequate knowledge and woeful technique.” The phrase is self-deprecating, but each part of it is accurate to his circumstances: he had the curiosity to frame a hypothesis, the determination to test it, the opportunity of a hospital full of patients, and very little in the way of equipment or training in laboratory method.

He kept that independence to the end. In a letter written about three months before his death to the lithium researcher F.N. Johnson, as quoted by Schioldann, he reflected that he had been able to go his own way “unhindered by advice, criticism or caution.” Johnson published a reminiscence of Cade in 1981, the year after his death.

In 1979 Cade published a book for general readers, Mending the Mind. It appeared the year before his death.

The historians who have studied his papers do not all accept his modesty at face value. Schioldann argues that Cade probably knew the older medical literature on lithium and uric acid, which went back to the nineteenth-century use of lithium salts in gout, and Cole and Parker reject the idea that he “simply rediscovered” lithium. Shorter, for his part, points out that lithium had been used in psychiatry in the mid-nineteenth century before falling out of use, and credits Cade with reintroducing it in 1949. How much was old knowledge and how much was new is discussed on the 1949 discovery page.

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10. Death, Memorials and Biographies

John Cade died of cancer on 16 November 1980 at Fitzroy, in inner Melbourne, aged 68. He had retired from Royal Park three years earlier and was still a member of the Medical Board of Victoria.

His memory is kept by several awards in Melbourne. The Encyclopedia of Australian Science lists the John Cade Memorial Lecture at the University of Melbourne (from 1980), the John Cade Award of the Victorian branch of the Royal Australian and New Zealand College of Psychiatrists (from 1982) and the John Cade Memorial Prize in the university’s Faculty of Medicine (from 1983).

The fiftieth anniversary of the lithium paper, in 1999, brought a wave of historical writing in Australian journals: Mitchell and Hadzi-Pavlovic on Cade and the discovery in the Medical Journal of Australia, Mitchell on the anniversary of the anti-manic effect, his son’s family memories, the portrait of “the man” by Chiu and Hegarty, Burrows and Tiller on the early Australian research, and Schou on the European studies that followed. Schioldann, the historian who has written most fully on the introduction of lithium, returned to Cade’s guinea-pig work in 2013.

Two full biographies have since appeared. Greg de Moore and Ann Westmore published Finding Sanity: John Cade, Lithium and the Taming of Bipolar Disorder (Allen & Unwin, 2016), and Walter A. Brown published Lithium: A Doctor, a Drug, and a Breakthrough (Liveright, 2019). Both books describe the setback that followed the first success: Brown’s, as summarised in Draaisma’s review, records that Cade stepped back from lithium in 1950 after his first patient, W.B., died of lithium poisoning — a reminder of the narrow margin between an effective and a toxic amount that later researchers learned to measure in the blood.

Timeline at a Glance

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Key Research Papers

  1. Cade JF. Lithium salts in the treatment of psychotic excitement. Med J Aust. 1949;2(10):349-52. PubMed PMID: 18142718
  2. Cole N, Parker G. Cade’s identification of lithium for manic-depressive illness—the prospector who found a gold nugget. J Nerv Ment Dis. 2012;200(12):1101-4. PubMed PMID: 23197126
  3. Chiu E, Hegarty RM. John Cade: the man. Aust N Z J Psychiatry. 1999;33 Suppl:S24-6. PubMed PMID: 10622175
  4. Cade JF. John Frederick Joseph Cade: family memories on the occasion of the 50th anniversary of his discovery of the use of lithium in mania. 1949. Aust N Z J Psychiatry. 1999;33(5):615-8. PubMed PMID: 10544983 (written by his son, Jack Cade)
  5. Johnson FN. John F.J. Cade, 1912 to 1980: a reminiscence. Pharmacopsychiatria. 1981;14(4):148-9. PubMed PMID: 7025041
  6. Mitchell PB, Hadzi-Pavlovic D. John Cade and the discovery of lithium treatment for manic depressive illness. Med J Aust. 1999;171(5):262-4. PubMed PMID: 10495760
  7. Mitchell PB. On the 50th anniversary of John Cade’s discovery of the anti-manic effect of lithium. Aust N Z J Psychiatry. 1999;33(5):623-8. PubMed PMID: 10544984
  8. Burrows GD, Tiller JW. Cade’s observation of the antimanic effect of lithium and early Australian research. Aust N Z J Psychiatry. 1999;33 Suppl:S27-31. PubMed PMID: 10622176
  9. Schou M. The early European lithium studies. Aust N Z J Psychiatry. 1999;33 Suppl:S39-47. PubMed PMID: 10622179
  10. Shorter E. The history of lithium therapy. Bipolar Disord. 2009;11 Suppl 2:4-9. PubMed PMID: 19538681
  11. Schioldann J. From guinea pigs to manic patients: Cade’s ‘story of lithium’. Aust N Z J Psychiatry. 2013;47(5):484-6. PubMed PMID: 23508681
  12. Draaisma D. Lithium: the gripping history of a psychiatric success story. Nature. 2019;572:584-585. DOI: 10.1038/d41586-019-02480-0

PubMed Topic Searches

  1. John Cade lithium
  2. Cade, lithium history and mania
  3. History of lithium therapy
  4. History of psychopharmacology in Australia

Further Reading

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Connections