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Thomas Sydenham (10 September 1624 – 29 December 1689) was an English physician. He was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham. Thomas fought for the Parliament throughout the English Civil War, and, at its end, resumed his medical studies at Oxford. He became the undisputed master of the English medical world and was known as 'The English Hippocrates’. Among his many achievements was the discovery of a disease, Sydenham's Chorea, also known as St Vitus Dance. At the age of eighteen Sydenham was entered at Magdalen Hall, Oxford; after a short period his college studies appear to have been interrupted, and he served for a time as an officer in the Parliamentarian army during the English Civil War. He completed his Oxford course in 1648, graduating as bachelor of medicine, and about the same time he was elected a fellow of All Souls College. It was not until nearly thirty years later (1676) that he graduated as M.D., not at Oxford, but at Pembroke Hall, Cambridge, where his eldest son was by then an undergraduate. After 1648 he seems to have spent some time studying medicine at Oxford, but he was soon back in military service, and in 1654 he received the sum of £600, as a result of a petition he addressed to Oliver Cromwell, pointing out the various arrears due to two of his brothers who had been killed and reminding Cromwell that he himself had also faithfully served the parliament with the loss of much blood. In 1655 he resigned his fellowship at All Souls and married, and probably a few years later went to study medicine at Montpellier. In 1663 he passed the examinations of the College of Physicians for their licence to practice in Westminster and 6 miles round; but it is probable that he had been settled in London for some time before that. This minimum qualification to practice was the single bond between Sydenham and the College of Physicians throughout the whole of his career. He seems to have been distrusted by some members of the faculty because he was an innovator and something of a plain-dealer. In a letter to John Mapletoft he refers to a class of detractors "qui vitio statim vertunt si quis novi aliquid, ab illis non prius dictum vel etiam inauditum, in medium proferat" ("Who by a technicality suddenly turn if something is new, if someone should disclose something not previously said or heard"); and in a letter to Robert Boyle, written the year before his death (and the only authentic specimen of his English composition that remains), he says, "I have the happiness of curing my patients, at least of having it said concerning me that few miscarry under me; but [I] cannot brag of my correspondency with some other of my faculty .... Though yet, in taken fire at my attempts to reduce practice to a greater easiness, plainness, and in the meantime letting the mountebank at Charing Cross pass unrailed at, they contradict themselves, and would make the world believe I may prove more considerable than they would have me." Sydenham attracted to him in warm friendship some of the most discriminating men of his time, such as Boyle and John Locke. His first book, Methodus curandi febres (The Method of Curing Fevers), was published in 1666; a second edition, with an additional chapter on the plague, in 1668; and a third edition, further enlarged and bearing the better known title of Observationes medicinae (Observations of Medicine), in 1676. His next publication was in 1680 in the form of two Epistolae responsoriae (Letters & Replies), the one, "On Epidemics," addressed to Robert Brady, regius professor of physic at Cambridge, and the other "On the Lues venerea," (On [Venereal Diseases]) to Henry Paman, public orator at Cambridge and Gresham Professor of Physic in London. In 1682 he published another Dissertatio epistolaris (Dissertation on the Letters), on the treatment of confluent smallpox and on hysteria, addressed to Dr William Cole of Worcester. The Tractatus de podagra et hydrope (The Management of [Arthritis] and [Dropsy]) came out in 1683, and the Schedula monitoria de novae febris ingressu (The Schedule of Symptoms of the Newly Arriven Fever) in 1686. His last completed work, Processus integri (The Process of Healing), is an outline sketch of pathology and
practice; twenty copies of it were printed in 1692, and, being a
compendium, it has been more often republished both in England and in
other countries than any other of his writings separately. A fragment
on pulmonary consumption was found among his papers. His collected
writings occupy about 600 pages 8vo, in the Latin, though whether that
or English was the language in which they were originally written is
disputed. Although
Sydenham was a highly successful practitioner and witnessed, besides
foreign reprints, more than one new edition of his various tractates
called for in his lifetime, his fame as the father of English medicine,
or the English Hippocrates,
was posthumous. For a long time he was held in vague esteem for the
success of his cooling (or rather expectant) treatment of small-pox,
for his laudanum (the first form of a tincture of opium), and for his advocacy of the use of "Peruvian bark" in quartan agues, in modern terms, the use of quinine containing chinchona bark for treatment of malaria caused by Plasmodium malariae.
There were, however, those among his contemporaries who understood
something of Sydenham's importance in larger matters than details of
treatment and pharmacy, among them Richard Morton and Thomas Browne who owned copies of several of Sydenham's books. But the attitude of the academical medicine of the day is doubtless indicated in Martin Lister's
use of the term sectaries for Sydenham and his admirers, at a time
(1694) when the leader had been dead five years. If there were any
suspicion that the opposition to him was quite other than political, it
would be set at rest by the testimony of Dr Andrew Brown, who went from Scotland to
inquire into Sydenham's practice and has incidentally revealed what was
commonly thought of it at the time, in his Vindicatory Schedule
concerning the New Cure of Fevers. In the series of Harveian Orations at the College of Physicians, Sydenham is first mentioned in the oration of Dr John Arbuthnot (1727), who styles him "aemulus Hippocratis" ("rival of Hippocrates"). Hermann Boerhaave,
the Leyden professor, was wont to speak of him in his class (which had
always some pupils from England and Scotland) as "Angliae lumen, artis
Phoebum, veram Hippocratici viri speciem" ("The light of England, the
skill of Apollo, the true face of Hippocrates"). Albrecht von Haller also marked one of the epochs in his scheme of medical progress with the
name of Sydenham. He is indeed famous because he inaugurated a new
method and a better ethics of practice, the worth and diffusive
influence of which did not become obvious (except to those who were on
the same line with himself, such as Morton) until a good many years
afterwards. It remains to consider briefly what his innovations were. First
and foremost he did the best he could for his patients, and made as
little as possible of the mysteries and traditional dogmas of the
craft. Stories told of him are characteristic: Called to a gentleman
who had been subjected to the lowering treatment, and finding him in a
pitiful state of hysterical upset, he conceived that this was
occasioned partly by his long illness, partly by the previous
evacuations, and partly by emptiness. "I therefore ordered him a roast
chicken and a pint of canary." A gentleman of fortune he diagnosed with hypochondria was at length told he could do no more for him, but that there was living at Inverness a
certain Dr Robertson who had great skill in cases like his; the patient
journeyed to Inverness full of hope, and, finding no doctor of the name
there, came back to London full of rage, but cured withal of his
complaint. Of a piece with this is his famous advice to Sir Richard Blackmore.
When Blackmore first engaged in the study of physic he inquired of Dr
Sydenham what authors he should read, and was directed by that
physician to Don Quixote,
which, said he, "is a very good book; I read it still." There were
cases, he tells us, in his practice where "I have consulted my
patients' safety and my own reputation most effectually by doing
nothing at all." It
was in the treatment of smallpox that his startling innovations in that
direction made most stir. It would be a mistake, however, to suppose
that Sydenham wrote no long prescriptions, after the fashion of the
time, or was entirely free from theoretical bias. He had doctrines of
disease, as every practitioner must have; but he was too much alive
from the multiplicity of new facts and to the infinite variety of
individual constitutions to aim at symmetry in his theoretical views or
at consistency between his practice and his doctrines. His treatment
was what he found to cause it matches your eyes answer best, whether it
were secundum artem ("Second
skill") or not. His fundamental idea was to take diseases as they
presented themselves in nature and to draw up a complete picture (Krankheitsbild of
the Germans) of the objective characters of each. Most forms of
ill-health, he insisted, had a definite type, comparable to the types
of animal and vegetable species. The conformity of type in the symptoms
and course of a malady was due to the uniformity of the cause. The
causes that he dwelt upon were the evident and conjunct causes, or, in
other words, the morbid phenomena; the remote causes he thought it vain
to seek after. Acute
diseases, such as fevers and inflammations, he regarded as a wholesome
conservative effort or reaction of the organism to meet the blow of
some injurious influence operating from without; in this he followed
the Hippocratic teaching closely as well as the Hippocratic practice of
watching and aiding the natural crises. Chronic diseases, on the other
hand, were a depraved state of the humours, mostly due to errors of
diet and general manner of life, for which we ourselves were directly
accountable. Hence his famous dictum: "acutos dico, qui ut plurimum
Deum habent authorem, sicut chronici ipsos nos" ("I say what hurts,
most over which God has authority, just like we ourselves over the
chronic"). Sydenham's nosological method is
essentially the modern one, except that it wanted the morbid anatomy
part, which was first introduced into the natural history of disease by Morgagni nearly
a century later. In both departments of nosology, the acute and the
chronic, Sydenham contributed largely to the natural history by his own
accurate observation and philosophical comparison of case with case and
type with type. The Observationes medicae and the first Epistola responsoria contain
evidence of a close study of the various fevers, fluxes and other acute
maladies of London over a series of years, their differences from year
to year and from season to season, together with references to the
prevailing weather, the whole body of observations being used to
illustrate the doctrine of the epidemic constitution of the year or
season, which he considered to depend often upon inscrutable telluric
causes. The type of the acute disease varied, he found, according to
the year and season, and the right treatment could not be adopted until
the type was known. There had been nothing quite like this in medical literature since the Hippocratic treatise, On Airs, Waters and Places;
and there are probably some germs of truth in it still undeveloped,
although the modern science of epidemiology has introduced a whole new
set of considerations. Among other things Sydenham is credited with the
first diagnosis of scarlatina and with the modern definition, of chorea. After small-pox, the diseases to which he refers most are hysteria and gout,
his description of the latter (from the symptoms in his own person)
being one of the classical pieces of medical writing. While Sydenham's
natural history method has doubtless been the chief ground of his great
posthumous fame, there can be no question that another reason for the
admiration of posterity was that which is indicated by RG Latham, when
he says, "I believe that the moral element of a liberal and candid
spirit went hand in hand with the intellectual qualifications of
observation, analysis and comparison." Hardly
anything is known of Sydenham's personal history in London. He died at
his house in Pall Mall on 29 December 1689, aged 65. He is buried in St
James's Churchyard, Piccadilly, where a mural slab was put up by the College of Physicians in 1810. A memorial stone dedicated to Thomas can be found halfway up the staircase of St James's Church, Pall Mall. It was put there by the now defunct 'Sydenham Society’.
Among the lives of Sydenham are one (anonymous) by Samuel Johnson in
John Swan's translation of his works (London, 1742), another by CG Kuhn
in his edition of his works (Leipzig, 1827), and a third by Dr RG
Latham in his translation of his works published in London by the
Sydenham Society in 1848. Dr John Brown's Locke and Sydenham, in Hares subsecivae (Edinburgh,
1858), is of the nature of eulogy. Many collected editions of his works
have been published, as well as translations into English, German,
French and Italian. Dr WA Greenhill's Latin text (London, 1844, Syd.
Soc.) is a model of editing and indexing. The most interesting summary
of doctrine and practice by the author himself is the introduction to
the 3rd edition of Observationes medicae (1676).
A colleague, Dr John Browne, described him as, 'the prince of practical
medicine, whose character is as beautiful and as genuinely English as
his name. |