Thomas Sydenham

Born 1624
Died 1689

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Thomas Sydenham, English physician, born (or at least baptized) September 10, 1624, Wynford Eagle, Dorset; died December 29, 1689, London.

Biography of Thomas Sydenham

In the later half of the seventeenth century, internal medicine took an entirely new turn in the work of one of its greatest figures, Thimas Sydenham, who has been called the English Hippocrates, and the father of English medicine. He revived the Hippocratic methods of observations and experience. He was one of the principal founders of epidemiology, and his clinical reputation rests upon his firsthand accounts of gout, malarial fever, scarlatina, measles, dysentery, hysteria, and numerous other diseases. He introduced Cinchona bark into England, and praised opium.

Thomas Sydenham was the son of William Sydenham, a wealthy Dorset Squire, and Mary, daughter of Sir John Geoffrey. During the Civil War, four or possibly five sons served in the army of Parliament. Two of the sons and the mother lost their lives. After distinguished military service, William, the eldest son, became a close confidant of Cromwell and a prominent figure during the Commonwealth.

Sydenham, himself, saw some military service and eventually attained the rank of captain. It was said that he was left among the dead on the battlefield on one occasion and narrowly escaped death on another. His war service and the prominence of his family in Cromwell’s cause gained him political preferences during the Commonwealth period.

Sydenham commenced the study of medicine at Magdalene Hall, Oxford in 1642, but after only two months interrupted his studies to participate in the civil war on the parliamentary side – for Cromwell and against Charles I, who was a friend of William Harvey. At the end of the first hostilities, he returned to the university in 1645 to enter Wadham College, on the advice of Thomas Coxe determined to become a physician. He received his M.B. - Bachelor of Medicine - by command of the chancellor of the university in 1648, and was made a Fellow of All Souls College. At this time he studied with Christopher Wren, later one of the most important natural scientists conducting physiological experiments at Oxford. Three years later he served in the army once more – Thomas the Cornet of the first civil war had become “Captain Sydenham” by 1654 – before settling in King Street, Westminster, London in 1655 as a practitioner. That year he married Mary Gee. He remained in Westminster for the rest of his life.

In 1655 he also gave up his fellowship at All Souls, when he received £600 and the promise of employment in view of his financial and military contributions. He was nominated but not elected to Parliament in 1659, and on July 14, 1659, he was appointed “comptroller” of the pipe.”

According to some authors, Sydenham in 1659 left England for Montpellier to undergo further education. The University of Montpellier at that time was considered the stronghold of Hippocratic medicine, and his time there, with Charles Barbeyrac, was to have a fundamental impact on the future work of Sydenham. Other authors say that he never left England. The question remains unsettled.

When Charles II became king in 1660, Sydenham, who had fought with the Cromwellian army, was not in favour. Political life was probably closed to him, and he devoted the rest of his career single-mindedly to medicine. In 1663 he became a licentiate of the Royal College of Physicians, and from this year was once more established in Westminster, where he soon he enjoyed an overwhelming reputation bordering on idolatry. In 1664 he settled in Pall Mall, near the pharmacy Pestle and Mortar. This was a wealthy neighbourhood, but separated from the Thames by the marshy district of St. James, the source of malaria observed and described by Sydenham.

Besides his practical work he concerned himself with academic studies, and on May 17, 1676, received a doctorate from Pembroke College, Cambridge. Sydenham never became a Fellow of the Royal College of Physicians, he never held public office in a hospital, and was never appointed to a university chair.

In his last years Sydenham was considerably disabled by gout and renal disease and died at his home in Pall Mall in 1689. He left three sons: William (also a physician), Henry, and James.

He himself suffered from gout and wrote an excellent description of the disease, detailing the attack, the changes in urine and the link with renal stones.

The physician
Sydenham is considered one of the most important of the revivers of the views of Hippocrates. Like his great predecessor he emphasised accurate observations of the clinical picture. To him the foundation of medicine was not scientific examinations of anatomical and physiological conditions, but bedside experiences. He advocated no particular dogmatic system, but always tried to found his teaching on an independent reasoning.

It was in London in the middle of the 1650’s he began his exacting studies of epidemics. This work formed the basis of his book on fevers (1666), which was dedicated to his friend, the Irish-born chemist and natural philosopher Robert Boyle (1627-1691). It was later expanded into Observationes Medicae (1676), a standard textbook for two centuries. He also presented the theory of an epidemic constitution, ie. conditions in the environment (air, season, etc.) which cause the occurrence of acute diseases. His treatise on gout (1683) is considered his masterpiece.

Sydenham appeared to distrust all recent discoveries in anatomy, botany, and physiology, and seemed to have no knowledge of William Harvey’s (1578-1657) discovery of the circulation in 1628, nor of Richard Lower’s (1631-1691) blood transfusion in 1665, or Christopher Wren’s (1632-1723) injections in 1656.

Sydenham’s favourite books were those of Hippocrates, Marcus Tullius Cicero (106-43 BC), Francis Bacon (1561-1626), and Miguel de Cervantes’ Don Quixote. Sydenham’s depreciation of bookish knowledge and university education for physicians has been linked with the belief that he was himself somewhat untutored and unlettered. But he had a good education, he was competent in Latin and well versed in contemporary medical thought. When asked by the later poet Richard Blackmore (1650-1729) to recommend books in preparation for a medical study, Sydenham replied: “Read Don Quixote; it is a very good book; I still read it frequently.”

It was Robert Boyle who inspired Sydenham to conduct his epidemiological studies, while another friend, John Locke (1632-1704) contributed a commendatory poem to Sydenham in his second edition of 1668. Sydenham’s association with Locke was particularly close between 1667 and 1671, when Locke was composing the earliest known drafts of his Essay Concerning Human Understanding. Locke, who eventually qualified himself medically, may have been Sydenham’s collaborator, or more likely his student. The two men corresponded through the rest of Sydenham’s life, and Locke included him in his Essay along with Boyle, Isaac Newton (1643-1727), and Christiaan Huygens (1629-1695) as a “master-builder” in the new sciences.

Sydenham, Locke, and Boyle had much in common in their approach to acquiring knowledge of the natural world. They held similar views in epistemology and shared an admiration for Bacon. The question of who might have influenced whom has often been debated, since the results of their respective efforts in medicine, philosophy, and chemistry have been so far-reaching.

Sydenham himself suffered with renal stones and gout, and apart from his accurate descriptions of these disorders he described a number of other disorders accurately for the first time. He noted the link between fleas and typhus fever. Sydenham introduced opium into medical practice and was the first to use iron in treating iron-deficiency anaemia, and helped popularise quinine in treating malaria. His treatment of fevers with fresh air and cooling drinks was an improvement on the sweating methods previously employed.

Sydenham preached that a doctor must rely on his own observation and clinical experience and he appeared to have practised largely common sense medicine. Although he advocated bleeding, he did it in relative moderation compared with that of his contemporaries and followers. Derided by his colleagues, Sydenham benefited immensely from a consequent detachment from the speculative theories of his time.

Sydenham had ample opportunity to study epidemics. He saw the Great Plague of London, followed by severe epidemics of smallpox. Sydenham, however, wisely spent the plague years in the countryside. Life at the time must have been hard, also because the climate was much colder than now. During the last half of the 17th century, The Thames was frozen for months every winter.

It was particularly as a contributor to therapy that Sydenham acquired his reputation. It was his moderate treatment of smallpox, his use of cinchona, and his invention of liquid laudanum that came to symbolise his contributions to medicine. His renown came chiefly from the fact that he alleviated the suffering of the sick and made ill people well. Ironically, the only eponymous use of his name that still remains common, “Sydenham’s chorea,” refers to two paragraphs interjected in one of his treatises, more or less as an aside. Sydenham was characterized as an investigator free of prejudices.

His grave is next to a memorial renewed by the College of Physicians in 1810, with the inscription:
Propre hunc locum sepultus est
Thomas Sydenham
Medicus in omne aevum nobilis

A man is as old as his arteries.
Quoted by F. H. Garrison in
Bulletin of the New York Academy of Medicine, 1928, 4: 993.

This is all very fine, but it won’t do – Anatomy – Botany – Nonsense! Sir, I know an old woman in Covent Garden who understands botany better, and as for anatomy, my butcher can dissect a joint full and well; no, young man, all that is stuff; you must go to the bedside, it is there alone you can learn disease.1
Quoted by John Comrie in
Selected Works of Thomas Sydenham, M.D., “Life if Thomas Sydenham”
Comment to Hans Sloane on Robert Boyle’s letter to him (1684)
describing Sloane as a “ripe scholar, a good botanist, and a skilled anatomist.”

The generality have considered that disease is but a confused and disordered effort in Nature, thrown down from her proper state, and defending herself in vain.
Medical Observations, 3rd edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

A disease, however much its cause may be adverse to the human body, is nothing more than an effort of Nature, who strives with might and main to restore the health of the patient by the elimination of the morbifdc humor.
Medical Observations, Section I, Chapter I.

Whoever takes up medicine should aeriously consider the following points: firstly, that he must one day render to the Supreme Judge an account of the lives of those sick men who have been entrusted to his care. Secondly, that such skill and science as, by the blessing of Almighty God, he has attained, are to be specially directed toward the honour of his Maker, and the welfare of his fellow-creatures; since it is a base thing for the great gifts of Heaven to become the servants of avarice and ambition. Thirdly, he must remember that it is no mean or ignoble animal that he deals with. We may ascertain the worth of the human race, since for its sake God’s Only-begotten Son became man, and thereby ennobled the nature that he took upon him. Lastly, he must remember that he himself hath no exemption from the common lot, but that he is bound by the same laws of mortality, and liable to the same ailments and afflictions with his fellows. For these and like reasons let him strive to render aid to the distressed with the greater care, with the kindlier spirit, and with the stronger fellow-feeling..
Medical Observations, 1st edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

Why! the Fever itself is Nature’s instrument.
Medical Observations, Section I, Chapter 5.
Translated by R. G. Latham in Works, Volume 1.

Gout attacks such old men as, after passing the best part of their life in ease and comfort, indulging freely in high living, wine and other generous drinks, at length, from inactivity, the usual attendant of advanced life, have left off altogether the bodily exercises of their youth. Such men have generally large heads, are of a full, humid, and lax habit, and possess a luxurious and vigorous constitution, with excellent vital stamina.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

The victim goes to bed and sleeps in good health. About two o’clock in the morning he is awakened by a severe pain in the great toe; more rarely in the heel, ankle, or instep. The pain is like that of a dislocation, and yet the parts feel as if cold water were poured over them . . . Now it is a violent stretching and tearing of the ligaments – now it is a gnawing pain, and now a pressure of tightening. So exquisite and lively meanwhile is the feeling of the part affected, that it cannot bear the weight of the bedclothes nor the jar of a person walking in the room. The night is spent in torture.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

Pain, lamenes, and the long list of enumerated symptoms are not all. Gout produces calcules in the kidney. . . .the patient has frequently to whether gout or stone be the worst disease.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

For humble individuals like myself, there is one poor comfort, which is this, viz. that gout, unlike any other disease, kills more rich men than poor, more wise men than simple. Great kings, emperors, generals, admirals, and philosophers have all died of gout. Hereby Nature shows her impartiality: since those whom she favors in one way she afflicts in another – a mixture of good and evil pre-eminently adapted to our frail mortality.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

The more closely I have thought upon gout, the more I have referred it to indigestion, or to the impaired concoctation of matters, both in the parts and the juices of the body. Gouty patients are, generally, either old men, or men who have so worn themselves out in youth as to have brought on a premature old age – of such dissolute habits none being more common than the premature and excessive indulgence in venery, and the like exhausting passions.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

Among the remedies which it has pleased Almighty God to give to man to relieve his sufferings, none is so universal and so efficacious as opium."

As for a radical cure, one altogether perfect, and one whereby a patient might be freed from even the disposition to the disease . This lies, like Truth, at the bottom of a well; and so deep is it in the innermost recesses of Nature, that I know not when or by whom it will be brought forward into the light of day.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

I confidently affirm that the greater part of those who are supposed to have died of gout, have died of the medicine rather than the disease – a statement in which I am supported by observation.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

The old saw is that “if you drink wine you have the gout, and if you do not drink wine then the gout will have you.”
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

As no man can say who it was that first invented the use of clothes and houses against the inclemency of the weather, so also can no investigator point out the origin of Medicine – mysterious as the source of the Nile. There has never been a time when it was not.
Medical Observations, 1st edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

The art of medicine was to be properly learned only from its practice and its exercise.
Medical Observations, 3rd edition, Dedicatory Epistle.
Translated by R. G. Latham in Works, Volume 1.

I watched what method Nature might take, with intention of subduing the symptom by treading in her footsteps.
Medical Observations, Section 5, Chapter 2.
Translated by R. G. Latham in Works, Volume 1.

I am conscious of having omitted certain distinctive observations now inaccessible in the lumber-room of my memory. The fact that they are inaccessible only shows that I did not attende to them at the time or register them afterwards as carefully as I should. Nothing in medicine is so insignificant as to merit attention.
Medical Observations, Translated by R. G. Latham in Works, Volume 1.

The arrival of a good clown exercises a more beneficial influence upon the health of a town than of twenty asses laden with drugs.

Nature, in the production of disease, is uniform and consistent, so much so, that for the same disease in different persons the symptoms are for the most part the same; and the selfsame phenomena that you would observe in the sickness of a Socrates you would observe in the sickness of a simpleton.
Medical Observations, 3rd edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

I have ever held that any accession whatever to the art of healing, even if it went no further than the cutting of corns, or the curing of toothaches, was of far higher value than all the knowledge of fine points, and all the pomp of the subtle speculations; matters which are as useful to physicians in driving away disease, as music is to masons in laying bricks.
Medical Observations, Section II, Chapter 2.
Translated by R. G. Latham in Works, Volume 1.

It is my nature to thin where others read.
Works, “A Treatise on Gout and Dropsy”. Translated by R. G. Latham.

We are overwhelmed as it is, with an infinite abundance of vaunted medicaments, and here they add a new one.
Medical Observations, 3rd edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

How can I make a patient vomit, and how can I purge or sweat him, are matters which a druggist’s shopboy can tell me offhand. When, however, I must use one sort of medicine in preference to another, requires an informant of a different kind – a man who has little or no practice in the arena of his profession

It is a great mistake to suppose that Nature always stands in need of the assistance of Art . . . nor do I think it below me to acknowledge that, when no manifest indication pointed out to me what was to be done, I have consulted the safety of my patient and my own reputation effectually by doing nothing at all.

Gout produces calculus in the kidney. . . . the patient has frequently to entertain the painful speculation as to whether gout or stone be the worst disease. Sometimes the stone, on passing . . . , kills the patient, without waiting for the gout.
A Treatise on Gout and Dropsy.
Translated by R. G. Latham in Works, Volume II. .

In writing the history of a disease, every philosophical hypothesis whatsoever, that has previously occupied the mind of the author, should lie in abeyance. This being done, the clear and natural phenomena of the disease should be noted – these, and these only. They should be noted accurately, and in all their minuteness; in imitation of the exquisite industry of those painters who represent in their portraits the smallest moles and faintest spots.
Medical Observations, 3rd edition, Preface.
Translated by R. G. Latham in Works, Volume 1.

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