Thomas Sydenham
Encyclopedia
Thomas Sydenham 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.
; 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
.
, 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.
, 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 cinchona
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 Oration
s 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 becomes every man who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care. Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for his glory, and the good of mankind, and not for mere gain or ambition. Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man, and thus ennobled it with his divine dignity, and far more than this, died to redeem it. And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer."
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 (in Sched. monit.). 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."
, 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’.
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. See also Frédéric Picard, Sydenham, sa vie, ses œuvres (Paris, 1889), and JF Payne, T. Sydenham (London, 1900). 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.
England
England is a country that is part of the United Kingdom. It shares land borders with Scotland to the north and Wales to the west; the Irish Sea is to the north west, the Celtic Sea to the south west, with the North Sea to the east and the English Channel to the south separating it from continental...
physician
Physician
A physician is a health care provider who practices the profession of medicine, which is concerned with promoting, maintaining or restoring human health through the study, diagnosis, and treatment of disease, injury and other physical and mental impairments...
. He was born at Wynford Eagle in Dorset
Dorset
Dorset , is a county in South West England on the English Channel coast. The county town is Dorchester which is situated in the south. The Hampshire towns of Bournemouth and Christchurch joined the county with the reorganisation of local government in 1974...
, where his father was a gentleman of property. His brother was Colonel William Sydenham
Colonel William Sydenham
William Sydenham was a Cromwellian soldier; and the eldest brother of Thomas Sydenham. He fought for Parliament and defeated the Royalists in various skirmishes in Dorset. He was member of the various parliaments of the Commonwealth, avowal conservative principles, and defended the liberties of...
. Thomas fought for the Parliament
Parliament
A parliament is a legislature, especially in those countries whose system of government is based on the Westminster system modeled after that of the United Kingdom. The name is derived from the French , the action of parler : a parlement is a discussion. The term came to mean a meeting at which...
throughout the English Civil War
English Civil War
The English Civil War was a series of armed conflicts and political machinations between Parliamentarians and Royalists...
, 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
Hippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
’. Among his many achievements was the discovery of a disease, Sydenham's Chorea
Sydenham's chorea
Sydenham's chorea or chorea minor is a disease characterized by rapid, uncoordinated jerking movements affecting primarily the face, feet and hands. Sydenham's chorea results from childhood infection with Group A beta-hemolytic Streptococci and is reported to occur in 20-30% of patients with...
, also known as St Vitus Dance.
Education
At the age of eighteen Sydenham was entered at Magdalen Hall, OxfordMagdalen College, Oxford
Magdalen College is one of the constituent colleges of the University of Oxford in England. As of 2006 the college had an estimated financial endowment of £153 million. Magdalen is currently top of the Norrington Table after over half of its 2010 finalists received first-class degrees, a record...
; 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
English Civil War
The English Civil War was a series of armed conflicts and political machinations between Parliamentarians and Royalists...
. 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
All Souls College, Oxford
The Warden and the College of the Souls of all Faithful People deceased in the University of Oxford or All Souls College is one of the constituent colleges of the University of Oxford in England....
. It was not until nearly thirty years later (1676) that he graduated as M.D., not at Oxford, but at Pembroke Hall, Cambridge
Pembroke College, Cambridge
Pembroke College is a constituent college of the University of Cambridge, England.The college has over seven hundred students and fellows, and is the third oldest college of the university. Physically, it is one of the university's larger colleges, with buildings from almost every century since its...
, where his eldest son was by then an undergraduate.
After 1648 he seems to have spent some time studying medicine at Oxford
Oxford
The city of Oxford is the county town of Oxfordshire, England. The city, made prominent by its medieval university, has a population of just under 165,000, with 153,900 living within the district boundary. It lies about 50 miles north-west of London. The rivers Cherwell and Thames run through...
, 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
Oliver Cromwell
Oliver Cromwell was an English military and political leader who overthrew the English monarchy and temporarily turned England into a republican Commonwealth, and served as Lord Protector of England, Scotland, and Ireland....
, 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
Montpellier
-Neighbourhoods:Since 2001, Montpellier has been divided into seven official neighbourhoods, themselves divided into sub-neighbourhoods. Each of them possesses a neighbourhood council....
. In 1663 he passed the examinations of the College of Physicians for their licence to practice in Westminster
Westminster
Westminster is an area of central London, within the City of Westminster, England. It lies on the north bank of the River Thames, southwest of the City of London and southwest of Charing Cross...
and 6 miles round; but it is probable that he had been settled in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
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
John Mapletoft
-Life:His father was Joshua Mapletoft, vicar of Margaretting and rector of Wickford, Essex, and his mother Susanna, daughter of John Collet by Susanna, sister of Nicholas Ferrar of Little Gidding. She afterwards married James Chedley, and, dying on 31 October 1657, was buried at Little Gidding....
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
Robert Boyle
Robert Boyle FRS was a 17th century natural philosopher, chemist, physicist, and inventor, also noted for his writings in theology. He has been variously described as English, Irish, or Anglo-Irish, his father having come to Ireland from England during the time of the English plantations of...
, 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
Charing Cross
Charing Cross denotes the junction of Strand, Whitehall and Cockspur Street, just south of Trafalgar Square in central London, England. It is named after the now demolished Eleanor cross that stood there, in what was once the hamlet of Charing. The site of the cross is now occupied by an equestrian...
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
John Locke
John Locke FRS , widely known as the Father of Liberalism, was an English philosopher and physician regarded as one of the most influential of Enlightenment thinkers. Considered one of the first of the British empiricists, following the tradition of Francis Bacon, he is equally important to social...
.
Published works
His first book, Methodus curandi febres (The Method of Curing Fevers), was published in 1666; a second edition, with an additional chapter on the plagueBubonic plague
Plague is a deadly infectious disease that is caused by the enterobacteria Yersinia pestis, named after the French-Swiss bacteriologist Alexandre Yersin. Primarily carried by rodents and spread to humans via fleas, the disease is notorious throughout history, due to the unrivaled scale of death...
, 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
Robert Brady (writer)
Robert Brady was an English academic and historical writer supporting the royalist position in the reigns of Charles II of England and James II of England. He was also a physician.-Biography:...
, regius professor of physic at Cambridge, and the other "On the Lues venerea," (On [Venereal Diseases]) to Henry Paman
Henry Paman
-Life:Son of Robert Paman, he was born at his father's estate of Chevington, Suffolk. He entered as a sizar at Emmanuel College, Cambridge, on 22 June 1643, where William Sancroft was his tutor. They became friends for life. He migrated to St. John's College, on 22 July 1646, graduated B.A. the...
, public orator at Cambridge and Gresham Professor of Physic
Gresham Professor of Physic
The Professor of Physic at Gresham College in London, England, gives free educational lectures to the general public. The college was founded for this purpose in 1596 / 7, when it appointed seven professors; this has since increased to eight and in addition the college now has visiting...
in London.
In 1682 he published another Dissertatio epistolaris (Dissertation on the Letters), on the treatment of confluent smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
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
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
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.
Father of English medicine
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 HippocratesHippocrates
Hippocrates of Cos or Hippokrates of Kos was an ancient Greek physician of the Age of Pericles , and is considered one of the most outstanding figures in the history of medicine...
, 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
Laudanum
Laudanum , also known as Tincture of Opium, is an alcoholic herbal preparation containing approximately 10% powdered opium by weight ....
(the first form of a tincture of opium
Opium
Opium is the dried latex obtained from the opium poppy . Opium contains up to 12% morphine, an alkaloid, which is frequently processed chemically to produce heroin for the illegal drug trade. The latex also includes codeine and non-narcotic alkaloids such as papaverine, thebaine and noscapine...
), and for his advocacy of the use of "Peruvian bark" in quartan agues, in modern terms, the use of quinine
Quinine
Quinine is a natural white crystalline alkaloid having antipyretic , antimalarial, analgesic , anti-inflammatory properties and a bitter taste. It is a stereoisomer of quinidine which, unlike quinine, is an anti-arrhythmic...
-containing cinchona
Cinchona
Cinchona or Quina is a genus of about 38 species in the family Rubiaceae, native to tropical South America. They are large shrubs or small trees growing 5–15 metres in height with evergreen foliage. The leaves are opposite, rounded to lanceolate and 10–40 cm long. The flowers are white, pink...
bark for treatment of malaria
Malaria
Malaria is a mosquito-borne infectious disease of humans and other animals caused by eukaryotic protists of the genus Plasmodium. The disease results from the multiplication of Plasmodium parasites within red blood cells, causing symptoms that typically include fever and headache, in severe cases...
caused by Plasmodium malariae
Plasmodium malariae
Plasmodium malariae is a parasitic protozoa that causes malaria in humans. It is closely related to Plasmodium falciparum and Plasmodium vivax which are responsible for most malarial infection. While found worldwide, it is a so-called "benign malaria" and is not nearly as dangerous as that...
. 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
Richard Morton (physician)
Richard Morton was an English physician who was the first to state that tubercles were always present in the tuberculosis disease of the lungs. In Morton's time, this wasting disease was termed consumption, or by its Greek name of phthisis...
and Thomas Browne
Thomas Browne
Sir Thomas Browne was an English author of varied works which reveal his wide learning in diverse fields including medicine, religion, science and the esoteric....
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
Martin Lister
Martin Lister FRS was an English naturalist and physician.-Life:Lister was born at Radcliffe, near Buckingham, the son of Sir Martin Lister MP for Brackley in the Long Parliament and his wife Susan Temple daughter of Sir Alexander Temple. Lister was connected to a number of well known individuals...
'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
Scotland
Scotland is a country that is part of the United Kingdom. Occupying the northern third of the island of Great Britain, it shares a border with England to the south and is bounded by the North Sea to the east, the Atlantic Ocean to the north and west, and the North Channel and Irish Sea to the...
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 Oration
Harveian Oration
The Harveian Oration is a yearly lecture held at the Royal College of Physicians of London. It was instituted in 1656 by William Harvey, discoverer of the systemic circulation. Harvey made financial provision for the college to hold an annual feast on St...
s at the College of Physicians, Sydenham is first mentioned in the oration of Dr John Arbuthnot
John Arbuthnot
John Arbuthnot, often known simply as Dr. Arbuthnot, , was a physician, satirist and polymath in London...
(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
Albrecht von Haller
Albrecht von Haller was a Swiss anatomist, physiologist, naturalist and poet.-Early life:He was born of an old Swiss family at Bern. Prevented by long-continued ill-health from taking part in boyish sports, he had the more opportunity for the development of his precocious mind...
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
Hypochondria
Hypochondriasis or hypochondria refers to excessive preoccupation or worry about having a serious illness. This debilitating condition is the result of an inaccurate perception of the body’s condition despite the absence of an actual medication condition...
was at length told he could do no more for him, but that there was living at Inverness
Inverness
Inverness is a city in the Scottish Highlands. It is the administrative centre for the Highland council area, and is regarded as the capital of the Highlands of Scotland...
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
Richard Blackmore
Sir Richard Blackmore , English poet and physician, is remembered primarily as the object of satire and as an example of a dull poet. He was, however, a respected physician and religious writer....
. 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."
Quotations
"Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium""It becomes every man who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care. Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for his glory, and the good of mankind, and not for mere gain or ambition. Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man, and thus ennobled it with his divine dignity, and far more than this, died to redeem it. And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer."
Nosology
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
Giovanni Battista Morgagni
Giovanni Battista Morgagni was an Italian anatomist, celebrated as the father of modern anatomical pathology.-Education:...
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 (in Sched. monit.). After small-pox, the diseases to which he refers most are hysteria
Hysteria
Hysteria, in its colloquial use, describes unmanageable emotional excesses. People who are "hysterical" often lose self-control due to an overwhelming fear that may be caused by multiple events in one's past that involved some sort of severe conflict; the fear can be centered on a body part, or,...
and gout
Gout
Gout is a medical condition usually characterized by recurrent attacks of acute inflammatory arthritis—a red, tender, hot, swollen joint. The metatarsal-phalangeal joint at the base of the big toe is the most commonly affected . However, it may also present as tophi, kidney stones, or urate...
, 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."
Death
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, PiccadillyPiccadilly
Piccadilly is a major street in central London, running from Hyde Park Corner in the west to Piccadilly Circus in the east. It is completely within the city of Westminster. The street is part of the A4 road, London's second most important western artery. St...
, 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
Pall Mall, London
Pall Mall is a street in the City of Westminster, London, and parallel to The Mall, from St. James's Street across Waterloo Place to the Haymarket; while Pall Mall East continues into Trafalgar Square. The street is a major thoroughfare in the St James's area of London, and a section of the...
. It was put there by the now defunct 'Sydenham Society’.
Biographies
Among the lives of Sydenham are one (anonymous) by Samuel JohnsonSamuel Johnson
Samuel Johnson , often referred to as Dr. Johnson, was an English author who made lasting contributions to English literature as a poet, essayist, moralist, literary critic, biographer, editor and lexicographer...
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. See also Frédéric Picard, Sydenham, sa vie, ses œuvres (Paris, 1889), and JF Payne, T. Sydenham (London, 1900). Dr John Brown
John Brown (doctor)
John Brown was a Scottish physician.Brown was born in Berwickshire and after attending the parish school at Duns, he moved to Edinburgh and enrolled in divinity classes at the university of Edinburgh and worked part time as a private tutor...
'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.