1902 Encyclopedia > Thomas Sydenham

Thomas Sydenham
English physician and founder of modern clinical medicine

THOMAS SYDENHAM (1624-1689), "the English Hippocrates," was born at Winford Eagle in Dorset in 1624, where his father was a gentleman of property and good pedigree. At the age of eighteen he was entered at Magdalen Hall, Oxford ; after two years his college studies appear to have been interrupted, and he served for a time as an officer in the army of the Parliament. 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 then an undergraduate. His interest in medicine seems to have been aroused at an early age. Nothing is known of Sydenham's life between 1648 and 1663 ; but it is probable that he spent part of the time at Oxford. It is said also (on the authority of one Desault, in a work published at Bordeaux in 1733) that he studied at Montpellier, although it is not so stated by himself in his dedicatory letter to Dr Mapletoft, among the other autobiographical facts there given. In 1663 he passed the examinations of the College of Physicians for their licence to practise 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 practise was the single bond between Sydenham and the College of Physicians throughout the whole of his career. He seems to have been distrusted by the heads of the faculty because he was an innovator and something of a plain-dealer. In his letter to 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"; 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 taking 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 John Locke and Robert Boyle. His first book, Metlwdus Curandi Febres, was published in 1666; a second edition, with an additional chapter on the plague, in 1668; and a third edition, much enlarged and bearing the better-known title of Observationes Medicse, in 1676. His next publication was in 1680 in the form of two Fpistolse Responsorix, the one, "On Epidemics," addressed to Brady, regius professor of physic at Cambridge, and the other, " On the Lues Venerea," to Paman, public orator at Cambridge and Gresham professor in London. In 1682 he issued another Dissertatio Epistolaris, on the treatment of confluent smallpox and on hysteria, addressed to Dr Cole of Worcester. The Tractatus de Podagra et Hydrope came out in 1683, and the Schedula Monitoria de Novx Febris Ingressu in 1686. His last completed work, Processus Integri, 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 at home and abroad 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 original Latin.

Hardly anything is known of Sydenham's personal history in London. He died in an acute paroxysm of gout in December 1689. He was buried in the church of St James's, Piccadilly, where a mural slab was put up by the College of Physicians in 1810.

Although Sydenham was a highly successful practitioner and saw more than one new edition of his various tractates called for, besides foreign reprints, in his lifetime, his fame as the father of English medicine, or the English Hippocrates, was decidedly posthumous. For a long time he was held in vague esteem for the success of his cooling (or rather expectant) treatment of smallpox, for his laudanum (the first form of a tincture of opium), and for his advocacy of the use of Peruvian bark in quartan agues. There were, however, those among his contemporaries who understood something of Sydenham's importance in larger matters than details of treatment and pharmacy, chief among them being the talented Morton. But the attitude of the academical medicine of the day is doubtless shown forth in 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 doubt that the opposition to him was quite other than political, it would be set at rest by the testimony of Dr Andrew Brown, wdio 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 Arbuthnot (1727), who styles him "aemulus Hippocratis." 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 Phcebum, veram Hippocratici viri speciem." 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. All the 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 who was a victim to hypochondria was at length told by Sydenham that 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 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 patient's 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. Doctrines of disease he had, as every practitioner must have ; but he was too much alive to 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; and his treatment was what he found to answer best, whether it were secundum artem 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 tj'pe, 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." 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 Observationcs Medicm 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, tlepi aipuv, voarac, TOTTIHV ; 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 smallpox, 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 R. G. 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."

The most critical biography is that by Dr K. G. Latham prefixed to his translation of Sydenham's Works (2 vols., London, 1848, Syd. Soc). Dr John Brown's " Locke and Sydenham," in Horse Subsecivie, Edinburgh, 1858, is more of the nature of eulogy. Many collected editions of his works have been published, as well as three English translations. Dr W. A. Greenhill's Latin text (London, 1844, Syd. Soc.) is a model of editing and indexing. There have been foreign monographs on Sydenham by Goeden (Berlin, 1S27), Rovers (Dort, 1838), P. Jahn (Eisenach, 1840), and Hvasser (Upsala, 1846). The most interesting summary of doctrine and practice by the author himself is the introduction to the 3rd ed. of Observations Medicse (1676). (C. C.)

The above article was written by: Charles Creighton, M.D.

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