Nov. 1S, r924] TERCENTENARY OF- THOMAS SYDENHAM IMCDICL JOUBNAl 919 Nov. _T9 practice and literary output, and eventually he died on December 29th, 1689, in his house in Pall Mall, where he THOMAS SYDENHAM: HIS WORK AND had lived since 1667, and was buried in St. James's Church, CHARACTER. Piccadilly, where a tablet, erected in 1810 by the College of BY Physicians, in the south wall aisle, eloquently describes him ARNOLD CHAPLIN, M.D., F.R.C.P., as " Medicus in omne aevum nobilis." HARVEIAN LIBRARIAN. To recall his works by name would be as uninecessary as it would be lengthy, for they are immortal, especially those IN the annals of medicine in this country three men may dealing with fevers, the distinction for the first time of be found who, by universal consent, are honouired above scarlet fever from measles and of rheumatism from gout, all others. They are William Harvey, John Huniter, .nad and the classical descriptions of chorea and of hysteria. Thomas Sydenham. Special measaries have been takeni to Scholarly criticism has been much concerned about the ques- prevent the glory belonging -to Harvey and Hunter from tion whether Sydenham originally wrote in English or in ever becoming dim, for a wise prevision has established Latin; the conclusion that appears to have most in its favouil societies and annual orations designed to perpetuate in is that he composed in the language he spoke, and that Dr. the minds of medical men the memory of those gireat John Mapletoft and Gilbert Havers, a scholar, did his text pioneers in medical and surgical scienice. But Thomas into Latin. But whatever medium he used he painted from Sydenham, although his labours have left an effect upon Nature, and, with the artistic instinct of a great clinician, medicine scarcely less than the work of the other two, hias emphasized the essential and kept the immaterial in due never been honoured by an annual oration for the purpose proportion. of keeping alive the memory of his great achievemenits. In his attitude of " back to Hippocrates," whom he called Indeed, apart from the society for medical publicationis ." the divine old man2" and the principle of observation bearing his name, the issue from time to time cf bis rather than the precepts of authority, Sydenham insisted collected writings, and attempts, sometimes inadequate, to on the importance of the accurate description of the natural portray his life and activities, but little has been dono to history of diseases, the constant and essential symptoms fix the public gaze upon the monumental work of thuis being distinguished from the accidental; he also advocated their separation into species, as in the classification of .. animals and plants, there being a common resemblance in their seasonal variations. Thus regarding diseases as specific, he urged that specific remedies should be sought for them. Sydenham has accordingly been regarded as the founder of scientific nosology. Further, he urged that a definite system of treatment should be established on rational grounds instead of on polypharmacy. As J. F. Payne, in comparing these two Masters of Medicine, wlho, as far as we know, never met, writes, Sydenham was the Master of Practice, while his contemporary William Harvey was the Master of Science. The importance of Sydenham's practical outlook cn medicine can hardly be over-emphasized, but this is l)ot his only claim on our remembrance; for in his attempts to obtain a cure for epidemic fevers he made observations on their incidence and variations which led to his famous hypothesis of " epidemic constitutions "-a somewhat nmysterious conception of a more elaborate character than Isaawc Bariow's certificate, slhowing the date of Sydenhlam's degree; those of Hippocrates and Ballonius (Guillaume Baillou) in the possession of the Royal College ot Ph3 sicians. in 1574. His view of acute, especially epidemic, diseases was to the effect that they were modified by the additionial most " English " of English physicians-this rugged geniu.s factor of a constitution or influence derived not only from wrho, unaided, laid the sure foundations of clinical medlicinle. the atmospheric and weather conditions, as Hippocrates Now, in this year 1924, three hundred years after his birth, believed, but from telluric and other sources; thus upon a tardy recognitionl of his merit is being laid at his shrinle a specific disease, in the modern bacteriological sense, are French medicine, ever ready to award a scientific crown superimposed features due to a common factor, which, wzherever it is deserved, irrespective of nationlality, has however, varies in the course of years and gives rise to already paid its tribute to one of England's greatest what he termed " stationary fevers." Thus in the years medical sons. And now a great journal, voicing th)e 1661-64 "the epidemic constitution " was malarial, in thougfhts of thousands of British medical practitioners, in 1665-66 plague-like, and in 1666-69 like small-pox. That tihe tongue that Sydenham spake, and in tile lanld that accomplished scholar-physician, the late Joseph Frank bared him, is placing on record its deep appreciation of tile Payne-sometime our Harveian Librarian-in his masterly work he accomplished. At the same time theB Royal College life of Sydenham expressed the hope that his " sketch of Physicians, of which body Sydenham was a distinguished should induce some readers to study for themselves member, has held a special evening session, and throughl Sydenham's own works." Since then several Fellows of the mouth of its President, Sir Hump)hry Rolleston, hiic- the College-Sir William Hamer, Dr. F. G. Crookshank, self a great clinical physician, has paid the debt it owes Dr. Major Greenwood-have devoted much thoughtful for the glory of having the name of Sydenham onl its roll. and to the epidemic constitutions, and Sydenham Thlis action of the College of Physicians is peculiarly fittinlg, hasconsiderationbeen rightly described by Dr. E. W. Goodall as " the for it is well known that, for reasons somewhat ob)scure Founder of the modern science of epidemiology." By a kind to us at the present time, Sydenham nevter applied for the :f prophetic sense he seems to have foreseen that bactelio- Feellowsllip of the College, nor was that honour ever offered [ogy might appear and be held to explain the whole question hlim, although for the last thirteen years of his life ho ' as Af the incidence of acute disease, and at any rate he in every way eligible. Bult thlis gatherinlg of the Fellows -rovided reservations to such a simple and exclusive of the Csollege in the twentieth century, for the purpose of ,onception. dloing honour to Sydenham's name, wvill surely be regardedl Thus the three-hundredth anniversary of the birth of as an adequate act of penance for its omission thlree ;ie Father of Clinical Medicine in Britain and the Prince centuries ago. Nor must we feel aggrieved that medicine )f Practical Physicians, of the Founder of the modern in a foreign land lhas peaid its tribute first to our Sydenlau!l ;cience of epidemiology, and of the originator of scientific in this year, the tercentenary of his birtil, for his influence mosology, " the incomparable Sydenham," should be kept upron medlicine w.as so great that it left its mark in a grateful and proud remembrance in his Country and XwllatsoeYer land it was p)ractised. It knew no national Jollege. boundaries. 'That vigorous intellect wrought for all timre r T Bitmsf 920 NoV. I5, I9241 TERCENTENARY OF THOMAS SYDEN-IAM. L MEDICAL Joiua2A.
and for all countries, and we do not, therefore, grudge our forth to the stern business of fighting for the Puritans colleagues their first-offerings of homiage to the niame of against the Royalists. Thomas Svdehllam. Long before the actual struggle began, the Sydenilini It is not the purpose of this article to write a biography family had become deeply committed to the Puritan cause, of Sydenlisam, for that has been done with great ability and Thomas Sydenham was therefore brought up undler and discrimiination by the late Dr. Payne; but rather to strict Puritan influences. The adherence of the family to consider his character, his mental environment, and the this cause was no mere formal acceptance of its tenets) results for us to-day of his work. Some biographical for, when the civil war broke out, the father and his fix-e details will, however, be necessary in order to appreciate sons bore arms for the sake of their consciences on the side the true position occupied by Sydenham as a great medical of the Puritans, and two of them lost their lives in battle. reformer. Thomas Sydenham had only been at Oxford for a few Thomas Sydenham was born in 1624, at the Manor House months when the summons came. He at once threw aside of Wyynford Eagle, in the counity of Dorset. The exact the gown for the sword, anid took his place beside his valiant date of his birth is not recorded, and it can only be stated brothers, ready to risk all for the honour of his belief. that he was bap- So far as is tized on Septem- of A ohrmember ber 10tht:z.d{[LSUvA~~~~~~~~~~~~~~~~~~~~~m;-of that ...... year. He camie the College ofof f rom an old Phiysicians, Dr. So me rsetshli r Mairtin Llewellyni, family dating back actaly bore armis to the time of the p of Ihe Ro Vin the civil war. King John, wichic acahe Ilowing s l av ~t the conclusio ni multiplied exceed-at thIt is a wellkept .~of the first civil ingly. for no less o g s tn h e s t h an e ig h t J,. ~~gaini repaired to branches were b e p mae aOxfoi d in 1646, founded in that tion of that brief period ofstudy,lastinglesand acting oni county. One of I the l c the atlvice of Dr. the branches was a t g ~~7j7~~~ il- ~Thioii is Coxe, a settled at Aller,of he totph3-sicidaie in the and a cadet of tsis c branch acquirhe,ds .t psariiin, devoted in the middle of i O hiimself to the the sixteenth cen it study of medicine. the Manior tury, himsel with hisifm 1648, being of Wynford Eagle t ieni a Fellowi- fromi Lord Zouich, Comimoner of of Harringworth. College, The Manor of ,adhiam Wyniford Eagle lie took the degree once formed part commendationwars eof of the great Honor teCancellor,Sydenhamtheo of the Eagle, Eail of Pe mibroke, granited by the and a few monithis Conqueror to one latei was elected of hiis companions, Gilbert, whlose Souls. In 1650 he chief castle was againi obeyed the at Pevensey in Sussex. Gilbert call to serve camie from Aigle iin Scot- (A1quilla) in Nor- landyedin niandy, and theo and else. -~~~~ but thei e Honor no doubt Nk -.,ij~ wlieire, is no evidence that derived its name he wvas present at fr-om that source. the battle of Wor- The Manor cester, as has beeni House of Wynford Diploima granted to 'Sydenham on'tak'ing the degr -e of M.D. at Cambridge. From the document in asseirted. After of the College of ~~~~~~thepossgession Ro, 'ai Physicians, this Sy denham re- itself at the bottom of a shallow valley in the downs of mained at Oxford until 1656, w~hen he iemoved to Londoni Dorsetshire, with a clear chalk s-tream flow ing swiftly in a and settled himself in practice in W1estmuinstei. During theo miasoned channel at the end of the It is a well garden. kept year 1659 he paid a visit to Mloitpellier, but wsith the excep- suibstantial of stone stained Its building grey w~ith lichen. tion of that brief period of study, lasting less than a year, are of red brick in the of the chimneys picturesque style Sydenhamn's career was uncolinect-ed with any of the medical early seventeenth It has the casemented century. large schools abroad. It was not until 1663, although he had already windows of the and the walls and of period, garden paits been in practice in Lonldon for somie y ears, that he obtained the side walls of the house are composed of the charac- the Licenice of the Coll-ege of Phy sicians to piractise, anid in teristic local flints in In the centre of chipped panels. the 1676 lie took the M.D. degree at Cambridge. When the front of the house, which faces w est, is a projecting porch great plague devastated London, Sydenham followed the wiith a room over it. On its gable is placed an eagle in example of niearly all the London phy sicians, and absented and -stone, under it the date 1630. Another eagle of older hiimself with his f'amily fiom Westminster. This actioni (late, and much battered, taken dowlln probably when the must always be a matter for regret, for, hiad lie been lhouse was repaired, still stands at the top of some steps present, we might have possessed an almost perfect clinical iii the yard. In 1630 Thomas Sydenham was 6 years old, picture of that great epidemic. But during his absence and, save for some inconspicuous farm buildings, the place from Londoni he was nlot idle, for he begani to place oni must be now very much as it was inl his boyhood. It looks record the results of his owln observations concerniing to-day a very home of ancient peace, though in Svdenlhanm's disease, and especially fevers. Since the year 1661 he hiad time it gave shelter to a family of valiant sons wvho issued been engaged in taking these niotes, and in 1666 he gave [ BRITISW tTOV. T5, 19241 TERCENTENARY OF THOMAS SYDENHAAT. L MEDICALTHh JOURXAL 921 to the world his first work, llethoduts Curandi Febres, in the symptoms of that complaint is so vivid and true that which the, treatmenit of disease was approached from an writers have been content to follow it witlhout alteration. entirelv niew standpoint. While advocating his new clinical nmetlhod in his book on This book of Sydenlhanam may be regarded as epoch-making, fevers, Sydenlham laid the founidation of the study of for it was the first treatise fouinded on the personal observa- epidemiology, and may tlherefore be regarded as tlle father tioni of the plhysician at the bedside when attending cases. of that branch of mediciiie in this country. Befoire lhis time it was the almost universal practice of In estimating the cast of mind of Sydenhliam regard must physiciains, when writinog of disease, to appeal entirely to the be paid to his upbringing. He was nlurttured iii a strict anlcient authorities, and to neglect what their own senses lhad Puritan household, and tllrouglhout hiis work the Puritan taught them. Vesalius and Harvey had already definitely influence is abundanitly evident. He hia(d risked hiis life broken witlh this tradition in the sciences of anatomy and on the field of battle for the cauise he believed to be righlit, physiology, and it was reserved for Sydenham to take the and he was just as ready to risk unpopularity andl criticimlll same bold step in medicinie. With a knowledge, scant it in promulgating views concernino thle practice of mediciiie may be, of the principles of medicine, he literally rejected wlhich were new, and tlherefore suspect. He ofteni con- all that had been written concerniing the practice, and r-elied plained, somewlhat bitterly, of the adverse criticism of dis absolutely oi Iiis own unirivalled powers of observation. conitemporaries, but, like a tinte Puritaii, it could lot tulrni Withl two important exceptions, Sydenlham had a profound him a lhair's breadtli firom the course lie had planniied. conitemipt for the knowle(lge of In medeicine hiis wvas, a voice medlicine to be fouiid in. book's elugin in. the wilderness, and(l both ancienit and modern, and M.~ ~ *-;aa|faiii as al8[P0uriitani lie pirobablvsll to the last refused to be influi- ...,..,N.~>....a 'elited the position with somlle enced by th-eir authority. The ~. ~ o~; ~i::2 ~ stisfactioiid He drove teachiings of anatomy and( -k m teP Igreat truth that the lioioiesu.- physiology, whic had received S f -