' 143 , THE ENGLISH HIPPOCRATES.

"THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES."1 % w. H. Coupland, L.R.C.P.Edin., Senior Assistant Medical Officer, The Royal Albert Asylum for Idiots, Lancaster. Gentlemen,?Iii the paper that1 had the this Club, entitled "Sir Thomas Browne, ^"^^^anyhmen- tioned pmitpinnoraries, and quoted an anecdote concerning one of his Thomas the of theo^mp ^ Sydenham, greatest ^ and one called tl century, who has been _ J ^ Of in e 0f niy him I purpose to and speak to-night, him remarks I shall mention others of his time v, ^uenced either m the intellectualinteilec by their friendship or by their position world of that day. . , .j t <-omi can must of be omi ,, only Many particulars necessity ^ attempt a mere sketch of his career, leaving 5 c ^ have used interest is aroused, to refer to some of the ma and ia en^on t0 which is before me; and among this I } the editions of the works of Sydenham issue? Sydenham " J,,. f0 the "Life to the of National Biogi y > Society; Dictionary (< iiellt of written Dr. Samuel John on Sydenham," by ^ Mr. and to^m Doctors," by Bettany; also "Masters of " Series, writtenespecially^: b) ? Payne-who wrote the article in the " Dictionary of a, 1 i>;0crraphy,"?a ^ book to am accu ' 0rmation, many which I indebted for much , points in the career of our hero jn obscurity, j?emS ivnwn ' to be found Lastly, to that essay, by in " delightful L>i-0111, friend Horae Subsecivl," in which j Locke, the are so > My physician-philosopher, and has paper is, I will at once confess, but a mass extracts, common been compiled the aid of scissoi s 1 only by jc factor in the of literary work, for, like Molieie, 1prcnds tnon hi*? -.v. etiology i j 111011 bien ou jc le trouve. Thomas Sydenham, " the man of many

vnown Sydenham's mother was killed auiiu0 for the have been year 1644. His stay in the army cannot of the Lancastei rjlni "^T a(Wress delivered at tlie annual meeting 2,Kia.uuar y "or. in- Med. Joum., April 1905. 144 W. H. COUPLAND. in 1648 he took the degree of Bachelor of Physic at Oxford, very little preparation for which sufficed in those elastic days, when curricula and degrees could be easily attained by influence, either active or passive. On 3rd October of the same year he was made a Fellow of All Souls' College in the place of one of the expelled Eoyalists, and after staying at the for some little time, " university according to Desault in his Dissertation on Consumptions," he took a journey to the celebrated at Montpellier in France. It seems that he took up the study of medicine owing to the influence and advice of a Dr. Th. Coxe, for in his " Medical Observations," third edition, Sydenham wrote:

" It is now the thirtieth year since the time when, being on my way to London, in order to go from thence a second time to Oxford (from which the misfortunes of the first war had kept me for some years), I had the good fortune to fall in with the most learned and honourable Dr. Thomas who was Coxe, at that time attending my brother during an and as illness, then, he has been up to the present time, practising medicine with great distinction. He, with his well-known kindness and courtesy, asked me what profession I was preparing to enter, now that I was resuming my interrupted studies, and was come to man's estate. I had at that time no fixed plans, and was not even dreaming of the profession of medicine ; but moved by the recommendation and influence a of so great man, and in some way, I suppose, by my own destiny, I applied myself seriously to that pursuit. And certainly, if my efforts have turned out to be of the least public utility, the credit must be referred to was thankfully him who the patron and promoter of my early studies. After spending a few years in the university, I returned to London and entered on the practice of medicine."

It is probable, although the point had not been settled in Dr. mind when he Payne's wrote his life, that Sydenham was pre- sented with the M. A. degree; however, by command of the Earl of Pembroke, he was inducted to the Bachelorship of Medicine on 14th April 1648, and it is apparent that this installation was hurried on to allow of him being made a Fellow of All Souls', as has been previously mentioned. Unlike practitioners of to-day, he obtained his qualification at the beginning instead of at the end of his student's course, but we shall with the remark of " agree apt Dr. Payne, who says, If we consider the incalculable gain to the science of medicine involved in making Sydenham a doctor, we must admit that seldom has the blind Goddess of Patronage dis- pensed her favours with a happier hand." The year 1647 was a stirring one for the University of Oxford, for the Parliament then appointed Visitors, of necessity advanced Puritans, to control it and to make fresh appointments. Any opposition was futile, as the University had to capitulate to the Earl of Pembroke in March 1648, who expelled about 400 Eoyalists; and we learn that in "THOMAS SYDENHAM, THE ENGLISH HIPrOCEATES." 145

September, the month after the overthrow had been completed, Sydenham entered Wadham College as a Fellow Commoner, lor views of some colleges at this time we can consult the volumes of Alumni Oxoniensis, one of which is before me. Some of the men thus forcibly introduced were afterwards famous, the names including Wallis, the mathematician; Seth Ward, Professor of Astronomy, one who had been previously ejected from Cambridge; also the celebrated Willis, of the group of Invisible Philosophers, the forerunners of the Boyal Society of London; there was Jonathan Goddard, Warden of Merton College and Cromwell's physician, who, it has been reported, made the first telescope in England; and many others, of whom we can learn much in the pages of the amusing, if not too accurate, historian, Anthony a Wood. He describes some of the scholars who came from Cambridge, "as the dregs of the neighbour University," as having a peculiar cut of their hair, which he styled the committee cut, with their clothes so shabby that they looked like apprentices or antiquated schoolboys. During the Puritan rule there were vastly more sermons than the modern Verdant Green would care . to hear, much less to transcribe, which was then the regulation. In his history of the Rebellion, Clarendon confesses that the " depopulation so roughly carried out yielded a harvest of extra- ordinary good and sound knowledge in all parts of learning," and, as has been noticed often in the course of the world's history, a period of political or military activity is succeeded by a revival of mental and intellectual output. This was so at this time, for the Eenaissance must be largely credited to the influence of the Commonwealth and not to that of Charles it., the Puritans making their appointments with great foresight, and choosing young men for promotion, while the scholars were kept under stern, steady discipline, which certainly increased their industry. Regarding medicine, Dr. Norman Moore remarked in the Lectures^ " Fitzpatrick of last year, that Sydenham is often regarded as the originator of modern medicine; his works might also be considered the culmina- tion of the effects of the Eenaissance." John Evelyn visited Oxford in 1654 and at other times, and in his diary has left us an impres- sion of the people he met there; he thought Dr. Wm. Petty, who was the deputy reader in Anatomy, a genius, for indeed he was a master of many sciences, being really the one who founded the study of demography or vital statistics. Petty was a friend of Hobbes of Malmesbury, and if Sydenham had been at all interested in anatomy he could not but have benefited by contact with him, and so lessened the narrow view he always had of matters scientific, since doubtless Hobbes' method of looking at phenomena would have appealed to him, filtered as it would have been through Petty's mind. The statutes authorised one dissection yearly, performed in the Lent term if possible; and in 1650 it fell to Petty's lot to revive a woman, named Anne Greene, who had been hung at 10 ED. MED. 626?NEW SER.?VOL. XXII.?II. 146 \V. H. COUPLAND.

Oxford, but whose body on being brought for dissection was found not to be dead, the case creating much interest at the time. At Oxford at this period the opportunities for medical study were small. There was no clinical work, but a bi-weekly lecture by the Professor of Medicine 011 a text from the writings of Hippocrates or Galen. There was some regular teaching on anatomy, a subject which never appealed to Sydenham, and for the want of a knowledge of which he made some serious mistakes later as in his writings on, for instance in his work on Dropsy. in our Lower, associated minds with the tubercle of that name, the all-round and genius Christopher Wren?better known as an architect than as a scientist?founded their work on a know- ledge of the circulation which for " Sydenham entirely ignored, he We said: may know the larger organs of the body, but its minute structure will always be hidden from us. No microscope ever show us will the minute passages by which the chyle leaves the intestine, or show by which the blood passes from the arteries to the veins," this passage being written, be it noted, twenty years after the capillaries had been demonstrated by Malpighi. In another place he stated that the human intellect will never be able to understand the use of the different parts of the brain, forgetting altogether what Galen had done centuries before, too the own ignoring work of his contemporary Willis,1 a name familiar to us in student days by the Circulns Willisii at the base of the brain, for whose work on this subject Wren did the drawings. The dogmatic argument from ignorance is always and illogical generally dangerous; and one can only say in defence of Sydenham, that, like many another original investigator, he was somewhat one-sided, for in later years he had as a pupil , the collector who gave that wonderful library and collection of manuscripts to London to form the nucleus of the British Museum. When this individual as a young man came to see Sydenham, bringing with him a letter of introduction, in " he was as which described ripe scholar, a good botanist, a skilful anatomist," the English looked him and " Hippocrates up down, and remarked, This is all very fine, but it won't do?Anatomy ?Botany. Nonsense! Sir, I know an old woman in Covent who Garden understands botany better; and as for anatomy, my can dissect a butcher joint full as well. No, young man, all this is stuff: you must go to the bedside; it is there alone you can learn disease." Charles II. landed in Scotland in June 1650, and, on the departure of Cromwell to meet him, a great fear arose in England that there would be a rising against the Parliament, so three thousand militia were called out, and there is much evidence that Sydenham took up an important command, for he was certainly 1 The discoverer of diabetes. 147 "THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES."

" known as Captain." It is probable that he was with Eich s forces 011 the Border, and in travelling to the bridge of Warrington, where there was severe fighting, would have passed through Lancaster. A document still existing shows that in March 165-4 Sydenham appealed to the Lord Protector for a grant, which was allowed to him, a sum equivalent to about ?2000 of our money being given in April, with the promise of an appointment, which, however, did not mature for five years, when we find that he became Comptroller of the Pipe Office, as a laconic announce- " " ment in the Domestic Series of State Papers records, on 14th July 1059. On the strength of this money lie married Mary ^ee, of whom records are silent beyond the fact that the family came from the west of England, the couple settling in London about 1050, where he commenced to practise medicine. His resid- ence was in Westminster, a district then swampy and malarious, for it was built over a creek of the river Thames. The marshes extended out to Pimlico, so that the present St. James' Park would have swarmed with gnats, a fact of importance as bearing on his future work on Agues and Fevers. The English Hippocrates must have found his stock of medical knowledge small even for those days, so he seems to have decided to go to Montpellier, and that in the year 1059, for " " the State Papers contain a permit for foreign travel made out to a Thomas Sydenham. Here he became a pupil of the great Charles Barbeyrac, who had not a professorial chair owing to his being a Protestant, but from these religious views he would be the most likely one to whom a Puritan would go. Barbeyrac used to take round his students with liim on his visits, and give them a clinical lecture, replying to questions; his method of treatment being simple, with but few of the very fantastic drugs then in common use. The pharmacopoeia of 1077 contained both adult urine and that of a boy before puberty, the idea being that this human beef-tea would be constituted differently with the different diet usual at these two ages. Into this pharmacopoeia enter for the first time jalap, serpentary, digitalis, and cinchona, but remedies like human skull, viper's flesh, millipedes occur in the Pliarmaccutica rcitionalis of Willis, which had appeared the year before, viper's flesh forming one of over sixty ingredients of the Thcriaca Androviachi contained in the pharmacopoeia of Sydenham's time, which complex Venice treacle figured even in the edition of 1721. Locke, better known as a philosopher than as a doctor, very " and excellently dealt with by Dr. Brown in the essay on Locke Sydenham," studied some years later at Montpellier, and, know- ing Sydenham well, said that he had never known two men more alike in opinions and character than he and Barbeyrac. Montpellier was more the home of the doctrines of Hippocrates, the the University of Paris holding more to those of Galen; but 148 W. H. COUPLAND. excellences of the former school had been praised at Oxford in a book published in Sydenham's student days, which book had been dedicated to Dr. Clayton, the Professor of Medicine, and it that was this work probably decided him to prefer a visit to Montpellier. By 1660 Sydenham had returned to London, for he had an attack of the gout in that year, a malady that plagued the rest of his him for life, accompanied, as it was later on, by renal calculus and severe hsematuria. After the three necessary examinations in 1663, he became L.R.C.P., apparently having practised illegally before that within the boundaries of London. He never was called to the Fellowship, for the bye-laws of the allowed College only this degree to be conferred on those who were and it was already M.D., not till thirteen years before he died, or in 1676, that lie took this qualification, and then at the of University Cambridge, the choice of the town having been made on account of the fact that his son had entered Pembroke College as a commoner two years before this. In 166-4 plague appeared in Yarmouth, but up to Christmas the cases were only mild as we now know is the condition at the of an beginning epidemic; but Boghurst, the apothecary, whose account of the scourge is the best we have, Defoe's of course being only fiction, states that it had been in Westminster for three before years this. The warmth of the early summer revived the and disease, by June the plague was at Sydenham's own door, so the left for family Dorset, he humorously quoting as an apology for their departure, a Latin line which translated is to " the effect that Your own property is concerned when the next wall is on fire." This departure is much to be regretted from the of view of the annals of point medicine, for here was an oppor- for such a tunity painstaking and astute observer as Sydenham to leave a grand treatise on the plague. Apart from the danger to the family, most of his patients had gone out of town, only left to be poor persons being doctored by the surgeons and since the apothecaries, physician's fee, an angel, was too high for them?the of a equivalent half-sovereign being called an " angel. The herbalist Culpepper scoffingly said that of the present day are like Balaam's Ass, they will not speak until an the see Angel," while Boghurst remarked that it was the " privilege of the rich to die surrounded by angels." In Evelyn's is a reference to the use of these coins in the cere- Diary " angel mony of Touching for the King's Evil." The condition of the poor physician of that time is thus painted for us by Cotgrave in his" Treasury of Wit and Language," printed in 1655 :

" name is a My Pulsefeel, poor Doctor of Pliysick, That does wear three pile velvet in his hat, Has paid a quarter's rent of his house before-liand, And simple as he stands here was made doctor beyond sea. 149 "THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES."

I vow, as I am right worshipful, the taking Of my degree cost me twelve French crowns, and Thirty-live pounds of butter in Upper Germany, I can make your beauty, and preserve it, Rectifie your body, and maintaine it, Claritie your blood, surfle your cheeks, perfume Your skin, tinct your hair, enliven your eye, Heighten your appetite; and as for Jellies, Dentifiizes, Dyets, Minerals, Fricassees, Pomatums, Fumes, Italia masks to sleep in, Either to moisten or dry the superficies, Faugh ! Galen Was a goose, and Paracelsus a Patch, To Doctor Pulsefeel."

Gideon Harvey, caricaturist and court physician, said the physicians had to be 011 good terms with the apothecaries and go " to church regularly, and that The Church door shall no sooner be opened but ccce Mr. Doctor, sitting in the most visible seat, Grave, Deaf, Dumb, and immoveable as if an Apoplexy of Devotion had seized him, out of which his Apothecary is to raise him by knocking at half Sermon at his Pew-door to fetch him away post to a dying patient; by which means he draws the Eyes of the whole Congregation after him; but instead of going to the pre- * tended House of Visitation they both drop into a Cabaret there to pass the fatigue of a Forenoon Sunday." For a similar procedure one can read Smollett's novel, "Ferdinand, Count Fathom." Such cases of the plague as Sydenham did treat he bled, a method that Boglmrst utterly condemned, and, speaking generally, lie believed in the disease being disseminated by atmospheric means, although he thought that some Fomes might be necessary, so that we may say that Sydenham leaned to the views of the Localists, and it is only since the proof of the relation of rats and fieas to the disease, with the description of the bacillus, that we have made much advancement as regards its etiology. The well- known buccaneer and physician, Dr. Dover,1 first compounder of the powder of that ilk, was treated by Sydenham for the plague he being at that time a pupil in his house, and we learn that for the first part of the illness he was not allowed to stay in bed, the idea being that this promoted the cooling of the fever. During part of his residence in London, Sydenham lived in a newly built street in Pall Mall, next door to an apothecary's shop, " the Pestle and Mortar," the owner of which was a Mr. Malthus, grandfather of the author of the Malthusian doctrine of Popula- tion, who having been a sufferer from chronic arthritis for a long time, and being a patient of Sydenham's, served as the example for an accurate record of the complaint. Mr. Malthus was highly respected by the doctor, who made him the guardian of his sons, as we find by the will. The domestic life of the great physician was happy, and he was 1 Dublin For an interesting account of Tli. Dover, M.B., see a paper by Knott, Joum. Med. Sc., February 1905. 150 W. H. COUPLAND. a kind and generous parent; as a doctor, Dr. Brown declares he " furnishes in himself the four qualities Hippocrates says are in- dispensable in every good physician?learning, sagacity, humanity, probity. This personality gives a constant charm to everything he writes, the warmth of his large, humane, practical nature is felt throughout." His professional life was prosperous, notwithstand- ing the attacks made upon him by various other physicians, his nature being too honest and conscientious to swerve from the desire to do good to mankind; as his own words put it:

" My fame is in the hands of others. I have weighed in a nice and whether it be scrupulous balance, better to serve men, or to be praised by them, and I prefer the former. It does more to tranquillize the mind; whereas fame, and the breath of popular applause, is but a bubble, a feather, and a dream. Such wealth as such fame gives, those who have scraped it together, and those who value it highly, are fully free to enjoy, only let them remember that the mechanical arts (and sometimes the meanest of them) bring greater gains, and make richer heirs."

May we not say this, gentlemen, of the art of medicine at the present time ? Sydenham never strove for riches for the sake " of riches, for said he, I have always thought that to have for published the benefit of afflicted mortals any certain method of subduing even the slightest disease, was a matter of greater felicity than the riches of a Tantalus or a Croesus." On 29th December 1689, at the age of G5, after being troubled with the Dominus morborum for thirty-five years, the prince of practical physicians passed away, and was laid to rest in St. -Tames' Church, Piccadilly, London. At the age of 37 he had hematuria, and seventeen years later, in 1G77, he had to retire to the country on account of the very severe symptoms of stone that made driving a to misery him, the result being that for one whole year he did not visit any patients. For gout and calculus his own personal regimen was to drink a dish or two of tea on getting out of bed, and then ride in his coach till noon; when he had a moderate, easily digested lunch, after which he drank over a quarter of a " " pint of Canary wine, to promote," so he said, the concoction of the food in stomach, and to keep away the gout from the bowels." Then he sought purer air by driving to the country, generally to Acton?would he could see it now ! Small beer, weak stuff com- pared to our everyday ale, formed his supper, and on retiring, as he did early, he had more of this, but on the days when he had an aperient, his food was poultry, with the dose of Canary along " wine. To him the best beverage for the gouty was one which neither rises to the generosity of wine, nor sinks to the debility of water," and no doubt, in his time, London water must have been a dangerous drink unless it was cleansccl by the addition of some alcohol! When Pepys had company to breakfast, he tells us that, " THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES." 151

I had for them a barrel of oysters, a dish of neats' tongues, and a dish of anchovies, with wine of all sorts, and ale." I fear, gentlemen, that I have not heeded the advice of the Look of Maccabees, but that I have been over-long in the prologue, so that time will oblige me to be short in the story itself, that is the story of Sydenham's medical works, for his theological writings 1 will leave severely alone. We must now turn and pass in review some interesting points in the practice of that man, who was one or the half-dozen intellectuals whose friendly visits gave to John " -Locke the germ of that Essay 011 the Human Understanding," winch lias served so many thinkers as a model for the arrange- ment of their mental equipment in a proper manner. Sydenham's woiks were published in Latin, with which language he was well acquainted, Cicero being his favourite author; but Dr. Payne inclines to the view that he wrote them in English, this matter laving been much discussed by the commentators on his works, " he most popular work is entitled the Complete Methods 01 Treating almost all Diseases," a small volume which, issued m 169o, remained the vade-mecum for physicians for over a century. The first medical book was a treatise 011 fevers, an octavo ot 15G pages, inscribed "Thomas Sydenham's Method of Treating Levers, based^upon his own Observations," and dedicated to the 011. Robert Boyle, the great experimental philosopher, to whom ie work really owed its origin, the man of science having often accompanied the man of physic on his round of visits. The pre- face is worth quoting from: hoever applies himself to medicine ought to weigh the o seriously owing considerations. First, that he will one day have to render an account to the Supreme Judge of the lives of sick persons committed to is caie. Xext, whatever skill or knowledge he may, by the Divine avour, iccome possessed of, should ho devoted, above all things, to the 0 e> ?ry God, and the welfare of the human race. Moreover, let him lemem >ei that it is not any base or despicable creature of which he has undertaken the cure ";

and so 011 " runs the Beligio Medici" of the English Hippocrates, ie man to whom Boerhaave metaphorically took off his hat when- evei Ins name was mentioned. From the body of the treatise we eain that he recommended for the iliac passion?whatever that have may been the application of a live puppy to the abdomen, an m the large section 011 agues he comes to the conclusion that here is a fermentation period of fourteen days for the fevers, which observation would come about from the number of cases of w at we now call typhus that he had to treat at that time. One 1 einember that measles and scarlatina were then hardly 11 erentiated, although Sydenham gave a remarkably clear descrip- tion of the former in these words: "The symptoms "of the measles 152 W. H. COUPLAND. do not abate by tho eruption as in the smallpox, yet I never observed the vomiting afterwards, but the cough and fever increase with the difficulty of breathing, weakness of the eyes, and the defluxion on them, with continual drowsiness and want of appetite as before." The history of the word measles in literature is inter- but cannot esting and curious, detain us now: it seems wrong to assert, as has been done, that Sydenham was the first to clearly describe scarlatina. The work on fevers was eventually recast and enlarged, in 1676 appearing as "Medical Observations about the Cure and History of Acute Diseases," wherein he laid down the general idea that fevers change their type according to the constitution of the that year, .and certain diseases are associated together, which was an opinion firmly held by Hippocrates. The difficulty is to know exactly what complaint Sydenham is dealing with, for he does not give, like his great master, detailed histories of his cases. In the section he sixth forestalled modern views, for he refuses to recog- nise pleurisy and pneumonia or quinsy or rheumatism as local diseases, but states that they are fevers. Sydenham hoped that " his book would not find less favour for being neither vast in bulk nor stuffed out with the spoils of former authors," and he finishes with these wise words :

" It is my temper and disposition to be careless both of tlie sayings and the doings of the over-proud and the over-critical. To the wise, however, and the honest, I wish to say this much : I have in nowise distorted either fact or experiment; I told the truth, the whole truth, and nothing hut the truth. ... In the meanwhile I ask the pardon, and submit to the arguments, of better judges than myself, for all errors of theory. Perhaps I may myself hereafter on many points change my word of my own accord. As I have no lack of charity for the errors of others, I have no love of obstinately persisting in my own." Can we, gentlemen, all speak with such an anti-Chauvinistic " " voice ? Etiology," said Sydenham, is a difficult and perhaps an inexplicable affair; and I choose to keep my hands clean of it. I am convinced, however, that Nature here, as elsewhere, moves in a regular and orderly manner." Sydenham was the founder of the expectant treatment; in his " own language the best plan, in the midst of so much darkness and ignorance, is to wait a little and proceed very slowly, especi- ally in the use of powerful remedies, in the meantime observing its nature and procedure, and by what means the patient was relieved or injured." In an passage he said that, like " oft-quoted Hippocrates, he found that Nature alone often terminates diseases, and works a cure with a few simple , and often enough with no medicines at all." He was a great advocate of the Peruvian bark, the Jesuit's powder distributed gratuitously over the country by the priests, a drug which has fully justified 153 "THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES."

make his advocacy, and every epidemic of influenza1 ought to us the value offer up a prayer to iiis memory for first recognising of a tonic. Opium he also used largely, and as Sydenham's drops, a preparation equivalent to Vinum Opii, it figured long in many continental pharmacopoeias. To us moderns some of his treatment was fantastic and absurd, ?is, for instance, he believed in the idea?as old as the time of King David?of putting a child or young person to bed with an invalid, with the intention of supplying the quantity of vital spirits that may be wanting. Mr. Little, it is recorded, had been treated by violent drugs, and so Sydenham says, " was as -weak as ever I saw any that recovered. Other treatment having failed, I told his wife that nothing could preserve his life hut the putting a hoy to bed with him. So she procured a link boy to lie very close to him all night. The next morning I found his fever almost off, and bis eye and countenance more lively, upon which I pronounced all danger to be over. Yet afterwards, upon the recess of the boy, he began to relapse, but the boy being got again, without any more treatment he perfectly recovered."

This was an age of quacks, there was the Auruni Potabilc over which the College of Physicians had an animated contro- versy, and there were numerous preparations of mercury, or Qucck-silbcr,?from which is derived the title quack,?and as in the present year of grace, there flourished venereal rascals like John Archer, the Chymical Physician to his Majesty. Gideon Harvey's racy pages tell us much of these times, and his " " Quidam Doctor," or the Doctor of Contraries," a man who cured most desperate diseases by methods and remedies quite the opposite of the practice of the other practitioners of the time, is undoubtedly a hit at Sydenham, for he first introduced the cooling treatment for fever, and was the first to listen to the desires of the patient, and to give free permission for fluids to be drunk in a burning fever, also to humour him as regards diet, allowing, as Hippocrates said, "such food as is most grateful, though not so wholesome, is to be preferred to that which is better, but distasteful." Sydenham believed that he acted as an honest man and a good physician when he refrained entirely from medicines if the patient was not any worse than when he had visited him the time before. As regards the treatment of patients after operation, we do not yet respond sufficiently to the wishes of the sufferer, but keep too much to old rules relating to posture, diet, and many other essentials that make for lessened mental strain after such an ordeal, especially trying if this has taken place in a private house. A celebrated tract of Sydenham's, dedicated to his friend, Sydenham recorded the epidemic of 1675. He said coughs and colds were very common, "and they ran through whole families at once." W. H. COUPLAND.

Dr. Thomas Short, and published in 1683, dealt with gout and dropsy; on the title-page of it is the well-known motto from Bacon's "Advancement of Learning," an author beloved our " by Hippocrates, the translation running: We have not to imagine, or to think out, but to find out what Nature does or produces." In the body of the work he says : " nature to It is my think where others read ; to ask less whether the world agrees with me than whether I agree with the truth : and to hold rumour cheap the and applause of the multitude. . . . For what can it profit me after my death if the eight letters which compose the name Sydenham should pass from mouth to mouth among men who can no more form an idea of what I was than I of what they will he."

This latter portion of the passage is referred to by Fielding, himself a sufferer from gout, in the second of Book xiii. " chapter of Tom Jones." Sydenham's tract is a masterpiece, as he gives an unequalled description of an attack of the gout, apologising for the small list of remedies of use in the complaint, supporting " his opinions by quoting from Lucien's Chorus," at the same time feeling satisfaction that it kills more rich than poor, and that it is an appanage of the great, for it affects alike generals, kings, and philosophers. His fame rests too on his great work on Hysteria, which, to him, accounted for one-sixth of all maladies, women being rarely free from it. His explanation of it amounted in substance, if not in to our modern that it is due to disordered language, knowledge " " innervation, or, as he put it, to animal spirits rushing down on the organ, exciting spasm and pain, thus "creating the proper symptoms of the part." Of course he carried the idea of hysterical causation too far, for he included ovarian dropsy and chlorosis in the group, yet he did much practical good in the treatment of the latter, for he advocated restoring the blood by giving steel, for which purpose he used doses of the so that when we " filings; prescribe bark and steel" we are only re-echoing the practice of Thomas Sydenham. Mere mention must be made of what is considered his discovery of chorea, that is, chorea minor or Sydenham's chorea, as opposed to chorea major, the rare epidemic hysterical dancing mania of the Middle Ages, so far unknown in England, and the real St. Vitus' dance. He defined chorea as

"a sort of convulsion which chiefly invades hoys and girls from ten years of age to puberty, showing itself first by a certain lameness or rather instability of one of the legs, which the patient drags after him like a fool." As this description hardly corresponds with our present day notions of an attack of chorea, it has been criticised notably by " Sturges in his monograph on Chorea and Whooping Cough." " 155 THOMAS SYDENHAM, THE ENGLISH HIPPOCRATES."

under- This description was the last literary effort that Sydenham took, for on 29th September 1686 he wrote: "And this is about the sum of all I know respecting the cure of diseases, up to the on was laid day which I write." Just over three years later he to rest. The philosopher of Scotia, Dugald Stewart, said that Syden- ham's method really belonged to his great friend John Locke, who, being a thoroughgoing sceptic, used to say that the art of medicine was to be properly learnt only from its practice and its exercise. To his friend Molyneux, Locke wrote that "You cannot imagine how far a little observation carefully made by a man not tied up to the four humours; or sal, sulphur,and mercury; or to acid and alcali, which has of late prevailed, will carry a man in the curing of diseases, though very stubborn and dangerous, and that with very little and common, and almost no medicine at all." The reference to the four humours is to the dogmas of Hippocrates and Galen; sal, sulphur refer to Paracelsus, the alchemist, and to Van Helmont, the philosopher-mystic, to whom we owe the term gas; acid and alcali are concerned in what was then the new chemical system of Sylvius, which was extended by Willis. Locke was a Fellow of the Eoyal Society, as was Eobert Boyle, a Society with which Sydenham would never have aught to do. Had not that common arbitrator, Time, been against me, I would have liked to have said more about the relation of Locke to Sydenham: yet what words of mine could bear with those written the author " comparison by of Bab and his Friends," so I counsel everyone who enjoys good " essays to smoke several pipes over the first series of Hone Subsecme,"?for this section appeals most to medical men, and especially to Edinburgh graduates,?with the page open at the part where these two philosophers are dealt with, turning, after this " essay is read, to the one on Dr. Andrew Brown and Sydenham." If the members do this, my own words will not have been written in vain. Thus, gentlemen, ends my tribute to the memory of him who would have been styled by Flato an artsman; for Sydenham was " a doer, not an abstract thinker, in that tentative art" to succeed in which Hartley Coleridge said demands

" a quickness of eye, thought, tact, invention, which arc not to he learned by study, nor, unless by connatural aptitude, to be acquired by experi- ence ; and it is the possession of this sense, exercised by a patient observation, and fortified by a just reliance on the vis medicatrix, the self-adjusting tendency of nature, that constitutes the true physician or healer."

" Said A man condemns the world to the task ot Flegel: " great " a bald explaining him ; this then must be my apology for such further and unconvincing narrative,"?for I hope you will seek for information about the English Hippocrates in Dr. Payne's mono- 156 W. H. COUPLAND.

graph,?it being apposite that at the literary evening during the eighty-fourth year of the existence of this Book Club we think of those great men in our commonwealth of medicine who are, as Burke said, "the guide-posts and landmarks in the State." As this is the time to think of books, let me offer to you this expostu- lation, couched in the lines of Wordsworth:

"Where are your books??that light bequeathed To beings else forlorn and blind ! Up ! up ! and drink the spirit breathed From dead men to their kind."

the nature of Considering the subject, I confess that this paper has been compiled too hurriedly ; yet I have kept in mind during its preparation the motto from the Book of Ecclesiastes that is " written on the manuscript copy of Sydenham's Medical Observa- tions," which now rests on the shelves of the library of the College of Physicians of London: "Whatsoever thy hand findeth to doe, doe it with thy might."