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A CLAIM to FAME: THOMAS SYDENHAM by J 465 Postgrad Med J: first published as 10.1136/pgmj.29.335.465 on 1 September 1953. Downloaded from ,,A CLAIM TO FAME: THOMAS SYDENHAM By J. S. STEWART ' Nothing so difficult as a beginning,' wrote his renown, it may be of interest to note some Byron of poetry. To record that Thomas Syden- events of his life and the views of his contem- ham was born on September io, I624, at Wynford poraries. In I642, at the ag3 of i8, he entered Eagle in Dorsetshire, where his father, William Magdalen Hall, Oxford, but soon left to serve, Sydenham, of strong Puritan family, had a fine first as a trooper and later as a captain, in the estate, is an admissible introduction to a detailed army of Parliament. This he did with his usual account of his life, but sounds quaint as a basis for vigour, being ' left on the field among the dead' his subsequent renown. That he was ' the after one battle and, on another occasion, being English Hippocrates' is the standard opening for a saved from the bullet of a pistol fired at arm's biographical note on his achievements. Per- length by the chance position of the left hand of haps the description of the physician in the last his drunken assailant, who was gripping him by Protected by copyright. book of the Aeneid can well be borrowed to intro- the shirt. In I647 he returned to Oxford, this duce some thoughts on the claim to fame of the time to study mzdicinm, and after spending only man who, modestly avoiding publicity, practised six months there was created Bachelor of Medicine medicine first and foremost as an art. ' It was his by order of the Earl of Pembroke, Chancellor of part to learn the powers of medicines and the the University. Even in those days this was re- practice of healing and, careless of fame, to garded as a highly irregular procedure, the more exercise that quiet art.' To this study Sydenham especially as he had not taken a degree in arts. devoted himself by ' collecting as genuine and About nine or ten years later he studied under natural a description or history of all diseases as the celebrated Barbeyrac at Montpzllier, and on can be procured.' returning to England practised in London for a A current definition of ill health is ' the failure year or two before obtaining, by examination, the of the body and mind to adapt themselves to the licence of the Royal College of Physicians to prac- environment-a failure which is the resultant of tise in the City of London and seven miles round. two factors, the imperfection of human nature and This was his only link with the Royal College, the hostility of the environment' (Roberts, I952). partly for political reasons and partly because some http://pmj.bmj.com/ This definition is both precise and comprehensive of the Fellows considered him as an upstart and an and makes an immediate appeal; but in the case imposter. He was a personal friend, however, of of acute organic disease Sydenham's more intimate some of his greatest contemporaries, including the approach seems to lead to a more personal inside Hon. Robert Boyle (I627-91), to whom he wrote, knowledge. 'A disease, in my opinion, how pre- in the last year of his life (I689), ' I have the judicial soever its causes may be to the body, is no happiness of curing my patients, at least of having more than a effort of nature to throw off it said concerning me that few miscarry under me; vigorous on September 29, 2021 by guest. the morbific matter, and thus recover the patient.' but I cannot brag of my correspondency with For ill health in its widest sense the modern some other of my faculty.' definition may well be more comprehensive and The situation is well seen in Dr. Andrew more accurate, but does not the idea of ' a vigorous Brown's book, published in Edinburgh in I69I and effort of nature ' produce a greater insight into the entitled ' A Vindicatory Schedule concerning the essence of acute organic disease than the idea of new Cure of Fevers, containing a disquisition, failure? theoretical and practical, of the new and most By his observations on the natural history of effectual method of curing continual fevers, first disease and his devotion to the cure of the patient, invented and delivered, by the sagacious Dr. Sydenham established his greatest claim to fame. Thomas Sydenham.' Dr. Brown describes his Before studying these and further reasons for first reactions: ' In the year i687, perusing the 466 POSTGRADUATE MEDICAL JOURNAL September I1953 Postgrad Med J: first published as 10.1136/pgmj.29.335.465 on 1 September 1953. Downloaded from first edition of his Schedula Monitoria, where he Subsecivae,' ' They pointed out a way, and them- delivers, as confirmed by manifold experiences, selves walked in it; they taught a method and used not only a new, but a quite contrarie method to it, rather than announced a system or discovery; the common, of curing Continual Fevers, I did they collected and arranged their " visa " before not long hesitate (setting forth to visit him), settling their " cogitata "-a mean-spirited pro- thinking that either he, or all other physicians, cedure doubtless in the eyes of the prevailing were grossly deceived about the cure of Fevers.' dealers in hypotheses, being in reality the exact After spending some months with Sydenham the reverse of their philosophy.' Edinburgh doctor returned home 'as much over- During and shortly after his lifetime, Syden- joyed as I had gotten a treasure, I presently set ham's reputation on the Continent was greater myself to the practice.' Besides Dr. Andrew than it was in his own country, where it rested Brown other contemporaries who bore still extant largely on his laudanum (the first form of a testimony to Sydenham's skill were Dr. Thomas tincture of opium), his cooling treatment for small- Dover (I660-1742), of Dover's powder fame, and pox, and his use of Peruvian bark in quartan agues. John Locke (I632-1704). The last was a close It was only 20 years after his death that Leyden friend and, at one time, a colleague of the man he University appointed to its Chair of Botany and described as ' one of the master builders at this Medicine the renowned Hermann Boerhaave (i668- time in the commonwealth of learning.' Both 1738). If English medical students know anything Locke and Sydenham were sufficiently unorthodox about ' the English Hippocrates' it is that Boer- to doubt the suitability of polypharmacy and even haave ' was wont to take his hat off whenever he of placebos. mentioned his name,' that Sydenham did 'some ' I do not think it below me or my art to things for his profession which, considering the acknowledge, with respect to the cure of fevers and dark age in which he worked, were highly to his other distempers, that when no manifest indication credit,' and that his name is connected with the pointed out to me what should be done, I have rheumatic type of chorea, to be distinguished fromProtected by copyright. consulted my patient's safety, and my own reputa- the hereditary type of Huntington (I85 I-I9I6). tion, most effectually, by doing nothing at all' Further investigation reveals that he ' recorded (Sydenham). Dr. Dover, patient as well as pupil, his own sufferings from the gout in a clever and has described how Sydenham treated his smallpox. entertaining way,' and that he was responsible for The regimen was based on the cooling principle, several classic descriptions of diseases, notably with no fire, open windows and few bedclothes, smallpox, measles and scarlet fever. and included ' twelve bottles of Small Beer every Sydenham's present claim to fame rests chiefly twenty-four hours' (see Bailey, I944). The beer, on his ' natural history ' method in the study of however, was ' acidulated with spirit of vitriol.' disease, his stress on the importance of direct Munk even says that the name of Sydenham was observation and his advocacy of the return from always mentioned with respect in the Royal current theoretical speculations to the practical College. Opinion among physicians, at first bedside medicine of Hippocrates. In present-day divided, grew gradually in Sydenham's favour American opinion ' Sydenham stands out as the throughout, and especially after, his lifetime. greatest representative of the practical medicine http://pmj.bmj.com/ That there should have been much opposition of practical England' (Major, I948). As R. G. is in no way surprising seeing that current medicine Latham points out in his biography, there can be was so largely academic. It was based not so no doubt that other reasons for the admiration of much on practice as on the theories of the different posterity are ' the moral elements of a liberal and schools of thought, chief among which were the candid spirit (which) went hand in hand with the iatro-physicists, who sought to explain disease on intellectual qualifications of observation, analysis a physical basis, and the iatro-chemists, who saw and comparison.' in every disease only a disturbance of the acid- Of the problems that occupied the great on September 29, 2021 by guest. alkali balance. For doctrines founded on specula- clinician's mind many still remain to perplex us tion and preached with dogma the father of today. Not the least of these are associated with English practical medicine substituted' downright epidemiology. Sydenham made a close study of matter of fact' gained by ' faithful observation' the various fevers and other acute maladies of and accurate note-taking at the bedside.
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