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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, , 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 ' 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 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 first and foremost as an art. ' It was his by order of the Earl of Pembroke, Chancellor of part to learn the powers of 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 practised in 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 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. (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 ), his cooling treatment for small- Dover (I660-1742), of Dover's powder fame, and pox, and his use of Peruvian bark in quartan agues. (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 in a clever and has described how Sydenham treated his . 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 . 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 . 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. London over a series of years, including i665, 'He knew what's what, and that's as high when the Great Plague was at its worst. (It is As metaphysic wit can fly.' interesting to note that he obtained his M.D. at (Samuel Butler: Hudibras, Pt. I, I663.) Cambridge two years after this.) He found that While Sydenham was doing this for medical the type of acute disease varied according to the thought, Locke was doing much the same for year and the season, and the right treatment could philosophy. As Dr. says in ' Horae not be adopted until the type was known. Since Postgrad Med J: first published as 10.1136/pgmj.29.335.465 on 1 September 1953. Downloaded from September I953 STEWART: A Claim to Fame: Thomas Sydenham 467 the Hippocratic treatise ' On airs, waters and and the process one of deduction from a general places' there had been nothing quite like this in principle to every case that presents itself. On the medical literature. ' I have carefully examined the other hand are the syrnthetic theories, in which different constitutions of different years, as to the many observed occurrences are built into one manifest qualities of the air, yet I must own I have whole framework or intellectual scaffolding. hitherto made no progress, having found that There are two approaches here also; the idea of years, perfectly agreeing as to their temperature duality is common to several spheres of thought. and other sensible properties, have produced very In both methods the aim is the same-to produce different tribes of diseases and vice versa.' A re- a rationally unified concept of a multitude of markably similar type of difficulty, considering events. In the sense that he reasoned by in- the extraordinary advances in knowledge, con- duction from the particular to the general, Harvey fronts the writer of ' Figures and 'Flu' in the stands out primarily as a man of science. As a British Medical Journal, September 20, 1952: result his work remains a monument to his name ' The spread all over Great Britain between the throughout the centuries, and its applications have week ending January 2 (I95i) and that ending benefited countless numbers. But would the in- January 9 was phenomenally rapid; it is hard to dividual patient lying ' sick of a fever' choose believe that any transference due to ordinary Harvey or Sydenham to attend him? man-to-man contact could have proceeded with In regarding Sydenham primarily as one who that speed. Naturally thoughts arise of pre- practised the art of medicine it is not intended to seeding of virus and all but simultaneous activa- suggest that he made no use of the scientific tion of that widely scattered seed. On the other method. But in his application of ' middle pro- hand, the start of the epidemic round East Coast positions' rather than complete hypotheses, in his ports most apt to be infected from Scandinavia practical use of theory in order to act, and in his induces quite a different train of thought. There exercise ofjudgment based on experience, his work Protected by copyright. is something odd here waiting to be found out.' appears as the product of the physician's art rather It is presumably a good thing that the solution so than as medical science. As a result of his de- often appears to be waiting just round the corner. votion to immediate needs much that was best in The study of Sydenham and his work seems him died with him. But the record of his work almost inevitably, at some point, to call to mind the still serves to keep his memory alive and to link dual nature of medicine. As a science medicine his name with that of Hippocrates himself. He demands the precise recording of accurate observa- set a high standard and took pains to maintain it. tions, their apposite correlation and the drawing of ' In writing, therefore, a history of diseases, every logical conclusions. As an art it must be practised philosophical hypothesis which hath prepossessed with tact, understanding and sound judgment. the writer in its favour ought to be totally laid These two methods of approach do not so much aside, and then the manifest and natural phenomena represent two separate types of doctor or of prac- of diseases, however minute, must be noted with tice as one complementary duality. Nevertheless, the utmost accuracy, imitating in this the great

we tend to associate some names with one con- exactness of painters, who in their picture copy http://pmj.bmj.com/ ception, others with the other. The word the smallest spots or moles in the originals; for it ' science ' is best taken in its broadest sense, as is difficult to give a detail of the numerous errors used by Einstein in his recent book, ' Out of my that spring from hypothesis . . .' It was just this Later Years,' where he describes it as ' the 'axptita or nicety of observation' that went to striving after the rational unification of the mani- make Thomas Sydenham the closest English fold.' On the one hand are the ' theories of disciple of Hippocrates and ' the greatest re- principles,' such as Thermodynamics and the presentative of the practical medicine of practical

Theory of Relativity, where the method is analytic England.' on September 29, 2021 by guest.

BIBLIOGRAPHY BAILEY, H., and BISHOP, W. J. (944), 'Notable Names in M.D., Translated from the Latin Edition of Dr. Greenhill, Medicine and Surgery,' H. K. Lewis, London. with 'a Life of the Author.' Printed for the Sydenham Society, BROWN, J. (i898), 'Horae Subsecivae,' Adam & Charles Bla*c, London. London. MAJOR, R. H. (1948), 'Classic Descriptions of Disease,' EINSTEIN, A. (I950), 'Out of my LaterYears,' Thomas & Hudson, Springfield, Illinois. London. ROBERTS, FRANGCON (I952), 'The Cost of Health,' Turnstile LATHAM, R. G. (I848-50), 'The Works of Thomas Sydenham, Press, London.