16 - Sydenham: Proponent of Clinical Medicine
TEXTBOOKS, not patents, were the basis of medical study and practice during the middle Ages. The rebels of the Renaissance upset this comfortable, static way of medicine so that more importance was accorded patients than philosophers. As the seventeenth century got under way, an era of discovery and rediscovery of diseases began. “Never was there a period when the medical profession underwent a more rapid change”, says Dr. Joseph F. Payne,” than it did in London after the Restoration (circa 1660). Before the Civil Wars (begun in 1642), physicians in London had been a very limited abd, on the whole, a very uniform class. They were guided chiefly by the Galenical tradition. . . . The traditions of the classical school still bore almost undisputed sway. . . . The traditions of the classical school of medicine which had any distinct name, or formed a distinct school in practice, was the Chemical, or Spagyrical, constituted by the disciples of Paracelsus and van Helmont. . . . Their exorbitant pretensions to infallible skill and their trafficking in secret remedies caused them to be ostracized by the Commonwealth the upheaval of thought and disregard of traditional opinion put a sort of premium on unorthodoxy. . . .
“After the Restoration the bonds of professional discipline were drawn tighter . . . . But the strife of conflicting opinions and methods of practice become keener than ever. . . . The growth of physical science naturally tended to foster skepticism in regard to traditional doctrines of all kinds. . . . “
The custom for young doctors from universities to spend a short time at one of the London hospitals was only just beginning and was by no means universal. Most physicians of the day, unless they had studied abroad, probably had not worked in a hospital, but got their experience at the expense of their earlier patients.
Another factor that contributed greatly to change and a short time at one of the century was the king himself, Charles II. On the one hand, Charles is said to have ordered medical regulation of the most conservative kind; on the other, because of an active interest in science, he gave patronage to quackery of every kind.
It was into this melting pot of medicine that Thomas Sydenham plunged, to begin his medical career in London. It is remarkable that, out of this morass of medical practice and malpractice, he was to rise, head and shoulders above his contemporaries, as the most famous British clinician of the century.
Sydenham has been described as having a large and robust frame, reddish complexion, gray eyes, hair that was brown in early life bit afterward turned gray, and which was worn long, in its natural state, without a wig. His manner was simple, as was his dress, in keeping with his Puritan background. He was essentially a man of action in a period when most physicians were men of books.
Thomas Sydenham was born in 1624 at Wynford Eagle, Dorsetshire, England the fifth son and eighth of ten children of William Sydenham and his wife, Mary. His social background was very similar to that of Oliver Cromswell, whom he was to serve well. Sydenham came from an old family of well-to-do landoweners who adhered to Puritanism.Hias father served as a Purtian captain in the Parliamentary army. His mother was killed by Royalist soldiers. Of his six brothers, four served in the Parliamentry cavalry, two of whom died in battle. His oldest brother, Colonel William Sydenham, became famous for military and political leadership.
In his eighteenth year, Thomas Sydenham was sent to Oxford University, where he matriculated as a Fellow Commoner, May20, 1642, at Magdalen Hall. Hardly were his studies under way when political events began to shape his life. In the summer of 1642, conflict between King Charles I and Parliament was rapidly proceeding to final rupture. Sydenham’s family connections and political feeling in his native country placed him inevitably on the side of Parliament; and some time that same summer he left Oxford to enlist in the Parliamentary cavalry, wherein he rose rank of captain.
Back at Oxford, in 1647, Sydenham transferred to Wadham College to study medicine. Like many others of his day, as a member of the victorious party, he was granted the degree of Bachelor of Medicine by command of the Earl of Pembroke, April 14, 1648. Later that same year he was appointed a Fellow at All Soul’s College to replace an expelled Royalist. Though he was a close friend of Robert Boyle, Sydenham did not participate in activities of the philosophical and scientific group known as the “invisible college,” which was forerunner of the Royal Society.
Archives of All Souls’ College show that, except for another brief period of military service in 1650, Sydenham continued as a Fellow there until 1655. The parish register of Wynford Eagle records the marriage of Thomas Sydenham and Mary Gee that same year. Shortly after, he took a house and started to practice medicine in Westminster, London.
During the years 1659 50 1661, Sydenham studied at the University of Montpellier, France. It has been conjectured that this was a very good time for Sydenham to have been absent from London; Restoration of Charles II took place in May, 1660. Because of the Act of Indemnity, however, Sydenham suffered no serious consequences; and he returned to London in 1661 to again practice medicine. At the age of 39, in 1663, he qualified as a licentiate of the Royal College of Physicians. Sydenham never attained the higher rank of Fellow, perhaps because of his earlier political affiliations, perhaps because he did not take his doctorate until 1676, at Cambridge. In view of his nature, it is likely that he carried little about academic distinctions. However, through the years he enjoyed friendship with several eminent Fellows; and in the College’s official records, Sydenham’s name me is frequently mentioned in terms connoting highest respect.
After settling down to practice in London a second time, Sydenham appears to have been an extremely active, successful, and respected practioner. Through he grumbled at times that political activities of his opponents kept him from getting certain advantageous appointments, he seems to have had all the patients he could care for, considering the state of his personal health. Gout afflicted him before his thirtieth year and was a more-or-less constant burden throughout life.
In his medical practice, Sydenham easily gained patients’ confidence with his plain honesty and strong nature. That he demanded his instructions be followed to the letter, there can be no doubt. When he deemed them necessary, he used strong measures; and he was not sparing of drugs, though at times he used no medicines at all. He repeatedly recommended use of Peruvian bark for intermittent fevers, and was one of the first to recommend the bark, sometimes “with steel’, as a tonic. Sydenham’s name is associated with the liquid form of laudanum;before his time, extract of opium had been used only in solid form. At times his procedures were quaint, such as directing that a puppy dog be applied to a patient’s stomach, or that a small boy or girl be put in bed with a patient- forerunners of the hot-water bottle.
Fleeing London with family during the plague of 1665, as did many of his colleagues (flight was the only effective preventive measire; and at that time such action was not looked upon as unethical), Sydenham used his enforced leisure time in the country to write his first medical book, on the subject of fevers. This volume was founded on his own observations, notes for which he had been collecting since 1661. His neighborhood was especially noted for its high was published in 1666: it contained but 156 pages, and was given good notices in England; on the Continent it was received with enthusiasm; and it was reprinted in many countries. A second, somewhat enlarged edition appeared in 1668, with an introductory poem by Dr. John Locke, Sydenham’s unorthodox medical ideas, including depreciation of anatomy; and he frequently accompanied Sydenham on his visits to patients’ bedsides.
In 1676, Sydenham’s medical observations appeared. It was about four times the size of the book on fevers, and included most of that earlier work. Epidemics came in for considerable discussion; and it was that volume which became the basis for crediting Sydenham with beginning the science of epidemiology.
There followed, in 1682, Sydenham’s dissertation on smallpox and hysteria; in 1683, his essay on gout and dropsy. Publication after publication came from his pen, until increasingly severe attacks of gout limited his activity.
Sydenham’s works were based on his own observations; seldom did he refer to or quote other writers. The only classical man of medicine for whom he had any regard was Hippocrates. His descriptions of diseases, such as gout, hysteria, chores minor (still called Sydenham’s chorea), dysentery, scarlet fever, and measles, have became medical classics.
In his latter years, the torture of urinary calculus was added to Sydenham’s sufferings from gout. He died December 29, 1689, at his house in Pall Mall, and was buried in St. James’s Church, Westminster.
By the first quarter of the eighteenth century, Sydenham’s reputation was well established in the annals of medical history abroad, and he was named with pride in Harveian orations at the Royal College of Physicians as the “English Hippocrates.” He had set an example of the true clinical method. Into it went his independent and unprejudiced spirit, combined with acute powers of observations. The great Puritan, says Payne, “made his profession a part of his religion; he prosecuted his task of advancing knowledge and healing the sick with the same fervent zeal which other men have shown in what are regarded as more sacred avocations.” Indeed, he well deserved the title given him posthumously: “The Father of Clinical Medicine in Britain.”