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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.”
THE PICTURE
Thomas Sydenham, seventeenth century (1624-1689) London physician, at the bedside
a patient-the only place, he believed, where doctors could learn about disease.
His plain Puritan costume contrasts markedly with high-fashion raiment worn by his
lifelong friend, physician-philosopher John Locke, who frequently accompanied him
on his rounds of patients. Sydenham’s honest and straightforward observations,
accepted and published in many countries, earned him posthumous titles of “English
Hippocrates”, and “Father of Clinical Medicine in Britain.”
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