Thomas Sydenham

English physician

• Born: September 10, 1624
• Birthplace: Wynford Eagle, Dorset, England
• Died: December 29, 1689
• Place of death: London, England

Sydenham laid the foundations for modern clinical, scientific, and public-health medicine, and he has been credited with the invention of the modern conception of disease, understood as a morbid entity in nature with its own history. This conception replaced the earlier model of disease as a set of peculiar events in people’s lives with only particular case histories.

Early Life

Thomas Sydenham (SIHD-nuhm) was born at Wynford Eagle, Dorset, early in September of 1624. The date September 10, which is conventionally given for his birthday, is in fact his baptismal day, which suggests that his birthday was a few days earlier. The Sydenham family were West Country Puritan gentry powerful in the county. Sydenham’s father was William Sydenham; his mother, Mary Jeffrey Sydenham. They were the parents of ten children, of which Thomas was the fifth son of seven, five of whom survived infancy. The eldest son became Colonel William Sydenham (1615-1661), a parliamentary commander in the English Civil War and prominent politician of the Commonwealth and Protectorate. Thomas had the conventional upbringing of a younger son of the gentry, and later, despite his international reputation and success in medicine, he would never completely outgrow his Puritan and provincial origins.

The Sydenhams were conspicuous on the Parliamentary side in the English Civil Wars , leading the Parliamentary forces in Dorset; serving in campaigns in England, Scotland, and Ireland; and shedding their blood for the cause. Father and sons held commissions: Thomas was a captain in the cavalry. His mother and three of her sons were killed in battle by the Royalists or died afterward of war wounds. Sydenham was so seriously wounded at the Battle of Worcester on September 3, 1651, that he was left for a while among the slain on the battlefield.

Sydenham had gone to Oxford and matriculated at Magdalen Hall in 1642, but almost immediately he had left Oxford to join the Parliamentary army at the outbreak of the Civil War. He fought bravely but was captured by the Royalists and imprisoned at Exeter. He was released and saw action again. He returned to Oxford in 1647 and entered Wadham College to resume study, which he now concentrated in medicine. In 1648, Sydenham was elected as a fellow of All Souls, but he left Oxford a second time for military service in 1651. He returned again, before resigning his fellowship in 1655.

Sydenham’s studies were desultory, his medical degrees nominal, and his formal academic medical education quite irregular. He received his bachelor of medicine degree in 1648 after only a few months of study and his master of medicine degree a year or so later. He would not receive his doctor of medicine degree from Cambridge until 1676, by which time he had been for a decade the leading English physician. This irregularity is explained not only by the disruption of academic life during the Civil War but also by Sydenham’s own scorn for mere book learning in medicine. He did read the classic medical texts of Hippocrates, and he was influenced by the works of the English philosopher Francis Bacon and especially by Bacon’s emphasis on experience, observation, inductive reasoning, and experimentation. At Oxford, too, Sydenham met and became lifelong friends with the scientist Robert Boyle . Sydenham later befriended the philosopher John Locke, who was also a physician.

Sydenham’s decision to enter the medical profession was made in 1646, on the advice of Thomas Coxe, an eminent physician who had served in the parliamentary army. Sydenham’s motives were altruistic: He sought, as he admitted to his colleagues, not to acquire riches but to find happiness in the greater felicity of reducing the sufferings of humankind. The cure of even one of the slightest of the diseases affecting humankind, as he put it, was worth much more than the fabled riches of Croesus. Sydenham was generous, tireless in his work, and open and unselfish in sharing his medical discoveries.

In 1655, Sydenham resigned his fellowship of All Souls, married Mary Gee of Wynford Eagle, and moved to Westminster, where he tentatively began to set up his practice. He was much involved with his brother William in the politics of the Protectorate and could not devote all of his efforts to medicine until his brother slipped from power around 1659. The Restoration in 1660 closed all political doors to the Sydenhams.

Life’s Work

Sydenham practiced medicine at Westminster part-time from 1655 and full-time from about 1659 until his death there in 1689. There, too, he wrote in English numerous medical treatises, some of which his friends translated into Latin and published for the international medical fraternity. Sydenham’s greatest published works include Methodus Curandi Febres (1666; the method of treating fevers), Observationes Medicae (1676; medical observations), Tractatus de Podagra et Hydrope (1683; treatise of gout and dropsy), and the last work published during his lifetime, Schedula Monitoria de Novae Febris Ingressu (1686; the warning of the appearance of a new fever).

Sydenham published other works in his lifetime, works were published posthumously, and he left unpublished manuscripts and correspondence. His practice and publications earned for Sydenham a large reputation and international distinction, and he treated patients from the wealthy London merchant class, gentry, nobility, and even royalty, when in the 1660’s he attended the infant duke of Cambridge, son of James, duke of York, who would later succeed to the throne as James II.

It is significant that Sydenham was never knighted or made a fellow of the Royal College of Physicians or of the Royal Society. He never won acceptance at court and in high society, although the royalty, nobility, and socialites availed themselves of his medical skills when they needed to do so. His past as a parliamentary soldier, his Puritan and provincial background, his somewhat rustic manner, and his independent opinions about medicine were all held against him in society. Enemies, who were less knowledgeable and skillful physicians than he, mocked him as a “rebel,” a “Western bumpkin,” the Roundhead “trooper turned physician,” and the “ploughman doctor.” Sydenham did not resent his ostracism; his circle of close friends included Boyle and Locke, and his own clinical apprentices who lived in his household and assisted in his practice included some of the greatest physicians of the next generation, such as Hans Sloane, Thomas Dover, Richard Blackmore, and Charles Goodall.

Sydenham the physician was a plain, stocky man whose broad, frank face was framed by long, uncoiffed hair severely parted in the middle. Even after the Restoration he dressed in simple and somber Puritan garb. His character was that of a rebel, both in youth and in maturity. He refused to defer to authority unless that authority could prove and justify itself. His approach to medicine was pragmatic and empirical rather than dogmatic and theoretical. He said plainly that his medical writings were based on “downright matter-of-fact.”

Like Hippocrates, Sydenham trusted in vis medicatrix naturæ, the healing power of nature, and he often opined that doctors killed more people than diseases did. Consequently, he advocated noninvasive therapies such as proper diet, bed rest, travel, and exercise, and was suspicious of medications and surgery except as a last resort. Still, it was Sydenham who pioneered such medications as quinine in the treatment of intermittent fevers and iron in the treatment of chlorosis or anemia. Sydenham also, perhaps because of his personal imperative to relieve suffering, prescribed analgesic medications generously and even developed a palatable, potable form of opium in wine, which is still called Sydenham’s laudanum. More controversial and subject to misinterpretation was his advocacy of accubitus, the revitalization of sick and especially elderly patients by having them cuddle a pet or a child. Accubitus often worked, so the pragmatic Sydenham recommended it.

Sydenham’s most significant contributions were made in the field of clinical medicine, but he also laid the foundations of modern public-health medicine and epidemiology and modern scientific medicine. His observations of epidemics in London from 1661 to 1675 were so acute that it remained only for modern microbiology and the germ theory of disease, the definitive work of the later German scientist Robert Koch to complete his pioneer work. Even without the germ theory, Sydenham’s work still has value for epidemiology in its emphasis on periodic, cosmic, telluric, and meteorological factors in epidemic disease.

From the mid-1650’s onward, Sydenham suffered from gout, renal colic, and calculus or stone, and on December 29, 1689, these diseases would kill him. It is characteristic of this great physician that he translated his own suffering into what remains the classic medical description of gout. His works abound in classic disease descriptions too numerous to relate. To give one more example, in his last published work during his lifetime in 1685, Sydenham wrote the classic medical description of Saint Vitus’s dance, the neurological complication of rheumatic fever that in medical nomenclature is still known as Sydenham’s chorea.

When his clinical apprentice Blackmore asked Sydenham for the titles of the most authoritative medical textbooks to read to qualify him for practice, Sydenham replied, “Read Don Quixote, it is a very good book, I read it still.” His reply expressed not only his scorn for abstract medical theorizing and his questioning of authority but also his knowledge of Miguel de Cervantes’ powers of observation. The sound advice concealed in this quip unhappily was lost on the apprentice, who merely wanted an easy answer.

Significance

Sydenham’s medical practice and writings mark the divide between ancient and medieval medicine on the one hand and modern medicine on the other. His empiricism, natural histories of diseases, and pragmatism led medicine out of the cul-de-sac of abstract theorizing into the thoroughfare of modern clinical, public-health, and scientific medicine. A brave young rebel captain of the parliamentary cavalry in the English Civil War became the “English Hippocrates” and father of modern medicine.

Bibliography

Debus, Allen G., ed. Medicine in Seventeenth Century England: A Symposium Held at UCLA in Honor of C. D. O’Malley. Berkeley: University of California Press, 1974. A collection of many specialized revisionist scholarly papers that all contribute to the understanding of Sydenham’s milieu. One by L. J. Rather tendentiously argues the superiority of Thomas Willis over Sydenham.

Dewhurst, Kenneth. Dr. Thomas Sydenham (1624-1689): His Life and Original Writings. Berkeley: University of California Press, 1966. Scholarly biography with an edition of some selected works and correspondence of Sydenham, but badly organized and somewhat flawed; for example, there is no discussion of Sydenham’s death, and the author proceeds erratically over topics.

Healy, Margaret. Fictions of Disease in Early Modern England: Bodies, Plagues and Politics. New York: Palgrave, 2001. Describes how people imagined their bodies and how the cultural imagery of human disease had political consequences in the seventeenth century.

Hunter, Richard, and Ida Macalpine, eds. Three Hundred Years of Psychiatry, 1535-1860: A History Presented in Selected English Texts. New York: Oxford University Press, 1963. Reprint. Hartsdale, N.Y.: Carlisle, 1982. Reprints Sydenham’s short but important piece on hysteria and an illuminating anecdote about his treatment of depression.

Lambert, Samuel W., and George M. Goodwin. Medical Leaders from Hippocrates to Osler. Indianapolis: Bobbs-Merrill, 1929. Brief essay that adds new details and regards Sydenham in the context of the history of medicine.

Martí-Ibáñez, Felix. Centaur: Essays on the History of Medical Ideas. New York: MD Publications, 1958. Contains several relevant essays, including “Books in the Physician’s Life,” which persuasively explains Sydenham’s recommendation of Don Quixote as the most instructive book on medicine. Other medical history essay collections by Martí-Ibáñez and Henry E. Sigerist contain pertinent material as well.

Power, Sir D’Arcy, ed. British Masters of Medicine. Baltimore, Md.: William Wood, 1936. Reprint. Freeport, N.Y.: Books for Libraries Press, 1969. Contains Sir Humphry Davy Rolleston’s brief but insightful essay on Sydenham and much background material.

Singer, Charles, and E. Ashworth Underwood. A Short History of Medicine. 2d ed. New York: Oxford University Press, 1962. A standard work, very useful for Sydenham’s place in the history of medicine.

Sloan, A. W. English Medicine in the Seventeenth Century. Durham, Scotland: Durham Academic Press, 2002. Sloan provides an overview of English medical, surgical, pharmaceutical, and obstetric practice during Sydenham’s lifetime.

Wear, Andrew. Knowledge and Practice in English Medicine, 1550-1680. New York: Cambridge University Press, 2000. Although Sydenham is not mentioned, the book explains medical practice within the social and cultural context of his time, describing remedies, notions of disease, and notions of preventive medicine. Provides a detailed examination of the pox and plague, the major medical problems of the period.