SYDENHAM, THOMAS

(b., or at least baptized, Wynford Eagle, Dorset, England, 10 September 1624; d. London, England, 29 December 1689)

medicine.

Sydenham was the son of William Sydenham, a Dorset squire, and Mary, daughter of Sir John Geffrey. During the civil war, four or possibly five sons served in the army of Parliament. Two of the sons and the mother lost their lives. After distinguished military service, William, the eldest son, became a close confidant of Cromwell and a prominent figure during the Commonwealth.

Sydenham, himself, saw some military service and eventually attained the rank of captain. It was said that he was left among the dead on the battlefield on one occasion and narrowly escaped death on another. His war service and the prominence of his family in Cromwell’s cause gained him political preferences during the Commonwealth period. In what sense their support for Cromwell made Sydenham’s family “Puritan” is difficult to say. The major Somerset branches of the family were, by and large, staunchly Anglican and Loyalist; but the Dorset Sydenhams, to whom Thomas belonged, were probably Presbyterian, and his brother William, latterly, Presbyterian-Independent. If a manuscript text entitled “Theologia rationalis” is correctly ascribed to Sydenham, it affords a more precise insight into his particular religious views but nothing on his attitude toward church polity.

The war disrupted Sydenham’s earliest education at Oxford soon after his matriculation in Magdalen Hall in 1642. At the end of the first hostilities, he returned to the university, determined to become a physician. Some evidence suggests that he reentered Magdalen Hall and was made master of arts in 1648, possibly so that he could be created bachelor of medicine. In any event, his favor with the parliamentary visitors is clear from his appointment as one of their delegates to Wadham College in 1647 and from his election by them as a fellow of All Souls College in the following year, having been created bachelor of medicine by command of the chancellor of the university a few months before.

Sydenham remained in the academic arena for several years, resigning his fellowship at All Souls in 1655. During this time he may have seen further military service, since Thomas the cornet of the first civil war had become “Captain Sydenham” by 1654. It is known that he received £600 and the promise of employment in view of his financial and military contributions, that he was nominated but not elected to Parliament in 1659, and that on 14 July 1659 he was appointed “comptroller of the pipe.”

Within a year or so of his marriage to Mary Gee in 1655, Sydenham began to practice medicine in Westminster, where he remained for the rest of his life. Evidence that he spent some time at Montpellier is no better than, if as good as, evidence that he never left England. It is highly improbable, therefore, that the works of Charles Barbyrac had any influence on him, as has been claimed.

After the Restoration, public political life was likely closed to Sydenham. In any event, he devoted the rest of his career single-mindedly to medicine. He obtained his license to practice from the Royal College of Physicians of London in June 1663. He was admitted member of Pembroke College, Cambridge, on 17 May 1676, and received an M.D. at that time.

In his last years, Sydenham was considerably disabled by gout and renal disease and died at his home in Pall Mall in 1689. He left three sons: William (also a physician), Henry, and James.

Sydenham’s depreciation of bookish knowledge and university education for physicians has been linked with the belief that he was himself some-what untutored and unlettered. But he had ample opportunity for a good education, and a close study of his writings suggests that he was competent in Latin and well versed in contemporary medical thought. Most likely his utilitarian, practical turn of mind owed much to his background, but it would be difficult to say what part was played by native temperament, by religious ethos, by political alignments, or simply by the rural life of a country squire’s son. Undoubtedly, this attitude was sustained in later life by the exigencies of an active medical practice. It is much less likely that it can be attributed to a poor education or the diamond-in-the-rough qualities of a cavalry officer, although this image of him has been cultivated. The fragmentary evidence that has survived suggests that his military career during the 1640’s and 1650’s was a good deal less remarkable than that of his brothers, and his university studies considerably more so. His subsequent career as a noted author, and the associations that he maintained, suggest an intellectual bent, albeit ruggedly individualistic rather than bookishly academic.

Syndenham’s associates included Robert Boyle and John Locke. To the former, Sydenham dedicated his first work of 1666, while the latter contributed a commendatory poem to Sydenham in his second edition of 1668. Sydenham’s association with Locke was particularly close between 1667 and 1671, when Locke was composing the earliest known drafts of his own Essay Concerning Human Understanding. Locke, who eventually qualified himself medically, may have been Sydenham’s collaborator, or more likely his student. Certainly Locke served him as an amanuensis, since a number of Sydenham’s medical texts are in manuscripts in Locke’s handwriting. This fact has raised the question of authorship of the important texts “Anatomia” (1668) and “De arte medica” (1669). Although in Locke’s hand, and long thought to be from his head, these texts almost certainly bear the ideas of Sydenham. The two men corresponded through the rest of Sydenham’s life, and Locke included him in his Essay along with Boyle, Newton, and Huygens as a “master-builder” in the new sciences.

Sydenham, Locke, and Boyle had much in common in their approach to acquiring knowledge of the natural world. They held similar views in epistemology and shared an admiration for Bacon. The question of who might have influenced whom has often been debated, since the results of their respective efforts in medicine, philosophy, and chemistry have been so far-reaching.

Sydenham’s philosophy was that of a skeptical physician: skeptical because he thought that human understanding is limited to observing and reasoning about experience and the data of the sensible world; physician because his philosophy was almost exclusively applied to improving medical practice, which made results of treatment the supreme test of the only kind of truth worth having. He was also an optimist, who believed such results to be within human grasp, assured by a nature that is the orderly instrument of a benevolent God.

In his studies of acute diseases, Sydenham began by propounding a method for treating fevers, and he hoped that this method would improve the uncertain and often bad effects of treatment current in his day. The simplicity and naiveté of these early efforts (1666 and 1668) were quickly apparent to him as the Great Plague of London, followed by severe epidemics of smallpox and by puzzling variations in the concurrent continued fevers, demonstrated that the hoped-for reform of therapeutics necessitated closer attention to the differences among diseases confronting him. Therefore, along with notes for a treatise on small-pox, and for a work on medical epistemology, Sydenham kept a notebook (Vaillant Manuscript, Royal College of Physicians, London) of clinical observations from 1669 to 1674. The outcome of this was his Observationes medicae circa morborum acutorum historiam et curationem (1676), his magnum opus.

In the preface to this work, Sydenham set forth his premises for more ambitious therapeutic reforms. These premises included his belief in the healing power of nature, nature’s orderly production of diseases by species, the need for a more refined delineation of the seasonal and annual variants of these diseases, the unknowability of the insensible causes, the possibility of deriving treatment from the observable phenomena of a disease, and the desirability of making repeated trials of treatment before declaring them effective. In the body of the text, Sydenham exemplified this therapeutic program with respect to acute, epidemic diseases; he paid special attention to one particular factor causing variations in these diseases from epidemic to epidemic. This was the epidemic “constitution,” a traditional concept that he had extensively revised.

Sydenham’s effort to tie treatment deductively to the observable phenomena, and his concern for epidemic variations, gave an impetus to the more careful bedside observation of disease. Moreover, his insistence that diseases, like plants, have species, was suggestive to eighteenth-century nosographers like Linnaeus, Sauvages, and Cullen. But Sydenham’s strong emphasis on the healing power of nature, and methodical treatment designed to modulate that nature, created in his work a systematizing tendency that cast doubt on the need for specific diagnoses. Consequently, almost a century later, he could also be appealed to by such a systematist and vigorous antinosologist as Benjamin Rush, “The Sydenham of America.”

For almost two centuries after his death, however, it was particularly as a contributor to therapy that Sydenham acquired his reputation. It was his moderate treatment of smallpox, his use of cinchona, and his invention of liquid laudanum that came to symbolize his contributions to medicine. His renown came chiefly from the fact that he alleviated the suffering of the sick and made ill people well.

In the final decade of his life, Sydenham turned to apply his principles to the chronic diseases and produced a classic description of gout. By this time he had achieved eminence in the world of medical letters, both at home and in continental Europe, having become the “English Hippocrates.” Ironically, the only eponymous use of his name that still remains common, “Sydenham’s chorea,” refers to two paragraphs interjected in one of his treatises, more or less as an aside.

BIBLIOGRAPHY

I. Original Works. Of the many editions of Sydenham’s published works, the best is the Opera omnia, William A. Greenhill, ed. (London, 1844; 2nd ed., 1846). It includes a bibliography of the Latin editions of all his writings into the nineteenth century. The standard English trans., The Works of Thomas Sydenham, M.D., 2 vols. (London, 1848), translated from the Latin ed. of Greenhill, with a biography of Sydenham by R. G. Latham, is not always reliable and should be compared with the Latin text, with the nearly contemporary trans. by John Pechey (London, 1696), and with that by John Swan (London, 1742).

A number of Sydenham’s MSS and documents relating to his life have been published. The largest collection of these is in Kenneth Dewhurst, Dr. Thomas Sydenham (1624–1689): His Life and Original Writings (London, 1966); this includes the controversial “De arte medica” and the “Anatomia,” in addition to “Theologia rationalis” and a number of medical fragments. More complete versions of these last works, with other material, are in the unpublished “Medical Observations by Thomas Sydenham” (the so-called Vaillant Manuscript), of various dates, in the library of the Royal College of Physicians, London. This MS is partially in Sydenham’s hand, and partially in Locke’s. Other literary remains of Sydenham, published and unpublished, are discussed by Dewhurst. See also the appendix to Bates, cited below.

II. Secondary Literature. The best known biographies of Sydenham are Joseph F. Payne (London, 1900) and Dewhurst. Payne’s biography is not documented, but his article on Sydenham in the Dictionary of National Biography, LV (1898), gives extensive references. Payne and Dewhurst differ in a number of details of Sydenham’s life, and sometimes both tend to be more assertive than their evidence warrants. L. M. F. Picard, Thomas Sydenham: Sa vie et ses oeuvres. Thèse pour le doctorat en médecine (Dijon, 1889), has many details not found in Payne or Dewhurst, and is well documented.

The development and elucidation of Sydenham’s concepts of epidemic constitutions, disease species, and methodical treatment can be found in D. G. Bates, “Thomas Sydenham: The Development of His Thought, 1666–1676” (unpublished doctoral diss., The Johns Hopkins University, 1975). A selected bibliography of the secondary literature and an extensive analysis of the Sydenham MSS will also be found there. A full account of the contemporary context for these ideas and Sydenham’s influence on eighteenth- and nineteenth-century clinical medicine is still needed.

Donald G. Bates

Thomas Sydenham

1624-1689

English Physician

Thomas Sydenham put British medical practice on a firm empirical foundation. He eschewed medical theorizing, discounted medieval medical traditions and Renaissance science, trusted no medical author except Hippocrates (460?-377? b.c.), and based his therapeutics on his own direct observation of each patient.

Sydenham was born the son of a country squire in Dorset. In 1642 he matriculated at Magdalen Hall, Oxford University, but the English Civil War interrupted his studies. He fought on the side of Parliament and achieved the rank of captain. He returned to Oxford in 1647 and received his bachelor of medicine there in 1648. This was not an earned degree, but a reward for his services to Cromwell. Much later, in 1676, he received an honorary M.D. from Pembroke College, Cambridge University. He became a licentiate of the Royal College of Physicians in 1663, but never was admitted as a fellow, probably because after the Restoration of Charles II in 1660, the British political climate was against those who had opposed the monarchy.

Although he remained at Oxford until 1655, he distrusted academic medicine and was skeptical of anything he was taught. He was more interested in curing diseases than in speculating about their causes. Nevertheless, he developed his own theories of the origins and transmissions of diseases and held to the humoral theory of Hippocrates that the healthy body is in balance with nature. He claimed that each disease must run its natural course, but that the physician, using nature, could ease the suffering of the patient along this course. His belief that each disease was a separate entity made him a godfather of the nosological movement in the eighteenth century.

In 1655 Sydenham opened the medical practice in Westminster, London, that occupied him for the rest of his life. The same year he married Mary Gee. They had three sons, one of whom, William, became a physician.

Sydenham's observations contributed much to the knowledge of dysentery, malaria, pneumonia, and several nervous conditions. He popularized using cinchona or Peruvian bark, the source of quinine, to treat malaria. He used opiates to treat nearly everything else and he invented laudanum. He was among the first to prescribe fresh air for convalescence, exercise for tuberculosis, and iron tonics for anemia. He formed close friendships with the chemist Robert Boyle (1627-1691) and the philosopher John Locke (1632-1704). The three mutually influenced each other's work for decades.

Sydenham's most important work was his 1683 Tractatus de podagra et hydrope (Treatise on gout and dropsy), in which he distinguished between gout and rheumatism. The first edition of his Observationes medicae (Medical observations), published in 1676, contained the best descriptions of measles and scarlet fever up to that time, and the first clear distinction between these two diseases. The fourth edition (1685) reported significant progress in smallpox research. His Schedula monitoria de novae febris ingressu (A warning essay on the emergence of a new fever), published in 1686, included his description of chorea minor or St. Vitus's dance, now called Sydenham's chorea or rheumatic chorea. Among his other books are: Methodus curandi febres (Method of curing fevers), 1666; Epistolae responsoriae duae (Two responsive letters), 1680; and Dissertatio epistolaris ad . . . Guilielmum Cole (Dissertation in the form of a letter to William Cole), 1682.

Sydenham had many followers, especially posthumously, and his positive influence lasted at least two centuries. His clinical reputation is based primarily on the fact that he made his patients feel better. He relied chiefly upon vegetable materia medica and noninvasive methods. He bled patients as often as did most other physicians of his time, but did not take such great quantities of blood. Even if he did not cure his patients, they were satisfied with his fatherly concern and gentle therapeutics.

The Sydenham Society, dedicated to the preservation of medical knowledge, was founded in London in 1844 and succeeded by the New Sydenham Society in 1858.

ERIC V.D. LUFT

SYDENHAM, THOMAS

Thomas Sydenham (1624–1689) is often referred to as the English Hippocrates because of the emphasis, in his medical practice and teachings, of the importance of bedside observation. His writings, controversial in his day, condemned theorizing in medicine and taught that the understanding of disease and its treatment should be based on observation of the evolution of signs and symptoms in groups of patients over time, and on the observed responses of patients to medicines and treatments. His importance in public health stems principally from his interest in classifying febrile diseases and his study of epidemic patterns of fevers in London over many years. He concluded that febrile diseases were not merely idiosyncratic humoral responses to environmental stimuli, but distinct species of disease whose expression was greatly dependent on atmospheric and seasonal influences.

In treatment, Sydenham avoided the heavy use of drugs characteristic of his time, challenged prevailing approaches to the treatment of smallpox, and was a strong advocate of physical exercise and diet as therapy. He was perhaps the first influential physician to embrace Peruvian bark (quinine) in the treatment of ague (malaria), and one of the first to treat anemia with iron. In spite of his opposition to academic theorizing and experimental approaches in medicine, he was close to many of English scientists of the time, including Robert Boyle, Christopher Wren, Robert Hooke, and philosopher John Locke (also a physician), who was a devoted student of his medical teachings.

Sydenham's unconventional, even revolutionary, approach to medicine cannot easily be divorced from his involvement in the seventeenth-century Puritan rebellion against the British crown. The Sydenham family, Dorsetshire landowners, were strong supporters of Parliament and Cromwell in the English civil war of the 1640s. All five Sydenham brothers (Thomas was the youngest) and their father served as officers in Cromwell's rebel army. Thomas was wounded, two of his brothers were killed, their mother was murdered by Royalist troops, and the eldest brother, William, became a leading figure in Cromwell's protectorate. Sydenham's unpopularity with leading physicians during the period of Restoration in which he practiced may in part have been the consequence of his political history, as well as his lack of a full classical education, attributable to the interruption of his Oxford education by military service. His two major works, Methodis Curandis Febres (1666) and Observationes Medicae (1676), are thought to have been written in English and translated by a Latin scholar for publication.

Nigel Paneth

Bibliography

Dewhurst, K. (1966). Dr. Thomas Sydenham (1624–1689): His Life and Original Writings. London: Wellcome Historical Medical Library.

Thomas Sydenham

The English physician Thomas Sydenham (1624-1689) emphasized, in practicing medicine, careful observation and experience and earned the title "English Hippocrates."

Born in Winford Eagle, Dorset, the fifth son of a wealthy country gentleman, Thomas Sydenham entered Magdalen College, Oxford, in 1642. His studies were interrupted by the outbreak of the civil war, during which the Sydenhams fought for the parliamentarians. He returned to Oxford in 1647, receiving his bachelor degree the following year. In 1651 he rejoined the army, after which he stayed at Oxford until 1663, when he was married and opened his London practice.

With only 18 months of formal medical education, consisting of a mixture of classics, anatomical dissections, and formal disputations, Sydenham found little use in theoretical learning, and experimental science seemed just as useless to him. He was convinced that only the careful observation of diseases at the bedside could lead to medical progress, and he spent all his efforts on detailed clinical observations. Despite his objection to theory and his insistence on a purely empirical medicine, he accepted the traditional concept that diseases resulted from disturbances of the bodily humors. He revived the Hippocratic notion that the seasons and atmospheric conditions played an equally important role, but he differed from Hippocrates in the emphasis he placed on the recognition of specific diseases. He believed that the detailed study of the natural history of any disease would eventually indicate what specific medication should be used for its treatment. Recognizing that Peruvian bark (crude quinine) was the only specific he knew, he prescribed it for malaria, which was the most prevalent fever in the London of his time.

At a time when most physicians were deeply concerned with theoretical questions, with systematization and attempts to relate medicine to experimental physics or chemistry, Sydenham's empiricism and emphasis on clinical description did not make him popular among his medical colleagues.

Some of Sydenham's writings became classics, like his description of gout (1683), which he suffered from for years and which ultimately led to his death. He differentiated scarlet fever from measles. His description of hysteria, which is frequently mentioned for its accuracy, included other conditions as well. The prevalence of smallpox led him to the conclusion that it was a physiological process which everyone had to go through. Because of his accurate portrayal of St. Vitus's dance, this disease became known as Sydenham's chorea. In therapy he insisted on simple prescriptions and measures, a fact which may have contributed to his great success as a practitioner.

His personal friend and fellow physician John Locke applied Sydenham's empiric medical ideas to philosophy. Succeeding generations of physicians found Sydenham's emphasis on bedside observation most useful and proclaimed him the "English Hippocrates." His emphasis on the study of the natural history of diseases and of all the factors surrounding their occurrence gave great impetus to the subsequent development of epidemiology.

Further Reading

A detailed biography, which also contains some of Sydenham's works in translation, is Kenneth Dewhurst, Dr. Thomas Sydenham, 1624-1689 (1966). Other studies are Joseph F. Payne, Thomas Sydenham (1900), and David Riesman, Thomas Sydenham, Clinician (1926). For background see Fielding H. Garrison, An Introduction to the History of Medicine (4th ed. repr. 1967). □

Sydenham, Thomas (1624–89) English physician, often called the ‘English Hippocrates’. Sydenham initiated the cooling method of treating smallpox, made a thorough study of epidemics, and wrote descriptions of malaria and gout.