_THOMAS SYDENHAM, THE BRITISH HIPPOCRATES._
In the front rank of practical physicians in England stands THOMAS
SYDENHAM, descended from an ancient Somersetshire family, one branch
of which migrated into Dorsetshire in the reign of Henry VIII., and
settled at Winford Eagle. Here he was born in 1624. We know nothing
of his early years till we find him entered at Magdalen Hall, Oxford,
in 1642. His studies were interrupted by Charles I.’s residence
there, and it is very probable that he took arms on the side of the
Parliament, while it is certain that his brothers did so—one of
them, William Sydenham, having been a well-known Parliamentarian
commissioner, and Governor of the Isle of Wight. His mother, too,
was in some way, of which we have no account, “killed in the civil
wars” in 1644, so that there is sufficient reason why Thomas Sydenham
should have withdrawn from Oxford at this time. Sir Richard Blackmore
indeed describes him as a disbanded officer, and this appears
possible from what Sydenham himself states.
In his letter dedicatory to Dr. John Mapletoft of the third edition
of his “Medical Observations,” Sydenham says: “It is now thirty
years since I had the good fortune to fall in with the learned
and ingenuous Master Thomas Coxe, Doctor.... I myself was on my
way to London, with the intention of going thence to Oxford, the
breaking out of the war having kept me away for some years. With
his well-known kindness and condescension, Dr. Coxe asked me what
pursuit I was prepared to make my profession.... Upon this point my
mind was unfixed, whilst I had not so much as dreamed of medicine.
Stimulated, however, by the recommendation and encouragement of so
high an authority, I prepared myself seriously for that pursuit.
Hence all the little merit that my works may have earned in the eyes
of the public is to be thankfully referred to him who was the patron
and promoter of my first endeavours.”
Dr. Lettsom in 1801 communicated to the _Gentleman’s Magazine_ a
MS. anecdote which has since been found to be derived from “The
Vindicatory Schedule,” by Dr. Andrew Brown, published two years after
Sydenham’s death. “Dr. Thos. Sydenham was an actor in the late civil
war, and discharged the office of captain. He being in his lodgings
in London, and going to bed at night with his clothes loosed, a mad
drunken fellow, a soldier, likewise in the same lodging, entered his
room, with one hand gripping him by the breast of his shirt, with the
other discharged a loaded pistol into his bosom; yet, oh strange!
without any hurt to him.” The story then goes on to relate how the
bullet happened to be discharged in the line of all the bones of the
palm of the hand edgeways, so that it lost its force and was spent
without doing any harm to Sydenham.
When Oxford surrendered to the Parliament, Sydenham returned to
Magdalen Hall, and was soon afterwards elected a fellow of All Souls’
in place of an expelled Royalist. The degree of M.B. he took in 1648,
without taking a degree in arts; and he appears to have resided
at Oxford for some years, with possibly an interval spent at the
Montpellier School of Medicine. Soon after taking his degree he began
to suffer from gout and symptoms of stone, to which he was a martyr
more or less for the rest of his life.
We do not know in what year Sydenham finally quitted Oxford and went
to London. He gives an account of the epidemics of 1661 in London,
where he must then have been settled. In 1663 he became a licentiate
of the College of Physicians, but could not proceed further without
a doctor’s degree, which he did not take till comparatively late in
life, in 1676.
In 1666 appeared Sydenham’s first work, the first edition of the
“Method of Curing Fevers,” dealing with continued and intermittent
fevers, and with smallpox.
This first edition was dedicated to Robert Boyle, whom Sydenham
describes as “truly and wholly noble,” and to whom he ascribes
transcendent parts, such as to raise him to the level of the most
famous names of foregone ages. He acknowledges many and great
favours conferred upon him by his friend; and he states soberly that
it was on Boyle’s persuasion and recommendation that he undertook to
write the book, and by his experience that some portions of it had
been tested. Boyle occasionally accompanied Sydenham in his visits
to the sick. The physician hopes his book will not find less favour
for being “neither vast in bulk, nor stuffed out with the spoils of
former authors.” “I have no wish to disturb their ashes,” he remarks.
The preface to the first edition begins thus: “Whoever takes up
medicine should seriously consider the following points: firstly,
that he must one day render to the Supreme Judge an account of
the lives of those sick men who have been intrusted to his care.
Secondly, that such skill and science as, by the blessing of God,
he has attained, are to be specially directed towards the honour of
his Maker and the welfare of his fellow-creatures, since it is a
base thing for the great gifts of heaven to become the servants of
avarice or ambition. Thirdly, he must remember that it is no mean
ignoble animal that he deals with. We may ascertain the worth of
the human race, since for its sake God’s only-begotten Son became
man, and thereby ennobled the nature that He took upon Him. Lastly,
he must remember that he himself hath no exemption from the common
lot, but that he is bound by the same laws of mortality, and liable
to the same ailments and afflictions with his fellows. For these
and like reasons let him strive to render aid to the distressed with
the greater care, with the kindlier spirit, and with the stronger
fellow-feeling.”
The candid and philosophic temperament of the man is also well
exemplified in the conclusion of the same preface. He foresees
that “even where my practice has been tried, and its results been
recognised, it will be asserted that my statements are anything but
new, and that the world has long known them. I have, notwithstanding,
never allowed myself to be deterred from communicating the following
pages to those of my fellow-creatures who unite the love of truth
with the love of their kind. It is my temper and disposition to be
careless both of the sayings and the doings of the over-proud and the
over-critical. To the wise, however, and the honest, I wish to say
this much:—I have in no wise distorted either fact or experiment;
I told the truth, the whole truth, and nothing but the truth....
In the meanwhile I ask the pardon, and submit to the arguments, of
better judges than myself, for all errors of theory. Perhaps I may
myself hereafter on many points change my mind of my own accord. As I
have no lack of charity for the errors of others, I have no love of
obstinately persisting in my own.”
At the outset of his treatise he asserts that a disease is an effort
of nature which strives with might and main to restore the health
of the patient by the elimination of the morbific matter. Yet he is
so far in accord with modern discovery of bacterial germs, that
he refers the specific differences between fevers to some unknown
constitution of the atmosphere. His wisdom is conspicuous when
he says he prefers nothing, on the outbreak of a new fever, to a
little delay, and diligently observes the character and cause of the
disease, and what kinds of treatment do good or harm. He discerns
thoroughly that the scientific working out of the characteristics
and phenomena of each disease must be accomplished before it can be
asserted that any good work worthy of mention has been got through.
It would be difficult to exhibit a more modest and a more truly
philosophical spirit than that shown in the following lines at the
close of his second chapter: “One thing most especially do I aim
at. It is my wish to state how things have gone lately; how they
have been in this the city which we live in. The observations of
some years form my groundwork. It is thus that I would add my mite,
such as it is, towards the foundation of a work that, in my humble
judgment, shall be beneficial to the human race. Posterity will
complete it, since to them it shall be given to take the full view of
the whole cycle of epidemics in their mutual sequences for years yet
to come.”
A signal instance of his philosophic moderation is given in the
following extract: “For my own part, I am not ambitious of the name
of a philosopher, and those who think themselves so, may perhaps
consider me blameable on the score of my not having attempted to
pierce into those penetralia. Now, writers like these I would just
recommend, before they blame others, to try their hand upon some
common phenomena of nature that meet us at every turn. For instance,
I would fain know why a horse attains its prime at seven, and a man
at one-and-twenty years? Why, in the vegetable kingdom, some plants
blow in May and others in June? There are numberless questions of
this sort. Hence, if many men of consummate wisdom are not ashamed to
proclaim their ignorance in these matters, I cannot see why I am to
be called in question for doing the same. Etiology is a difficult,
and, perhaps, an inexplicable affair; and I choose to keep my
hands clear of it. _I am convinced, however, that Nature here, as
elsewhere, moves in a regular and orderly manner._”
In how wise and firm a tone does Sydenham denounce and demolish the
quacks and patent medicine vendors! He considers that any man who
can, by any sure line of treatment, or by the application of any
specific remedy, control the course of diseases or cut them short,
is bound by every possible bond to reveal to the world in general so
great a blessing to his race. If he withheld it, he pronounced him a
bad citizen and an unwise man; for no good citizen would monopolise
for himself a general benefit for his kind, and no wise man would
divest himself of the blessing he might reasonably expect from his
Maker in contributing to the welfare of the world.
Sydenham stands out as a great advocate and champion of Peruvian
bark, which, in its modern form of quinine, has justified all that he
claimed for it. He is also the founder of the “expectant” treatment.
“My chief care,” he says, “in the midst of so much darkness and
ignorance, is to wait a little, and proceed very slowly, especially
in the use of powerful remedies, in the meantime observing its nature
and procedure, and by what means the patient was relieved or injured.”
The new treatise at once attracted attention, and was reviewed in
the Philosophical Transactions for 1666. In the same year there
appeared a Dutch edition of the Method. The value and the effect of
this treatise we can scarcely fully appreciate at the present time,
but its pith is well given by Dr. John Brown, author of the “Horæ
Subsecivæ.” “Besides their broad, accurate, vivid delineations of
disease—portraits drawn to the life, and by a great master—and their
wise, simple, rational rules for treatment, active and negative,
general and specific—there are two great principles continually
referred to as supreme in the art of medicine. The first is that
nature cures diseases; that there is a recuperative and curative
power, the _vis medicatrix_, in every living organism, implanted in
it by the Almighty, and that it is by careful reverential scrutiny
of this law of restoration that all our attempts at cure are to be
guided; that we are its ministers and interpreters, and neither
more nor less; and the second, that symptoms are the language of a
suffering and disordered and endangered body, which it is the duty
of the physician to listen to, and as far as he can to explain and
satisfy, and that, like all other languages, it must be studied. This
is what he calls the natural history of diseases.... What Locke did
for the science of mind, what Harvey and Newton did for the sciences
of organic and inorganic matter, Sydenham did for the art of healing
and of keeping men whole: he made it in the main observational; he
founded it upon what he himself calls downright matter of fact,
and did this not by unfolding a system of doctrines or raising up
a scaffolding of theory, but by pointing to a road, by exhibiting
a method—and moreover teaching this by example, not less than by
precept—walking in the road, not acting merely as a finger-post, and
showing himself to be throughout a true artsman and master of his
tools. The value he puts upon sheer, steady, honest observation, as
the one initial act and process of all true science of nature, is
most remarkable; and he gives himself, in his descriptions of disease
in general and of particular cases, proofs quite exquisite of his own
powers of persevering, minute, truthful scrutiny.”
In 1668 a second edition of the Method was published, with additions,
especially a chapter on the Plague, and prefaced by a eulogistic
address in Latin verse, extending to fifty-four lines, by the
illustrious Locke. In 1676 appeared the third edition of the Method,
so much enlarged that it is better regarded as the first edition of
the “Medical Observations.” In the same year Sydenham proceeded to
the degree of Doctor of Medicine, not at Oxford, but at Cambridge,
this choice being probably due to the fact that his son had entered
at Pembroke College, Cambridge, two years before.
From the preface to his treatise on gout and dropsy, published in
1683, we find that Sydenham was compelled to lay aside his project of
a complete book on chronic diseases by the extreme attacks of gout
which his labours brought on. “Whenever I returned to my studies,”
he says, “my gout returned to me.” A few years before, in 1677, he
had been prevented from practising by a severe attack of gout, and
he was compelled to spend another three months in the country to
restore his health. He continued his labours, however, it is to be
believed, beyond his strength, and several editions of his works,
with fresh observations, were issued in the later years of his life.
He died at his house in Pall Mall on the 29th of December, 1689,
aged sixty-five, being buried at St. James’s, Westminster. The truly
appropriate description, “Medicus in omne ævum nobilis,” was given
of him by the College of Physicians in 1810, when a mural tablet was
raised to his memory near his place of burial.
Sydenham’s will shows that he had three sons—William, Henry, and
James—the eldest of whom received entailed estates in Hertfordshire
and Leicestershire. He bequeathed £30 for the professional education
of his nephew James, afterwards Sir James Thornhill, Hogarth’s
father-in-law. Sydenham’s executor was Mr. Malthus, an apothecary of
Pall Mall (great-grandfather of Professor Malthus), whom he enjoins
to bury him with a careful abstinence from all ostentatious funeral
pomp.
It is perhaps not necessary to regret so acutely the lack of
biographical details regarding Dr. Sydenham, as many have done, for
we think that his character stands out clearly in his writings. In
his letter to Dr. Mapletoft, already referred to, he says:—
“After a few years spent in the arena of the university, I returned
to London for the practice of medicine. The more I observed the facts
of this science with an attentive eye, and the more I studied them
with due and proper diligence, the more I became confirmed in the
opinion which I have held up to the present hour, viz., _that the art
of medicine was to be properly learnt only from its practice and its
exercise_; and that, in all probability, he would be the best skilled
in the detection of the true and genuine indications of treatment
who had the most diligently and the most accurately attended to the
natural phenomena of disease.”
The same preface contains Sydenham’s opinion of a great contemporary
and valued friend of his. “You know also how thoroughly an intimate
and common friend, and one who has closely and exhaustively examined
the question, agrees with me as to the method I am speaking of—a man
who, in the acuteness of his intellect, in the steadiness of his
judgment, in the simplicity (and by _simplicity_ I mean _excellence_)
of his manners, has amongst the present generation few equals and
no superiors. This praise I may confidently attach to the name of
John Locke.” Dugald Stewart, commenting on this, says: “The merit of
the Method therefore may be presumed to have belonged in part to Mr.
Locke.” There is no reason, however, in the co-operation of these
great minds, for detracting from the praise of either.
Sydenham’s idea of a satisfactory method of curing was a line of
practice based upon a sufficient number of experiments. His business
was, he says, to support his own observations, not to discuss the
opinions of others. The facts would speak for themselves, and would
alone show whether he acted with truth and honesty, or, like a
profligate and immoral man, was to be a murderer even when in his
grave. In the preface to the third edition he says, “The breath of
life would have been to me a vain gift, unless I contributed my mite
to the treasury of physic.” He considered that medicine was to be
advanced in two main ways—by a history of diseases, by descriptions
at once graphic and natural, and by formulating a praxis or method
of treating them. The most modern thought could produce no sounder
principle for describing disease than the following: “In writing
the history of a disease, every philosophical hypothesis whatsoever
that has previously occupied the mind of the author should lie in
abeyance. This being done, the clear and natural phenomena of the
disease should be noted—these and these only. These should be noted
accurately and in all their minuteness.” He wittily remarks that
it often happens that the character of the complaint varies with
the nature of the remedies, and that symptoms may be referred less
to the disease than to the doctor. He traces the lack of accurate
descriptions of diseases to an idea that disease was but a confused
and disordered effort of nature defending herself in vain, so that
men had classed the attempts at a just description with the attempts
to wash blackamoors white.
Sydenham conceived the idea, too, of paying some attention to the
wishes and tastes of the patient. “A person in a burning fever
desires to drink freely of some small liquor; but the rules of art,
built upon some hypothesis, having a different design in view,
thwart the desire, and instead thereof order a cordial. In the
meantime the patient, not being suffered to drink what he wishes,
nauseates all kinds of food, but art commands him to eat. Another,
after a long illness, begs hard, it may be, for something odd or
questionable; here, again, impertinent art thwarts him and threatens
him with death. How much more excellent the aphorism of Hippocrates:
‘Such food as is most grateful, though not so wholesome, is to be
preferred to that which is better, but distasteful.’” He has nothing
of the meddlesome practitioner about him. “Indeed, if I may speak my
mind freely, I have been long of opinion that I act the part of an
honest man and a good physician as often as I refrain entirely from
medicines, when, upon visiting the patient, I find him no worse
to-day than he was yesterday; whereas, if I attempt to cure the
patient by a method of which I am uncertain, he will be endangered
both by the experiment I am going to make on him and by the disease
itself; nor will he so easily escape two dangers as one.”
A fine description of one aspect of hysteria and hypochondria may
here be given as an example of his power in the delineation of
disease: “The patients believe that they have to suffer all the
evils that can befall humanity, all the troubles that the world can
supply. They have melancholy forebodings, they brood over trifles,
cherishing them in their anxious and unquiet bosoms. Fear, anger,
jealousy, suspicion, and the worst passions of the mind arise without
cause. Joy, hope, cheerfulness, if they find place at all in their
spirits, find it at intervals ‘few and far between,’ and then take
leave quickly. In these, as in the painful feelings, there is no
moderation. All is caprice. They love without measure those whom they
will soon hate without reason. Now they will do this, now that—ever
receding from their purpose.... All that they see in their dreams are
funerals and the shadows of departed friends.”
The great physician has nowhere described his own character more
clearly than in the following passage: “In all points of theory where
the reader finds me in error, I ask his pardon. In all points of
practice I state that I speak nothing but the truth; and that I have
propounded nothing except what I have properly tried. Verily, I am
sure that, when the last day of my life shall have come upon me, I
shall carry in my heart a willing witness that shall speak, not only
to the care and honesty with which I have laboured for the health of
both rich and poor who have intrusted themselves to my care, but also
to those efforts which I have made to the best of my power, and with
all the energies of my mind, to give certainty to the treatment of
diseases even after my death, if such may be. In the first place, no
patient has been treated by me otherwise than I would myself wish to
be treated under the same complaint. In the second, I have ever held
that any accession whatever to the art of healing, even if it went no
further than the cutting of corns or the curing of toothaches, was of
far higher value than all the knowledge of fine points, and all the
pomp of subtle speculations—matters which are as useful to physicians
in driving away diseases, as music is to masons in laying bricks.”
The last comparison leads us to note that a vein of humour runs
through Sydenham’s works, as when he quotes
“Tua res agitur paries quum proximus ardet,”
as a reason for his leaving London in the height of the plague.
In another passage, he is referring to the want of opportunity of
the poor to injure themselves by unsuitable diet in smallpox, owing
to the “res augusta domi.” Yet even among the poor, he says, since
they learnt the use of certain cordials, many more have died than in
previous ages less learned but more wise. “Nowadays every house has
its old woman,” he says, “a practitioner in an art she never learnt,
to the killing of mankind.”
In one place he grimly remarks, that if a certain mode of treatment
be resorted to, the patient will die of his own doctor, an end which
in that age must have too frequently resulted, though not specified
in the catalogue of diseases.
Here is a specimen of Sydenham’s witty apophthegms: “A man who finds
a treasure lying on the ground before him, is a fool if he do not
stoop and pick it up; but he is a greater one who, on the strength
of such a single piece of luck, wastes labour and risks life for the
chance of another.”
Again, “The usual pomp of medicine exhibited over dying patients is
like the garlands of a beast at the sacrifice.” Elsewhere he refers
to some persons “to whom nature has given just wit enough to traduce
her with.” We must also refer to Sydenham’s humour his answer to Sir
Richard Blackmore, who asked him what books he should study medicine
in: “Read Don Quixote, sir, which is a very good book: I read it
still.”
We notice as an instance of Sydenham’s kind-heartedness, a case
in which he lent a poor man one of his horses for a several days’
journey, believing continuous horse-exercise to be the best cure for
his disease.
Another characteristic touch is the following: “I have always thought
that to have published for the benefit of afflicted mortals any
certain method of subduing even the slightest disease, was a matter
of greater felicity than the riches of a Tantalus or a Crœsus.” To
Dr. Brady he remarks: “To you that undeserved abuse wherewith I am
harassed by many, is a vexation and sorrow; whilst, of those who
utter it this I may safely say, that if a harmless life, hurting
none by word or deed, had been sufficient to protect me from their
tongues, they never would have thundered against me. Since, then, it
is from no fault of mine that these calumnies have fallen on me, this
is my resolution, viz., that I will not afflict myself because other
men have done wrong.”
Again he says: “My fame is in the hands of others. I have weighed in
a nice and scrupulous balance, whether it be better to serve men,
or to be praised by them, and I prefer the former. It does more
to tranquillise the mind; whereas fame, and the breath of popular
applause, is but a bubble, a feather, and a dream. Such wealth as
such fame gives, those who have scraped it together, and those who
value it highly, are fully free to enjoy, only let them remember that
the mechanical arts (and sometimes the meanest of them) bring greater
gains, and make richer heirs.”
He addressed to Dr. Thomas Short his treatise on Gout and Dropsy,
because “although others despised the observations which I previously
published, you had no hesitation in attributing to them some
utility.”... “It is my nature to think where others read; to ask less
whether the world agrees with me than whether I agree with the truth;
and to hold cheap the rumour and applause of the multitude.”
We have yet to note a remarkable fragment entitled “Theologia
Rationalis, by Dr. Thomas Sydenham,” in manuscript in the Cambridge
University Library. It appears to coincide very closely with other
indications of his views, and it has been said of it, “There is much
in it of the spirit both of Locke and Butler—of Locke in the spirit
of observation and geniality; of Butler in the clear utterances as to
the supremacy of reason, and the necessity of living according to our
own true nature.” The general principles of his regard of the Divine
Being may be judged from the following extract: “Wherefore, to this
eternal, infinitely good, wise, and powerful Being, as I am to pay
all that adoration, thanks, and worship which I can raise up my mind
unto; so to Him, from the consideration of His providence, whereby
He doth govern the world, myself and all things in it, I am to pray
for all that good which is necessary for my mind and body, and for
diverting all those evils which are contrary to their nature; above
all desiring that my mind may be endowed with all manner of virtue.
But in requesting things relating to my body and its concerns, having
always a deference to the will of the Supreme Being, who knows what
is best for me better than I do myself. And though my requests to
these bodily concerns of mine are not answered, nevertheless, herein
I worship Him, by declaring my dependence upon Him; and forasmuch as
that, in many respects, I have transgressed His divine laws written
upon my nature, I am humbly to implore His pardon, it being as
natural for me to do it, as it is to implore the pardon of a man whom
I know I have offended. In all which requests of mine, and all His
creatures, how many soever they be in number, and how distant soever
they be in place, He being infinite, is as ready at hand to hear and
to help as any man who is but finite is at hand to administer food to
his child that craves it.”
Thus we take leave of Sydenham, denominated by Locke “one of the
master-builders at this time in the commonwealth of learning;”
reckoned by the masters in his own and the next age as second to
Hippocrates alone—the man whom Boerhaave never mentioned to his class
without lifting his hat, describing him as “Angliæ lumen, artis
Phœbum, veram Hippocratici viri speciem.”