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Thomas (Tom) Sydenham
Thomas Sydenham in a 1689 portrait by Mary Beale.
|Died||29 December 1689 65) (aged|
|Alma mater|| All Souls College, Oxford (MB, 1648)|
Pembroke College, Cambridge (MD, 1676)
|Known for||Clinical medicine|
Thomas Sydenham (10 September 1624 – 29 December 1689) was an English physician. He was the author of Observationes Medicae which became a standard textbook of medicine for two centuries so that he became known as 'The English Hippocrates'. Among his many achievements was the discovery of a disease, Sydenham's Chorea, also known as St Vitus Dance.
England is a country that is part of the United Kingdom. It shares land borders with Wales to the west and Scotland to the north-northwest. The Irish Sea lies west of England and the Celtic Sea lies to the southwest. England is separated from continental Europe by the North Sea to the east and the English Channel to the south. The country covers five-eighths of the island of Great Britain, which lies in the North Atlantic, and includes over 100 smaller islands, such as the Isles of Scilly and the Isle of Wight.
A physician, medical practitioner, medical doctor, or simply doctor, is a professional who practises medicine, which is concerned with promoting, maintaining, or restoring health through the study, diagnosis, prognosis and treatment of disease, injury, and other physical and mental impairments. Physicians may focus their practice on certain disease categories, types of patients, and methods of treatment—known as specialities—or they may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families, and communities—known as general practice. Medical practice properly requires both a detailed knowledge of the academic disciplines, such as anatomy and physiology, underlying diseases and their treatment—the science of medicine—and also a decent competence in its applied practice—the art or craft of medicine.
Hippocrates of Kos, also known as Hippocrates II, was a Greek physician of the Age of Pericles, who is considered one of the most outstanding figures in the history of medicine. He is often referred to as the "Father of Medicine" in recognition of his lasting contributions to the field as the founder of the Hippocratic School of Medicine. This intellectual school revolutionized medicine in ancient Greece, establishing it as a discipline distinct from other fields with which it had traditionally been associated, thus establishing medicine as a profession.
Thomas Sydenham was born at Wynford Eagle in Dorset, where his father was a gentleman of property. His brother was Colonel William Sydenham.
Wynford Eagle is a hamlet and small parish in Dorset, England, situated approximately 1.5 miles (2.4 km) southwest of Maiden Newton and 7.5 miles (12.1 km) northwest of Dorchester. Dorset County Council's 2013 mid-year estimate of the parish population is 60.
Dorset is a county in South West England on the English Channel coast. The ceremonial county comprises the unitary authority areas of Bournemouth, Christchurch and Poole and Dorset. Covering an area of 2,653 square kilometres (1,024 sq mi), Dorset borders Devon to the west, Somerset to the north-west, Wiltshire to the north-east, and Hampshire to the east. The county town is Dorchester which is in the south. After the reorganisation of local government in 1974 the county's border was extended eastward to incorporate the Hampshire towns of Bournemouth and Christchurch. Around half of the population lives in the South East Dorset conurbation, while the rest of the county is largely rural with a low population density.
At the age of eighteen Sydenham attended Magdalen Hall, Oxford; after a short period his college studies appear to have been interrupted, and he served for a time as an officer in the Parliamentarian army during the Civil War. He completed his Oxford course in 1648, graduating as bachelor of medicine, and about the same time he was elected a fellow of All Souls College. It was not until nearly thirty years later (1676) that he graduated as MD, not at Oxford, but at Pembroke Hall, Cambridge,where his eldest son was by then an undergraduate.
Magdalen College is one of the wealthiest constituent colleges of the University of Oxford, with a financial endowment of £273.2 million as of 2018.
Oxford is a university city in south central England and the county town of Oxfordshire. With a population of approximately 155,000, it is the 52nd largest city in the United Kingdom, with one of the fastest growing populations in the UK, and it remains the most ethnically diverse area in Oxfordshire county. The city is 51 miles (82 km) from London, 61 miles (98 km) from Bristol, 59 miles (95 km) from Southampton, 57 miles (92 km) from Birmingham and 24 miles (39 km) from Reading.
All Souls College is a constituent college of the University of Oxford in England.
After 1648 he seems to have spent some time studying medicine at Oxford, but he was soon back in military service, and in 1654 he received the sum of £600, as a result of a petition he addressed to Oliver Cromwell, pointing out the various arrears due to two of his brothers who had been killed and reminding Cromwell that he himself had also faithfully served the parliament with the loss of much blood.
Oliver Cromwell was an English military and political leader. He served as Lord Protector of the Commonwealth of England, Scotland, and Ireland "and of the dominions thereto belonging" from 1653 until his death, acting simultaneously as head of state and head of government of the new republic.
In 1655 he resigned his fellowship at All Souls and married Mary Gee in his home town of Wynford Eagle. They had two sons, William (c.1660–1738) and Henry (1668?–1741); another son, James, apparently died young.In 1663 he passed the examinations of the College of Physicians for their licence to practice in Westminster and 6 miles round; but it is probable that he had been settled in London for some time before that. This minimum qualification to practice was the single bond between Sydenham and the College of Physicians throughout the whole of his career.
Westminster is an area in central London within the City of Westminster, part of the West End, on the north bank of the River Thames. Westminster's concentration of visitor attractions and historic landmarks, one of the highest in London, includes the Palace of Westminster, Buckingham Palace, Westminster Abbey and Westminster Cathedral.
London is the capital and largest city of both England and the United Kingdom. Standing on the River Thames in the south-east of England, at the head of its 50-mile (80 km) estuary leading to the North Sea, London has been a major settlement for two millennia. Londinium was founded by the Romans. The City of London, London's ancient core − an area of just 1.12 square miles (2.9 km2) and colloquially known as the Square Mile − retains boundaries that follow closely its medieval limits. The City of Westminster is also an Inner London borough holding city status. Greater London is governed by the Mayor of London and the London Assembly.
He seems to have been distrusted by some members of the faculty because he was an innovator and something of a plain-dealer. In a letter to John Mapletoft he refers to a class of detractors "qui vitio statim vertunt si quis novi aliquid, ab illis non prius dictum vel etiam inauditum, in medium proferat" ("Who by a technicality suddenly turn if something is new, if someone should disclose something not previously said or heard"); and in a letter to Robert Boyle, written the year before his death (and the only authentic specimen of his English composition that remains), he says, "I have the happiness of curing my patients, at least of having it said concerning me that few miscarry under me; but [I] cannot brag of my correspondency with some other of my faculty .... Though yet, in taken fire at my attempts to reduce practice to a greater easiness, plainness, and in the meantime letting the mountebank at Charing Cross pass unrailed at, they contradict themselves, and would make the world believe I may prove more considerable than they would have me."
John Mapletoft (1631–1721) was an English clergyman and physician.
Robert Boyle was an Anglo-Irish natural philosopher, chemist, physicist, and inventor. Boyle is largely regarded today as the first modern chemist, and therefore one of the founders of modern chemistry, and one of the pioneers of modern experimental scientific method. He is best known for Boyle's law, which describes the inversely proportional relationship between the absolute pressure and volume of a gas, if the temperature is kept constant within a closed system. Among his works, The Sceptical Chymist is seen as a cornerstone book in the field of chemistry. He was a devout and pious Anglican and is noted for his writings in theology.
Charing Cross is a junction in London, England, where six routes meet. Clockwise from north these are: the east side of Trafalgar Square leading to St Martin's Place and then Charing Cross Road; the Strand; Northumberland Avenue; Whitehall; The Mall leading to Admiralty Arch and Buckingham Palace; and two short roads leading to Pall Mall.
Sydenham attracted to his support some of the most discriminating men of his time, such as Boyle and John Locke. His religious views have been described as an early form of natural theology.
His first book, Methodus curandi febres (The Method of Curing Fevers), was published in 1666; a second edition, with an additional chapter on the plague, in 1668; and a third edition, further enlarged and bearing the better-known title of Observationes mediciae (Observations of Medicine), in 1676. His next publication was in 1680 in the form of two Epistolae responsoriae (Letters & Replies), the one, "On Epidemics," addressed to Robert Brady, Regius Professor of Physic at Cambridge, and the other "On the Lues venerea," (On Venereal Diseases ) to Henry Paman, public orator at Cambridge and Gresham Professor of Physic in London.
In 1682 he published another Dissertatio epistolaris (Dissertation on the Letters), on the treatment of confluent smallpox and on hysteria, addressed to Dr William Cole of Worcester. The Tractatus de podagra et hydrope (The Management of Arthritis and Dropsy ) came out in 1683, and the Schedula monitoria de novae febris ingressu (The Schedule of Symptoms of the Newly Arrived Fever) in 1686. His last completed work, Processus integri (The Process of Healing), is an outline sketch of pathology and practice; twenty copies of it were printed in 1692, and, being a compendium, it has been republished more often both in England and in other countries than any other of his writings separately. A fragment on pulmonary consumption was found among his papers. His collected writings occupy about 600 pages 8vo, in the Latin, translated into that language by various scholars.
Although Sydenham was a successful practitioner and witnessed, besides foreign reprints, more than one new edition of his various treatises called for in his lifetime, his fame as the father of English medicine, or the English Hippocrates, was posthumous. For a long time he was held in vague esteem for the success of his cooling (or rather expectant) treatment of smallpox, for his laudanum (the first form of a tincture of opium), and for his advocacy of the use of "Peruvian bark" in quartan agues, in modern terms, the use of quinine-containing cinchona bark for treatment of malaria caused by Plasmodium malariae . There were, however, those among his contemporaries who understood something of Sydenham's importance in larger matters than details of treatment and pharmacy, among them Richard Morton and Thomas Browne who owned copies of several of Sydenham's books.
But the attitude of the academical medicine of the day is doubtless indicated in Martin Lister's use of the term sectaries for Sydenham and his admirers, at a time (1694) when the leader had been dead five years. If there were any suspicion that the opposition to him was quite other than political, it would be set at rest by the testimony of Dr Andrew Brown, who went from Scotland to inquire into Sydenham's practice and has incidentally revealed what was commonly thought of it at the time, in his Vindicatory Schedule concerning the New Cure of Fevers. In the series of Harveian Orations at the College of Physicians, Sydenham is first mentioned in the oration of Dr John Arbuthnot (1727), who styles him "aemulus Hippocratis" ("rival of Hippocrates"). Herman Boerhaave, the Leyden professor, was wont to speak of him in his class (which had always some pupils from England and Scotland) as "Angliae lumen, artis Phoebum, veram Hippocratici viri speciem" ("The light of England, the skill of Apollo, the true face of Hippocrates"). Albrecht von Haller also marked one of the epochs in his scheme of medical progress with the name of Sydenham. He is indeed famous because he inaugurated a new method and a better ethics of practice, the worth and diffusive influence of which did not become obvious (except to those who were on the same line with himself, such as Morton) until a good many years afterwards. It remains to consider briefly what his innovations were.
First and foremost he did the best he could for his patients, and made as little as possible of the mysteries and traditional dogmas of the craft. Stories told of him are characteristic: Called to a gentleman who had been subjected to the lowering treatment, and finding him in a pitiful state of hysterical upset, he conceived that this was occasioned partly by his long illness, partly by the previous evacuations, and partly by emptiness. "I therefore ordered him a roast chicken and a pint of canary." A gentleman of fortune he diagnosed with hypochondria was at length told he could do no more for him, but that there was living at Inverness a certain Dr Robertson who had great skill in cases like his; the patient journeyed to Inverness full of hope, and, finding no doctor of the name there, came back to London full of rage, but cured withal of his complaint.
Of a piece with this is his famous advice to Sir Richard Blackmore. When Blackmore first engaged in the study of physic he inquired of Dr Sydenham what authors he should read, and was directed by that physician to Don Quixote , which, said he, "is a very good book; I read it still." There were cases, he tells us, in his practice where "I have consulted my patients' safety and my own reputation most effectually by doing nothing at all."
In 1679, Sydenham gave Whooping cough the name pertussis, meaning a violent cough of any type.Sydenham was a zealous Puritan and "He rejected on religious grounds attempts such as pathological anatomy and microscopic analysis to uncover the hidden causes of disease. He argued God only gave man the ability to perceive the outer nature of things with his senses."
"Of all the remedies it has pleased almighty God to give man to relieve his suffering, none is so universal and so efficacious as opium"
"The arrival of a good clown exercises a more beneficial influence upon the health of a town than of twenty asses laden with drugs."
"I confidently affirm that the greater part of those who are supposed to have died of gout, have died of the medicine rather than the disease - a statement in which I am supported by observation."
"For humble individuals like myself, there is one poor comfort, which is this, viz. that gout, unlike any other disease, kills more rich men than poor, more wise men than simple. Great kings, emperors, generals, admirals, and philosophers have all died of gout. Hereby Nature shows her impartiality: since those whom she favors in one way she afflicts in another - a mixture of good and evil pre-eminently adapted to our frail mortality."
"It becomes every man who purposes to give himself to the care of others, seriously to consider the four following things: First, that he must one day give an account to the Supreme Judge of all the lives entrusted to his care. Secondly, that all his skill, and knowledge, and energy as they have been given him by God, so they should be exercised for his glory, and the good of mankind, and not for mere gain or ambition. Thirdly, and not more beautifully than truly, let him reflect that he has undertaken the care of no mean creature, for, in order that he may estimate the value, the greatness of the human race, the only begotten Son of God became himself a man, and thus ennobled it with his divine dignity, and far more than this, died to redeem it. And fourthly, that the doctor being himself a mortal man, should be diligent and tender in relieving his suffering patients, inasmuch as he himself must one day be a like sufferer."
The aphorism Primum non nocere (First, do no harm) is attributed to Sydenhamin a book written by Thomas Inman
Sydenham's fundamental idea was to take diseases as they presented themselves in nature and to draw up a complete picture (Krankheitsbild of the Germans) of the objective characters of each. Most forms of ill-health, he insisted, had a definite type, comparable to the types of animal and vegetable species. The conformity of type in the symptoms and course of a malady was due to the uniformity of the cause. The causes that he dwelt upon were the evident and conjunct causes, or, in other words, the morbid phenomena; the remote causes he thought it vain to seek after.
Acute diseases, such as fevers and inflammations. he regarded as a wholesome conservative effort or reaction of the organism to meet the blow of some injurious influence operating from without; in this he followed the Hippocratic teaching closely as well as the Hippocratic practice of watching and aiding the natural crises. Chronic diseases, on the other hand, were a depraved state of the humours, mostly due to errors of diet and general manner of life, for which we ourselves were directly accountable. Hence his famous dictum: "acutos dico, qui ut plurimum Deum habent authorem, sicut chronici ipsos nos" ("I say what hurts, most over which God has authority, just like we ourselves over the chronic").
Sydenham's nosological method is essentially the modern one, except that it lacked the morbid anatomy part, which was first introduced into the natural history of disease by Morgagni nearly a century later. In both departments of nosology, the acute and the chronic, Sydenham contributed largely to the natural history by his own accurate observation and philosophical comparison of case with case and type with type. The Observationes medicae and the first Epistola responsoria contain evidence of a close study of the various fevers, fluxes and other acute maladies of London over a series of years, their differences from year to year and from season to season, together with references to the prevailing weather, the whole body of observations being used to illustrate the doctrine of the epidemic constitution of the year or season, which he considered to depend often upon inscrutable telluric causes. The type of the acute disease varied, he found, according to the year and season, and the right treatment could not be adopted until the type was known.
There had been nothing quite like this in medical literature since the Hippocratic treatise, On Airs, Waters and Places; and there are probably some germs of truth in it still undeveloped, although the modern science of epidemiology has introduced a whole new set of considerations. Among other things Sydenham is credited with the first diagnosis of scarlatina and with the modern definition, of chorea (in Sched. monit.). After smallpox, the diseases to which he refers most are hysteria and gout, his description of the latter (from the symptoms in his own person) being one of the classical pieces of medical writing. While Sydenham's natural history method has doubtless been the chief ground of his great posthumous fame, there can be no question that another reason for the admiration of posterity was that which is indicated by RG Latham, when he says, "I believe that the moral element of a liberal and candid spirit went hand in hand with the intellectual qualifications of observation, analysis and comparison."
Hardly anything is known of Sydenham's personal history in London. He died at his house in Pall Mall on 29 December 1689, aged 65. He is buried in St James's Church, Piccadilly, where a mural slab was put up by the College of Physicians in 1810.
A memorial stone dedicated to Thomas can be found halfway up the staircase of St James's Church, Piccadilly. It was put there by the now-defunct 'Sydenham Society’.
Among the lives of Sydenham are one (anonymous) by Samuel Johnson in John Swan's translation of his works (London, 1742), another by C. G. Kühn in his edition of his works (Leipzig, 1827), and a third by Robert Gordon Latham in his translation of his works published in London by the Sydenham Society in 1848. See also Frédéric Picard, Sydenham, sa vie, ses œuvres (Paris, 1889), and Joseph Frank Payne, Thomas Sydenham (London, 1900). Dr John Brown's Locke and Sydenham, in Hores subsecivae (Edinburgh, 1858), is of the nature of eulogy. Many collected editions of his works have been published, as well as translations into English, German, French and Italian. William Alexander Greenhill published the Latin text (London, 1844, Syd. Soc.).
The most interesting summary of doctrine and practice by the author himself is the introduction to the 3rd edition of Observationes medicae (1676). A colleague, Dr John Browne, described him as "the prince of practical medicine, whose character is as beautiful and as genuinely English as his name".
The history of medicine shows how societies have changed in their approach to illness and disease from ancient times to the present. Early medical traditions include those of Babylon, China, Egypt and India. The Indians introduced the concepts of medical diagnosis, prognosis, and advanced medical ethics. The Hippocratic Oath was written in ancient Greece in the 5th century BCE, and is a direct inspiration for oaths of office that physicians swear upon entry into the profession today. In the Middle Ages, surgical practices inherited from the ancient masters were improved and then systematized in Rogerius's The Practice of Surgery. Universities began systematic training of physicians around 1220 CE in Italy.
Medicine is the science and practice of establishing the diagnosis, prognosis, treatment, and prevention of disease. Medicine encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness. Contemporary medicine applies biomedical sciences, biomedical research, genetics, and medical technology to diagnose, treat, and prevent injury and disease, typically through pharmaceuticals or surgery, but also through therapies as diverse as psychotherapy, external splints and traction, medical devices, biologics, and ionizing radiation, amongst others.
Gout is a form of inflammatory arthritis characterized by recurrent attacks of a red, tender, hot, and swollen joint. Pain typically comes on rapidly, reaching maximal intensity in less than 12 hours. The joint at the base of the big toe is affected in about half of cases. It may also result in tophi, kidney stones, or urate nephropathy.
Internal medicine or general medicine is the medical specialty dealing with the prevention, diagnosis, and treatment of adult diseases. Physicians specializing in internal medicine are called internists, or physicians in Commonwealth nations. Internists are skilled in the management of patients who have undifferentiated or multi-system disease processes. Internists care for hospitalized and ambulatory patients and may play a major role in teaching and research.
Primum non nocere is a Latin phrase that means "first, to do no harm." The phrase is sometimes recorded as primum nil nocere.
Chorea is an abnormal involuntary movement disorder, one of a group of neurological disorders called dyskinesias. The term chorea is derived from the Ancient Greek: χορεία, as the quick movements of the feet or hands are comparable to dancing.
Sydenham's chorea (SC), also known as chorea minor and historically referred to as St Vitus' dance, is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea results from childhood infection with Group A beta-haemolytic Streptococcus and is reported to occur in 20–30% of people with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of rheumatic fever. Sydenham's chorea is more common in females than males and most below 16 years of age. Adult onset of Sydenham's chorea is comparatively rare and the majority of the adult cases are associated with exacerbation of chorea following childhood Sydenham's chorea.
Sir Jonathan Hutchinson, was an English surgeon, ophthalmologist, dermatologist, venereologist, and pathologist.
George Huntington was an American physician who contributed a classic clinical description of the disease that bears his name – Huntington's disease.
Thomas Willis was an English doctor who played an important part in the history of anatomy, neurology and psychiatry. He was a founding member of the Royal Society.
Robert Bentley Todd was an Irish-born physician who is best known for describing the condition postictal paralysis in his Lumleian Lectures in 1849 now known as Todd's palsy. He was the younger brother of noted writer and minister James Henthorn Todd.
Sir George Newman GBE, KCB FRSE was an English public health physician, Quaker, the first Chief Medical Officer to the Ministry of Health in England, and wrote a seminal treatise on the social problems causing infant mortality.
Chorea gravidarum is a rare type of chorea which presents with involuntary abnormal movement, characterized by abrupt, brief, nonrhythmic, nonrepetitive movement of any limb, often associated with nonpatterned facial grimaces. It is a complication of pregnancy which can be associated with eclampsia and its effects upon the basal ganglia. It is not an causal or pathologically distinct entity but a generic term for chorea of any cause starting during pregnancy. It is associated with history of Sydenham's chorea. It mostly occurs in young patients; the average age is 22 years.
Psychiatry is the medical specialty devoted to the diagnosis, prevention, and treatment of mental disorders. These include various maladaptations related to mood, behaviour, cognition, and perceptions. See glossary of psychiatry.
The Goulstonian Lectures are an annual lecture series given on behalf of the Royal College of Physicians in London. They began in 1639. The lectures are named for Theodore Goulston, who founded them with a bequest. By his will, dated 26 April 1632, he left £200 to the College of Physicians of London to found a lectureship, to be held in each year by one of the four youngest doctors of the college. These lectures were annually delivered from 1639, and have continued for more than three centuries. Up to the end of the 19th century, the spelling Gulstonian was often used. In many cases the lectures have been published.
Andrés Piquer (1711–1772) was a Spanish physician, philosopher, logician, writer and author. During the eighteenth century, a critique and re-evaluation of the Hippocratic Corpus within Spanish universities was pushed by Galenist scholars. Piquer contributed to this analysis of the corpus and served as a philosopher and doctor to the Kings Ferdinand VI and Charles III.
George Young (1692–1757) was an Edinburgh surgeon, physician, philosopher and empiric. As a young man he was a member of the Rankenian Club, a group of intellectuals who were to go on to become some of the most influential figures of the Scottish Enlightenment. Young's lecture notes (1730–31) give a clear account of contemporary medical and surgical practice and are characterised by the empirical approach to the advancement of medical knowledge, especially in the evolving understanding of nerve and muscle function. His Treatise on Opium (1753) was a practical guide for physicians in the use of the drug which emphasises its complications. It was the longest, most balanced and most comprehensive English language account written yet written. Young's legacy is also apparent in the work of his pupil Robert Whytt (1714–1766) and his surgical apprentice James Hill (1703–1776). Young had taught both the value of repeated observation and a sceptical approach to prevailing dogma. Whytt was to advance knowledge of nerve and muscle function while Hill went on to make important contributions to the understanding and management of head injury.
Modern understanding of disease is very different from the way it was understood in ancient Greece and Rome. The way modern physicians approach healing of the sick differs greatly from the methods used by early general healers or elite physicians like Hippocrates or Galen. In modern medicine, the understanding of disease stems from the “germ theory of disease”, a concept that emerged in the second half of the 19th century, such that a disease is the result of an invasion of a microorganism into a living host. Therefore, when a person becomes ill, modern treatments “target” the specific pathogen or bacterium in order to “beat” or “kill” the disease. In Ancient Greece and Rome, disease was literally understood as dis-ease, or physical imbalance. Medical intervention, therefore, was purposed with goal of restoration of harmony rather than waging a war against disease. Surgery was regarded by Greek and Roman physicians as extreme and damaging while prevention was seen as the crucial first step to healing almost all ailments. In both prevention and treatment of disease in classical medicine, food and diet was central. The eating of correctly-balanced foods made up the majority of preventative treatment as well as to restore harmony to the body after it encountered disease.
Peter Wallwork Latham (1832–1923) was an English physician and professor of medicine at the University of Cambridge.