One of the founding fathers of modern clinical medicine was Thomas Sydenham. But who was he? And how did he earn such a legacy?
About Thomas Sydenham
Thomas Sydenham was born in Dorset, England in 1624. He attended Magdalen College, Oxford at the age of 18, but his studies were interrupted when the English Civil War (1642-51) broke out, and he was conscripted into the army of the Parliamentarians.
Fig. 1 - Thomas Sydenham
After the war, he completed his medical degree at Oxford, but would not become an MD for another 30 years. In the 1660s, he settled in London and became a member of the College of Physicians there, which allowed him to practice medicine in London.
English Civil War (1642-51)
A war between the royalists and the parliamentarians culminating in the execution of Charles I in 1649 and the protectorate of parliamentarian Oliver Cromwell.
MD
The acronym for a medical doctor.
Sydenham was not especially well-liked or respected by his fellow physicians. Many of them did not like his theories and his ideas, but Sydenham did not seem to mind this. All that mattered was that he was able to treat his patients, and he actually benefitted from being outside the mainstream of medical thought at this point.
Despite his unpopularity, he did also inspire some people who would go on to make advances in the fields of science and medicine, notably John Locke, who became one of the most important figures in the Enlightenment.
The Enlightenment
Also known as the Age of Reason, this period spanned the late 17th and 18th centuries. Traditional ideals were replaced by individualism and empirical evidence.
John Locke
British philosopher John Locke was one of the catalysts for the Enlightenment near the end of the 17th century. His writings marked a departure from traditional ideals and proclaimed that the individual must undergo his quest for truth. In Essay Concerning Human Understanding (1690) these ideas were most prevalent. Locke also began the framework for some modern constitutions, particularly in France and the United States, proclaiming that every human had the right to life, freedom and property.
Sydenham would earn the title of the 'English Hippocrates' for his contributions to the field of medicine.
Sydenham: Discovery
Now that we understand the context of Sydenham's time, let's examine his work as a physician.
Practising Medicine
Sydenham favoured practical learning, instead of simply reading medical texts. In particular, he promoted careful observation of patients to note their symptoms and understand their health issues.
He would also often ask for medical histories and underlying conditions from patients as well, as he thought it was very important to understand the patient themselves, not just their disease.
Bleeding
Also known as bloodletting, bleeding is the releasing of blood from the body to help balance bodily fluids. This theory stemmed from classical physicians such as Hippocrates and Galen.
Purging
Medical practices to release harmful contents from the body, which included fasting and vomiting.
Sydenham also encouraged patients to keep the windows open and keep fresh air circulating, which did have benefits. Contrary to all medical beliefs at the time, he was a strong advocate of letting the body heal itself, without resorting to methods like bleeding and purging.
Discovering and Classifying Diseases
Sydenham's desire for close observation led to him classifying and categorising diseases based on symptoms. He grouped together diseases that had similar symptoms. This led to him writing the first description of scarlet fever and differentiating it from measles.
Sydenham was also responsible for the discovery of Sydenham chorea, a neurological disorder resulting from an infection of streptococcus bacteria. He also provided detailed descriptions of the nature of hysteria.
Scarlet fever
An infection, present in children, that causes the skin to flare up with a rash that looks like sandpaper.
Measles
An infection, present in children, that causes spots and red blotches on the skin.
Sydenham chorea
An infection that results in uncontrollable twitches and loss of motor function created by streptococcus bacteria.
Hysteria
A disorder marked by fluctuating and heightened emotions.
Medicines
Thomas Sydenham was responsible for the introduction of some remedies and medicines that would become widely used for centuries to come:
- He introduced laudanum, the liquid form of opium, as a form of pain relief.
- He popularised the use of quinine in treating malaria.
- He started to use iron to treat anaemia (iron deficiency).
Laudanum: A medical tool or a dangerous drug?
After its introduction by Thomas Sydenham, laudanum became the most popular form of pain relief in the 18th and 19th centuries. It was a liquid concoction, with 10% pure opium. However, it was an opiate and therefore was highly addictive. In the Victorian era, there was quite a crisis with people becoming addicted to laudanum as it was easily purchased.
Widely referred to as the aspirin of the day laudanum worked alongside other harmful substances such as arsenic and cocaine, to kill pain in the Victorian period. It even resulted in the Chinese Opium Wars, underlining the dependence of the everyday population before more refined painkillers came into play. It is ironic that in his willingness to stop infectious epidemics, Sydenham directly contributed to a drug abuse epidemic.
Fig. 2 - A bottle of laudanum
Thomas Sydenham: Epidemiology
When he was practising in London, Sydenham studied epidemic diseases - how and why they occurred and why some people were more susceptible than others. Although his work was not fully correct and would later be disproved in part by germ theory, Sydenham's grouping of certain epidemic diseases was correct.
Epidemiology
The study of health and disease in a particular population.
Germ Theory
Louis Pasteur's 1861 theory finally proved germs existed and replaced the previous understanding of infection.
He also noted how some epidemic diseases were more prevalent at different times of the year when the weather was hot or cold.
The prevailing miasma theory of bad air believed that diseases were more present during warm weather, tying in with Sydenham's ideas. Although Sydenham correctly believed that some bacteria thrived in colder conditions.
Thomas Sydenham: Theory
Thomas Sydenham published several very important texts to explain his theories and practices.
Observationes Medicae, 1676
In 1666, Sydenham published a work called The Method of Curing Fevers, which was a collection of all his work on fevers. After adding another chapter in 1668 which focused on the plague, he published an updated version of this work in 1676, which he called Observationes Medicae, or 'The Observations of Medicine'.
Fig. 3 - The front page from Sydenham's Observationes Medicae
This is the most famous of Sydenham's works, and it became a standard medical textbook for the next two centuries. It was an extremely important contribution to the study of medicine.
Treatise on Gout, 1683
Considered the pinnacle of Sydenham's literary oeuvre, Treatise on Gout is remarkable for the way it detailed the need for close clinical observation of a patient.
Sydenham focused on gout, a form of arthritis also known as the 'disease of the kings' as it was brought on by overindulgence in meat and alcohol. Sydenham did not indulge in alcohol, but this was probably for religious rather than health reasons. He also used opiates to treat the condition, believing correctly that bleeding would worsen the affliction.
Other works
Some more of Sydenham's works include:
- Letters and Replies, 1680: This consisted of two letters, one on epidemics and one on venereal diseases.
- 1682: He published two more letters concerning Smallpox and Hysteria.
- The Schedule of Symptoms of the Newly Arrived Fever, 1686: Detailed how fevers developed in the human body.
- The Process of Healing, 1692 (posthumous): Detailed his ideas about pathology and medical practice.
Thomas Sydenham: Impact on Medicine
Overall, Thomas Sydenham had a significant impact on the development of medicine and public health in Early Modern Britain.
He stood out for his medical views as he did not conform to the mainstream thought of the time. His introduction of certain medicines, such as laudanum, was particularly key as these would continue to be used in medicine for centuries after.
His studies and classification of diseases were ground-breaking, even if they were not taken seriously at the time. He understood that diseases were separate from the body, they were not caused by humours and therefore people could suffer from the same illness. Carling summarises Sydenham's legacy succinctly.
Sydenham, a diligent and insightful observer of clinical issues, was the first true epidemiologist, although he realized only limited success in categorizing many diseases on the basis of the nature and the patterns of the fevers with which they were associated.
- Philip C. Carling, 'Sir Thomas Sydenham Revisited', 2001
His published work stood the test of time, having many reprints and many new editions published over the years. His work became central to medical knowledge and training in the Early Modern era, where it was built upon by men including William Harvey, and beyond.
Thomas Sydenham - Key takeaways
Sydenham was born in Dorset, England and was educated at Oxford - however, his studies were interrupted by the English Civil War. It is thought that he was partially self-taught due to this.
He did not get along with many of his colleagues, who did not agree with his ideas about medicine and the body. Nevertheless, he also inspired some very important figures like John Locke.
He became known as the 'English Hippocrates' due to his methods of close clinical observation of his patients.
His study of epidemic diseases and his classification of common diseases were incredibly important and fairly accurate for the time.
He was responsible for introducing several important medications, like laudanum for pain relief and quinine for treating malaria.
His work 'Observationes Medicae' became a key medical handbook for the next two centuries.
References
- Philip C. Carling, 'Sir Thomas Sydenham Revisited', Clinical Infectious Diseases, Vol. 32, No. 10 (May 15, 2001), p. 1519.
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