SYDENHAM, THOMAS—the greatest name in English practical medicine—was born in 1624 at Winford Eagle, Dorsetshire, where his father, William Sydenham, had a fine estate. He was a commoner of Magdalen Hall, Oxford, 1642, but was obliged to leave that city when it became a royal garrison, not having taken up arms for the king, as the students of those days generally did. In 1649, after the garrison delivered up Oxford to the Parliamentary forces, he returned to Magdalen Hall, and was created Bachelor of Physic on the Pembrokean creation, when Lord Pembroke became chancellor of the university, and honorary degrees were conferred. This was in April 1648. He had not previously taken any degree in arts. He then, on submitting to the authority of the visitors appointed by the Parliament, was made by them (at the intercession of a relative) Fellow of All Souls, in the room of one of the many ejected Royalists. He continued for some years earnestly prosecuting his profession, and left Oxford without taking any other degree. He was also, according to his own account, in a letter to Dr Gould, fellow-commoner of Wadham College in the year Oxford surrendered. It is not easy to understand why he went to Wadham, as he was not a fellow but a fellow-commoner—equivalent to a gentleman commoner in Cambridge—unless it was that, on returning to Magdalen Hall, he found himself, as a Parliamentarian, more at home in Wadham—where the then head was John Wilkins, Cromwell's brother-in-law—a man of genius and of a keen scientific spirit, and afterwards and still famous as Bishop of Chester—one of the founders of the Royal Society, which first met at Oxford; and author, among other works, of a discourse on a Universal Language and of an Inquiry as to the best Way of Travelling to the Moon; a man of rare parts and worth, and of a liberality in religion and science then still rarer, being according to Anthony Wood, "an excellent mathematician and experimentist, and one as well seen in the new philosophy as any of his time;" such a man would be sure to cordialise with Sydenham, who was of the Baconian or genuine Empiric school; and who, in the "new philosophy," saw the day spring of all true scientific progress. It is not clear when Sydenham settled in Lon-
Sydenham, don, or more properly speaking in Westminster, it certainly was before 1661. In 1663 he was admitted a licentiate of the College of Physicians of London, he never was a fellow; his degree of doctor of medicine was taken at Cambridge in 1676, long after he was in full practice, his college being Pembroke; his diploma is signed by Isaac Barrow. His reason probably for taking a Cambridge degree may have been that his eldest son was a pensioner at that college.
Sydenham's elder brother, William, was a distinguished soldier and politician during the Commonwealth. This, along with his own likings, and his love of the new philosophy, prevented him, during the reigns of the second Charles and James, from enjoying court favour. It has often been doubted whether Sydenham actually served in the army of the Parliament; but from an anecdote known generally as Dr Lettsom's, but which appears first in a curious old controversial book by Dr Andrew Brown, the Vindicatory Schedule, published two years after Sydenham's death, it is made quite certain that he did.
Before settling in London he seems, on the authority of Desault, to have visited Montpellier, and to have attended the lectures of the famous Barbeyrac. After this he devoted himself to his profession, and became the greatest physician of his time, in spite of the court, and of the College of Physicians; by one of whose fellows—Lister—he was called "a miserable quack." He suffered for many of the later years of his life from the gout, his description of which has become classical, and died in his house, Pall-Mall—or as he spells it, Pell-Mell—in 1689. He lies buried in St James, Westminster, with the following noble because true inscription:—"Prope hunc locum sepultus est Thomas Sydenham, medicus in omne ævum nobilis, natus erat, a.d. 1624; vixit annos 65." His works, which became rapidly popular during his lifetime, and to an extraordinary extent soon after his death—there were upwards of twenty-five editions in less than a hundred years—consist chiefly of occasional pieces, extorted from him by his friends, and often in the form of letters, none of them are formal treatises, and all are plainly the result of his own immediate reflection and experience. One is greatly struck at the place he occupies in the writings of all the great medical authors at the end of the seventeenth and beginning of the eighteenth centuries. Morton, Willis, Boerhaave, Gaubius, Bordeu, &c., always speak of him as second in sagacity to "the divine Hippocrates" alone. Boerhaave never mentioned him in his class without lifting his hat, and called him Angliae lumen, artis Phabum, veram Hippocratici viri speciem. His simple, manly views of the nature and means of medicine as an art seem to have come upon the profession like revelations; it was as if the men in Plato's cavern, who had been all their lives with their backs to the light, studying their own shadows, had suddenly turned round and gazed on the broad face of the outer world, lying in sunshine before them.
All Sydenham's works are in Latin, and though from his education and tastes, and the habits of his time, and also from the composition of the Processus Integri—brief notes left by him for his sons' use, and published after his death—there is little doubt he could have written them in that tongue, there seems every likelihood that he was assisted in this by his friends Drs Mapletoft and Havers. There are three English translations—one by Dr Pechey, another by Dr Swan, to which is prefixed a life by Samuel Johnson, among his earliest performances, and published by Cave, and the last, the Sydenham Society's edition, by Dr Latham.
This, we believe, is nearly all of a personal kind we know, or are likely to know of this great and good man—his private tastes and worth we can only infer from his associates. He who had the right and the honour to call John Locke convinctissimus, and who lived on cordial terms
with Boyle and all the best men of his time, was not likely to be otherwise than a man of moral excellence as well as intellectual greatness; and from his own unstudied writings we cannot but be sure that he was a most affectionate father, a warm and faithful friend, and a lover of truth and liberty for their own sakes—a man of keen, generous, habitual humanity and tenderness to suffering, and a man profoundly and pervasively religious. Not that he is ever a moraliser, or given to be didactic, or given to public religiosity; his clear, manly, modest nature would despise this as much as it did any other quackery or nonsense; but his sense of God—of our constant relation to him as our Maker and Judge—of the law of duty—is felt throughout everything he writes, and at times breaks out into the noblest acknowledgments. We do not know how to exemplify his characteristic spirit and manner, better than in the first sentence of his preface to his first work, or "Opusculum" as it was called—"Observationes Medicae circa Morborum Acutorum Historiam et Curationem."
"He who sets himself to the work of curing men would do well to ponder again and again these four things. 1st, That he must himself some day render an account to the supreme Judge of the lives of the sick committed to his care. 2d, That whatsoever of art or of science he has by the divine blessing attained to, is to be directed in the main to the glory of God in the highest, and to the welfare of the human race; for it were an unworthy thing that their celestial gifts should be made to serve avarice or ambition. Moreover, 3d, that he has taken upon himself the charge of so ignoble or contemptible creature; for that we may estimate the worth of the human race, the only begotten Son of God became man, and thus enriched by his own dignity. His nature we assumed. Finally, that he is himself not exempted from the common lot, but is subject to the same laws of mortality and is obnoxious and open to the same calamities and sorrows as are others; so that, being himself a fellow-sufferer, he may the more diligently, and with a more tender affection succour those who are sick."
Here is the key-note of the character and life of this admirable man. We know of no more impressive assertion of the dignity, privilege, and peril of being a healer of men, and we question if there ever was a case in which a man was more truly as good as his word. The religious nature of Sydenham comes more formally and explicitly out in a theological fragment, printed for the first time by Dr Latham; it is taken from a manuscript in the public library of the university of Cambridge. Of this remarkable fragment it has been said by one well qualified to judge, "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."
But we must advert to the more specific qualities of these practical tracts. 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. With these two central convictions, it is amazing how much error, rubbish, and mischief he exposes and ends. In these respects, the impression in reading him is a very striking one. Here is a man writing nearly two hundred years ago, and yet we have the truth as to hygienic physiology—the duty of living according to the,
Sydenham's constitution given us by God, and obeying the laws of health, watching, following, assisting the efforts of nature, all which we now believe and glory in, as a sort of modern gospel of the body,—taught with the same downrightness, authority, earnestness, and unencumbered good sense, as in the pages of Andrew Combe, or Sir John Forbes, or Sir James Clark. It is difficult for us, living as we do in the broad light of our day, to understand all that is implied in an English physician writing and practising in 1680 as Sydenham did; it amounted to a new revelation—to a restauratio magna of the entire study and art of treating diseases—and was among the first and the best fruits of the then dawning philosophy of Lord Bacon. What Locke did for the science of mind, for the conduct of the understanding, and for the art of making men reason justly,—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 sleek, 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. Like most complete men, Sydenham was a humorist. The well-known story of his saying to Sir Richard Blackmore, when he asked him what books he should study medicine in, "Read Don Quixote, Sir," is a proof of his sense as well as of his fun; he doubtless meant that medicine, the art of curing diseases, was not to be learned from books. He has acknowledged his obligations to John Locke in a well-known passage quoted by Dugald Stewart:—
"Nisi propterea," writing to Dr Mapletoft, "quas hinc meo methodo suffragantes habeam, qui eam intimius per omnia persequerentur, utique nostrum conjunctivarium Dominum Johannem Lock; quo quidem viro, sic ingenio judicioque acuti et subacti, siue etiam antiquis (hoc est optimis) moribus, viz. superiorum quensquam inter eos qui nunc sunt homines reproductum iri confido, pauciusvis certe pares."
And Locke, in the preface to the immortal Essay, speaks of Sydenham as "one of the master builders at this time in the commonwealth of learning," in company with "Boyle, Huygens, and the incomparable Mr Newton."
The subjects of his tracts are, as has been said, all practical, and comprehend almost the entire round of the art of medicine; but the best known are those upon acute diseases,—upon fevers, and the "constitutions of years," as in connection with epidemics,—the smallpox,—the gout,—and hysteria. In all these the powers of insight and of description are quite unmatched, making any attempt at improvement in the natural history of disease hopeless enough.
We conclude with one or two selections from his writings, which, to be fully appreciated, must, as has been already said, be read with some understanding of the times he lived in; what a mass of errors and prejudices his art was sunk in; how rampant the hypothesis mania was, and how utterly the practice of his art was overrun with the vilest and silliest nostrums. We must have this in our mind, or we shall fail in estimating the full amount of exact, strong, independent thought, of true courage and uprightness, and of all that deserves to be called magnanimity and virtue, which was involved in his thinking, writing, and practising as he did.
"The improvement of physic, in my opinion, depends, 1st, Upon collecting as genuine and natural a description or history of dis-
eases as can be procured; and 2d, Upon laying down a fixed and complete method of cure. With regard to the history of diseases, whoever considers the undertaking deliberately will perceive that a few such particulars must be attended to: 1st, All diseases should be described as objects of natural history, with the same exactness as is done by botanists, for there are many diseases that come under the same genus and bear the same name, that being specifically different, require a different treatment. The word carduus or thistle, is applied to several herbs, and yet a botanist would be inaccurate and imperfect who would content himself with a generic description. Furthermore, when this distribution of distempers into genera has been attempted, it has been to fit into some hypothesis, and hence this distribution is made to suit the bent of the author rather than the real nature of the disorder. How much this has obstructed the improvement of physic any man may know. In writing, therefore, such a natural history of diseases, every merely philosophical hypothesis should be set aside, and the manifest and natural phenomena, however minute, should be noted with the utmost exactness. The usefulness of this procedure cannot be easily overrated, as compared with the subtle inquiries and trifling notions of modern writers; for can there be a shorter, or indeed any other way, of coming at the morbid causes, or of discovering the curative indications, than by a certain perception of the peculiar symptoms? By these steps and helps it was that the father of physic, the great Hippocrates came to excel; his theory (theoria) being no more than an exact description or view of Nature. He found that Nature alone often terminates diseases, and works a cure with a few simple medicines, and often enough with no medicines at all. If only one person in every age had accurately described, and consistently cured, but a single disease, and made known his secret, physic would not be where it is now; but we have long since forsaken the ancient method of cure, founded upon the knowledge of conjunct causes, inasmuch that the art, as at this day practised, is rather the art of talking about diseases than of curing them. I make this digression in order to assert, that the discovering and assigning of remote causes, which now-a-days so much engrosses the minds and feeds the vanity of curious inquirers, is an impossible attempt, and that only immediate and conjunct causes fall within the compass of our knowledge."
Or as he elsewhere pithily states it:—
"Cognoscit nostra, in rerum cortice, omnis ferme versatur, ac ad vi res siue quod res hoc modo se habeat, forte tantum asurgit; vi vero, siue rerum causas, nulla tenuis attingit."
He was the first to point out what he called the varying "constitutions" of different years in relation to their respective epidemics, and the importance of watching the type of each new epidemic before settling the means of cure. In none of his works is his philosophic spirit, and the subtlety and clearness of his understanding, shown more signally than in his successive histories of the epidemics of his time. Nothing equal to them has ever appeared since; and the full importance of the principles he was the first to lay down, is only now beginning to be acknowledged. His confession as to his entirely failing to discover what made one epidemic so to differ from another, has been amply confirmed by all succeeding observers. He says:—
"I have carefully examined the different constitutions of different years as to the manifest qualities of the air, yet I must own I have hitherto made no progress, having found that years, perfectly agreeing as to their temperature and other sensible properties, have produced very different tribes of diseases, and vice versa. The matter seems to stand thus: there are certain constitutions of years that owe their origin neither to heat, cold, dryness, nor moisture, but upon a certain secret and inexplicable alteration in the bowels of the earth, whence the air becomes impregnated with such kinds of effluvia as subject the human body to distempers of a certain specific type."
As to the early treatment of a new epidemic, he says:—
"My chief care, 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."
and he concludes by regretting the imperfection of his observations, and hoping that they will assist in beginning a work that, in his judgment, may greatly tend to the advantage of mankind. Had his successors followed in his track with equal sagacity, honesty, and circumspection, our
Sydenham, knowledge of these destructive and mysterious incursions of disease, would, in all likelihood, have been greatly larger and more practical than it is now.
Sydenham is well known to have effected a revolution in the management of the smallpox, and to have introduced a method of treatment upon which no material improvement has since been made. We owe the cool regimen to him. Speaking of the propriety of attending to the wishes of the sufferer, he says, with equal humanity and good sense:—
"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.' Nor will this appear strange, if it be considered that the all-wise Creator has formed the whole with such exquisite order, that, as all the evils of nature eminently conspire to complete the harmony of the whole work, so every being is endowed with a Divine direction or instinct, which is interwoven with its proper essence, and hence the safety of mankind was provided for, who, notwithstanding all our doctoring, had been otherwise in a sad enough plight."
"He would be no honest and successful pilot who were to apply himself with less industry to avoid rocks and sands, and bring his vessel safely home, than to search into the causes of the ebbing and flowing of the sea, which though very well for a philosopher, is foreign to him whose business it is to secure the ship. So neither will a physician, whose province it is to cure diseases, be able to do so, though he be a person of great genius, who bestows less time on the hidden and intricate method of nature, and adapting his means thereto, than on curious and subtle speculations."
The following is frank enough:—
"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 at once."
"That practice, and that alone, will bring relief to the sufferer, which elicits the curative indications from the phenomena of the diseases themselves, and confirms them by experience, by which means the great Hippocrates made himself immortal. And had the art of medicine been delivered by any one in this wise, though the cure of a disease or two might come to be known to the common people, yet the art in its full extent would then have required men more prudent and skilful than it does now, nor would it lose any of its credit; for as there is in the operations of nature (on the observations of which a true medical praxis is founded) more of nicety and subtlety than can be found in any art supported on the most specious hypotheses, so the science of Medicine which Nature teaches will exceed an ordinary capacity in a much greater degree than that which mere philosophy teaches."
There is much profound truth in this. Observation, in its strict sense, is not every man's gift, and but few men's actual habit of mind. Newton used to say, that if in any one way he differed from other men, it was in his power of continued attention—of faithful, unbroken observation; his ladder had all its steps entire, and he went up with a composed, orderly foot. It requires more strength and fineness of mind, more of what deserves to be called genius, to make a series of trustworthy observations in Medicine, or any other art, than to spin any amount of nice hypotheses, or build any number of "castella in aere," as Sydenham calls them.
It would not be easy to over-estimate the permanent impression for good, which the writings, the character, and the practice of Sydenham have made on the art of healing in England, and on the continent generally. In the writings of Boërhæve, Stahl, Gaubius, Pinel, Bordeu, Haller, and
many others, he is spoken of as the father of rational medicine; as the first man who applied to his profession the Baconian principle of interpreting and serving nature, and who never forgot the master's rule, "Non fingendum aut excogitandum, sed inventendum, quid natura aut faciat aut ferat." He was what Plato would have called an "artsman," as distinguished from a teacher of abstract science. But he was by no means deficient either in the capacity or the relish for speculative truth. Like all men of a large sagacious nature, he could not have been what he was, or done what he did, without possessing and often exercising the true philosophizing faculty. He was a man of the same quality of mind in this respect with Watt, Franklin, and John Hunter, in whom speculation was not the less genuine that it was with them a means rather than an end. (S. B.—X.)