Since the time of Hippocrates, known as the 'father of medicine,' to William Osler, regarded as the 'father of modern medicine,' there have been numerous praises for physicians, highlighting their various virtues (Pearce, 2020). Thomas Sydenham, a prominent English physician, was recognized, especially after his death, as 'the English Hippocrates.' According to Pearce (2020), his epitaph, which describes him as a 'noble physician of all times,' also reflects his great reputation in the medical field.
Background
It is important to consider the era of Thomas Sydenham, since, according to Iglesias (2020), the ancient theory of humors predominated until the late 16th and early 17th centuries. This situation necessitated a new conception of the concept of disease, as everything known at that time was considered a consequence of this theory. By the end of the 16th century, prominent figures emerged, such as Jan Baptista von Helmont, who transformed the concept of humoral constitution into that of individual disease. Furthermore, according to Iglesias (2020), he introduced the idea that the cause of diseases was a specific agent, which opened the way for a more precise understanding of etiology, pathological anatomy, and diagnosis.
Subsequently, Franz de le Boe appeared, who was a follower of Harvey's circulation theory (Iglesias, 2020). Additionally, the development of anatomy by the Danish Thomas Bartholin is noteworthy, as well as the introduction of new concepts such as iatrochemistry. Finally, during the era of Hermann Boerhaave, clinical empiricism and rationalism became well-known. Iglesias (2020) mentions that with these precedents in 17th-century medicine, Thomas Sydenham arrived to introduce the modern concept of morbific species by describing the clinic of diseases as a way to explain the balance between experience and reason.
Biography
Thomas Sydenham was born on September 10, 1624, in Winford Eagle, England, into a wealthy and well-established Puritan family (Iglesias, 2020; Fresquet, 2000). In this region, health was precarious, and the climatic conditions favored the spread of bone diseases such as rickets, as well as infections like tuberculosis and measles (Iglesias, 2020). Additionally, the state of medicine at that time was chaotic; surgical interventions were performed by barbers and herbalists, while the shortage of surgeons and lack of hygiene characterized the medical landscape of the 17th century. According to Iglesias (2020), this context was influenced by Paracelsus' rationalism, miasma theories, and religious fanaticism.
He participated in the English Civil War on the side of Cromwell’s parliamentarians, where he witnessed the medical treatment of his brother by Thomas Coxe (Pearce, 2020). This experience sparked in him the desire to become a physician (Pearce, 2020). He began his studies at Oxford but had to interrupt them due to the war (Fresquet, 2000). After returning to Magdalen Hall in October 1647, he moved to Wadham College, where he focused on studying medicine and completed his bachelor’s degree in April 1648 (Pearce, 2020). According to some authors, Sydenham may have also studied at the University of Montpellier, where he was a student of Barbeirac (Fresquet, 2000). Later, Sydenham practiced medicine in London, but his political views prevented him from becoming a member of the Royal College of Physicians (Fresquet, 2000). According to Iglesias (2020), after 30 years of professional practice, he earned a doctorate from the University of Cambridge in 1687.
Finally, it is known that Sydenham suffered from clinical hematuria and gout, and it is believed that his death in 1689 was related to these conditions (Jacobson, 2017). He was buried in Westminster Abbey (Fresquet, 2000). Sydenham's fame solidified after his death, largely thanks to the Dutchman Hermann Boerhaave, a professor in Leiden known as the "communis Europeae praeceptor." According to Fesquet (2000), Boerhaave linked Sydenham's ideas with bedside teaching and emphasized the importance of conducting autopsies to investigate anatomical lesions.
Works
Through meticulous work, Sydenham was a pioneer in the description of scarlet fever and in identifying the relationship between fleas and typhus (Jacobson, 2017). Additionally, he popularized the use of quinine as a treatment for malaria, described a movement disorder that occurred after fever (now known as Sydenham's chorea), and introduced a liquid opium tincture to relieve pain. His work, "Observationes Medical," according to Jacobson (2017), became a functional reference text for the next two hundred years.
Sydenham's most notable and enduring work was his treatise on gout, published in 1683, where he brought the art of clinical observation to a personal level (Jacobson, 2017). Having suffered frequent and debilitating attacks of gout since the age of thirty, he provided a descriptive, first-person account of the affliction. Despite correctly identifying obesity, excessive red meat consumption, and alcohol as risk factors for gout, his puritanical outlook likely influenced his recommendation of temperance over other treatments. Jacobson (2017) mentions that, in modern medicine, gout is associated with coronary artery disease, kidney stones, and sleep apnea.
Ironically, colchicine, an ancient natural remedy and future pharmacological treatment for acute gout, was not used in England for more than a century due to the notable opposition of Thomas Sydenham (Jacobson, 2017). Regarding treatment, Sydenham sought to find a specific medication that could act quickly, in contrast to what nature achieved slowly (Fresquet, 2000). In his distinction between acute and chronic diseases, he argued that in the case of the former, the physician should quickly and precisely eliminate the causes, while for the latter, the focus should be on eradicating the disease at its essence. Therefore, according to Jacobson (2017), he prescribed bloodletting, sweating, or purging for acute diseases, while recommending temperance and rebalancing the humors for chronic diseases.
Legacy
In addition to the eponym "Sydenham's laudanum," it is currently known as "Sydenham's cough" (Fresquet, 2000; Fernández & Tamaro, 2004). The latter is characterized by hysterical spasms of the respiratory muscles. Additionally, "Sydenham's chorea" is another associated condition, defined as an inflammatory-degenerative disease of the central nervous system. It primarily affects children between the ages of 6 and 15, causing involuntary, rapid, disordered, and arrhythmic movements in the muscles (Fresquet, 2000; Fernández & Tamaro, 2004). In addition to his contributions to identifying these pathologies, he made significant advances in the field of medicine by distinguishing scarlet fever from measles (Fernández & Tamaro, 2004). Regarding the treatment of various diseases, according to Fernández & Tamaro (2004), Sydenham promoted the use of iron to treat anemia, quinine to fight malaria, and Sydenham's laudanum, an opium dissolved in alcohol, used to relieve the symptoms of gout.
References
Fernández, T., & Tamaro, E. (2004). Biografia de Thomas Sydenham. Biografías y Vida. Recuperado 20 de enero de 2022, de https://www.biografiasyvidas.com/biografia/s/sydenham.htm
Fresquet, J. (2000). Thomas Sydenham (1624–1689). Historia de la Medicina. Recuperado 20 de enero de 2022, de https://www.historiadelamedicina.org/sydenham.html
Iglesias, A. (2020). Thomas Sydenham, ¿el primer reumatólogo?. Global Rheumatology. Recuperado 20 de enero de 2022, de https://www.globalrheumpanlar.org/articulo/thomas-sydenham-el-primer-reumatologo-457
Jacobson, A. (2017). The “English Hippocrates” and the disease of kings. Hektoen International. Recuperado 20 de enero de 2022, de https://hekint.org/2017/10/11/thomas-sydenham/
Pearce, J. (2020). Thomas Sydenham, “The English Hippocrates”. Hektoen International. Recuperado 6 de abril de 2022, de https://hekint.org/2020/08/13/thomas-sydenham-the-english-hippocrates/
