From Hippocrates, the "father of medicine", to William Osler, the "father of modern medicine", praise for physicians abounds and venerates their varied virtues (Pearce, 2020). Thomas Sydenham, the illustrious English physician, was regarded, but especially after his death, as "the English Hippocrates". In correspondence with Pearce (2020), his epitaph "noble physician of all ages" also proclaimed his great reputation.
Background
It is important to take into account the time of Thomas Sydenham, since, according to Iglesias (2020), until the end of the 16th and beginning of the 17th century, the old theory of humours predominated and a new conception of the concept of disease was necessary, because everything that prevailed was a consequence of this idea.
At the end of the 16th century, according to Iglesias (2020), extraordinary figures emerged, such as Jan Baptista von Helmont, who transformed the concept of humoral constitution into that of individual disease, as well as the cause by a specific agent and, consequently, opened the perspective of an aetiology, pathological anatomy and diagnosis of a disease.
Subsequently, the figure of Franz de le Boe, a follower of Harvey's circulation theory, the development of anatomy by the Dane Thomas Bartholin and the emergence of other concepts such as iatrochemistry and finally clinical empiricism and rationalism make themselves known in the era of Hermann Boerhaave (Iglesias, 2020). Iglesias (2020) mentions that, with these precedents in 17th century medicine came Thomas Sydenham, who introduced the concept of the modern morbid species by describing the clinic of diseases as a way of explaining the balance between experience and reason.
Biography
Thomas Sydenham was born on 10 September 1624 in Winford Eagle, England, into a wealthy and well-to-do Puritan family (Iglesias, 2020; Fresquet, 2000). There, health was poor and, due to climatic conditions, bone diseases such as rickets, tuberculosis, measles and other infectious diseases were prevalent (Iglesias, 2020). Also, according to Iglesias (2020), medical conditions were chaotic, and operations were performed by barbers and herbalists; the lack of medical surgeons and the lack of hygiene was the scene of the early 17th century, influenced by Paracelsus' rationalism, miasma and religious fanaticism.
He fought in the English civil war for Cromwell's parliamentarians and there witnessed the treatment of his brother by Thomas Coxe (Pearce, 2020). This awakened his desire to become a doctor (Pearce, 2020). He began his studies at Oxford, which he had to interrupt due to the Civil War (Fresquet, 2000). He returned to Magdalen Hall, but in October 1647, on the advice of Thomas Coxe, he moved to Wadham College to read medicine, completing his medical degree in April 1648 (Pearce, 2020). Fresquet (2020) mentions that, according to some authors, he also seems to have studied at the University of Montpellier, where he was a student of Barbeirac.
Subsequently, he practised in London, although his political views prevented him from becoming a member of the Royal College of Physicians (Fresquet, 2000). According to Iglesias (2020), in 1687, after 30 years of practising medicine, he obtained his doctorate at Cambridge University.
Finally, Sydenham is known to have had attacks of clinical haematuria and gout, and his death in 1689 is thought to be related to both (Jacobson, 2017). He was buried in Westminster Abbey (Fresquet, 2000). Sydenham's fame arose after his death and, above all, thanks to the Dutchman Hermann Boerhaave, a professor at Leyden who became known as the "communis Europeae praeceptor". According to Fesquet (2000), he linked Sydenham's plans to bedside teaching and insisted on performing necropsies to look for anatomical lesions. Translated with www.DeepL.com/Translator (free version)
Works
Through his meticulous work, Sydenham was the first to describe scarlet fever; identify the relationship between fleas and typhus; popularise the use of quinine to treat malaria; explain a movement disorder that occurred after fever (now known as Sydenham's chorea); and introduce a liquid tincture of opium to relieve pain. Similarly, according to Jacobson (2017), his work of recorded observations, Observationes Medical, would serve as a functional textbook for the next two hundred years.
Sydenham's most famous and enduring work was his treatise on gout in 1683, which took the art of clinical observation to a personal level (Jacobson, 2017). Having suffered frequent and debilitating attacks of gout from the age of thirty, he gave a descriptive, first-person account of the affliction. Although Sydenham correctly identified obesity, excessive red meat intake and alcohol as risk factors for gout, his Puritan religion also probably influenced his recommendation of temperance rather than other treatments. Jacobson (2017) mentions that, in modern medicine, gout has a known association with coronary artery disease, kidney stones and sleep apnoea.
Corresponding with Jacobson (2017), ironically, colchicine, an ancient natural remedy and future pharmacological treatment for acute gout, was not used in England for over a hundred years due to the influential opposition of Thomas Sydenham.
With regard to treatment, Sydenham aspired to find a specific medication that would act quickly what nature did slowly (Fresquet, 2000). In his distinction between acute and chronic diseases, he believed that in the former, the physician should quickly and precisely eliminate the causes; in chronic diseases, the disease is destroyed in kind. Therefore, according to Jacobson (2017), he prescribed bloodletting, sweating or purging for acute diseases, but recommended temperance and rebalancing of humours for chronic diseases. Translated with www.DeepL.com/Translator (free version)
Legacy
In addition to the eponymous "Sydenham's laudanum", according to Fresquet (2000) and Fernández & Tamaro (2004), also known today is the so-called "Sydenham's cough", which consists of hysterical spasms of the respiratory muscles; and "Sydenham's chorea", an inflammatory and degenerative disease of the central nervous system, which mainly affects children between 6 and 15 years old and causes involuntary, rapid, disordered and arrhythmic movements of the muscles of the whole body.
Thomas Sydenham also made important advances in the identification of diseases, for example, he differentiated scarlet fever from measles (Fernández & Tamaro, 2004). Regarding the treatment of different diseases, Fernandez & Tamaro (2004) mentioned that he promoted the use of iron for anaemia and quinine for malaria, and Sydenham's famous laudanum (opium dissolved in alcohol) for gout.
Referencias
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/
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