Sydenham and the Gout

 Thomas Sydenham (1624–1689). One of England’s most highly regarded physician, Sydenham believed in direct observation and the power of reason. Like Hippocrates, he charted the course of disease. He believed in credible signs and symptoms and differential diagnosis. Sydenham also suffered from gout and so felt a deep compassion for others. He proclaimed that gout attacked the rich more often than the poor, and that it rarely attacked fools.  He has been quoted as saying that “those who may choose may except the present writer,” and “If you drink wine, you have the gout, if you do not drink wine, the gout has you.” Too bad Sydenham was unaware of the autumn crocus/colchicine.

“Gout attacks such old men as, after passing the best part of their lives in ease and comfort, indulging freely in high living, wine, and other generous drinks, at length, from inactivity, the usual attendment of advanced life, have left off altogether the bodily exercises of their youth. Such men have generally large heads, are of a full, humid, and lax habit, and process a luxurious and vigorous constitution, with excellent vital stamina” 

When you explore the molecular biology of gout, you will see a high level of coffee like stimulant in continuous circulation due to an inborn error of metabolism.  Many kings, generals, professors, many of these famous doctors and possibly a recent US president share Sydenham’s hyperuricemia.

Sydenham was first a cavalryman/officer on the side of parliament in the Protestant Civil War (1642–51) His works include The Method of Curing Fevers (1666–68), Observations of Medicine (1676), Letters and Replies (1680), Dissertation on Smallpox and Hysteria (1682), Symptoms of the Newly Arrived Fever (1686), and The Process of Healing (1692), his textbook of medicine most widely read and republished.

Sydenham made efficacious use of laudanum and Peruvian bark (quinine) and diagnosed erysipelas and “Sydenham’s” chorea (St. Vitus dance). 

A strong proponent of the Hippocratic method, advocating primum non nocere (first, do no harm), irascible and controversial, Sydenham earned his reputation as a great physician and internist after his death.