Jonathan McFarland 27th January 2014

“ it is good to hark back to the olden days and gratefully to recall the men whose labours in the past have made the present possible.” ( Sir William Osler -AEQUANIMITAS )

I could talk about:

Andreas Vesalius

Alexander Fleming

Robert Koch

Galen

John Hunter

Rene Laennec

“We are here to add what we can to life, not to get what we can from life”

Featherstone Osler, the father – (1805-1895)

Interestingly enough, in 1831 Featherstone Osler was invited to serve on HMS Beagle as the science officer on Charles Darwin’s historic voyage to the Galapagos' Islands, but he turned it down because his father was dying

William Osler was born in Bond Head Canada West (now Ontario) on July 12, 1849.

He entered Trinity College, Toronto (now part of the University of Toronto) in the autumn of 1867.

His chief interest proved to be medicine and, forsaking his original intention, he enrolled in the Toronto School of Medicine.

Osler left the Toronto School of Medicine after being accepted to the MDCM program at McGill University Medicine Faculty in Montreal.

He received his Medical Degree in 1872

In 1874 Osler became a professor at McGill University Faculty of Medicine

He created his first journal club. In 1884, he was appointed Chair of Clinical

Medicine at the University of Pennsylvania in Philadelphia

  In 1885, was one of the seven founding

members of the Association of American Physicians, a society dedicated to "the advancement of scientific and practical medicine." 

In 1889, he accepted the position as the first Physician-in-Chief of the new Johns Hopkins Hospital in Baltimore, Maryland.

 In 1893, Osler was instrumental in the

creation of the John Hopkins School of Medicine and became one of the school's first professors of medicine.

Osler quickly increased his reputation as

a clinician, humanitarian, and teacher. 

The Four Doctors by John Singer Sargent, 1905, depicts the four physicians who founded Johns Hopkins Hospital . From left to right: William Henry Welch, William Stewart Halsted, Osler, Howard Kelly

In 1905, he was appointed to the Regius Chair of Medicine at Oxford, which he held until his death. He was also a Fellow of Christ Church, Oxford.

In 1911, he initiated the Postgraduate Medical Association, of which he was the first President.

He died at the age of 70, on December 29, 1919 in Oxford, during the Spanish Influenza epidemic

Osler was a founding donor of the American Anthropometric Association, a group of academics who pledged to donate their brains for scientific study. Osler's brain was taken to the Wistar Institute in Philadelphia to join the Wistar Brain Collection.

In 1925, a biography of William Osler was written by Harvey Cushing* who received the 1926 Pullitzer prize for the work. A later biography by Michael Bliss was published in 1999.

 In 1994 Osler was inducted into the Canadian Medical Hall of Fame

* Often called the “Father of Neurosurgery”

 He has frequently been described as the "Father of Modern Medicine"

With his wife and son

Perhaps Osler's greatest contribution to medicine was to insist that students learn from seeing and talking to patients and the establishment of the medical residency. The latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. 

 While at Hopkins, Osler established the full-time, sleep-in residency system whereby staff physicians lived in the administration building of the hospital. 

Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients

The contribution to medical education of which he was proudest was his idea of clinical clerkship – having third- and fourth-year students work with patients on the wards.

He pioneered the practice of bedside teaching, making rounds with a handful of students, demonstrating what one student referred to as his method of "incomparably thorough physical examination." 

He reduced the role of didactic lectures and once said he hoped his tombstone would say only,

"He brought medical students into the wards for bedside teaching." 

Series of four photographs of Sir William Osler at patient's bedside, in the stages of observation, palpation, auscultation and contemplation

“The four points of a medical student’s compass are: Inspection, Palpation, Percussion, and Auscultation.”

Baltimore Period (1889-1905)

The Doctor, Luke Fildes 1891 "Ciencia y caridad" (1897). Pablo Picasso

“Listen to the patient, he is telling you the diagnosis. “

“Every patient you see is a lesson in much more than the malady from which he suffers.”

“The kindly word, the cheerful greeting, the sympathetic look, trivial they may seem, help to brighten the paths of the poor sufferers”

Osler fundamentally changed medical teaching in the North America, and this influence, helped by a few such as the Dutch internist Dr. P.K. Pel, spread to medical schools across the globe.

Osler was a prolific author and public speaker and his public speaking and writing were both done in a clear, lucid style. His most famous work, ”The Principles and Practice of Medicine” quickly became a key text to students and clinicians alike. It continued to be published in many editions until 2001 and was translated into many languages.

Osler's essays were important guides to physicians. The title of his most famous essay, "Aequanimitas", espousing the importance of imperturbability.

Osler’s nodes are raised tender nodules on the pulps of fingertips or toes, an autoimmune vasculitis that is suggestive of sub acute bacterial endocarditis. They are usually painful

Osler-Libman Sacks syndrome is an atypical, verrucous, nonbacterial, valvular and mural endocarditis.

Osler's syndrome is a syndrome of recurrent episodes of colic pain, with typical radiation to back, cold shiverings and fever; due to the presence in Vater’s diverticulum of a free-moving gallstone which is larger than the orifice

Osler's triad: association of pneumonia, endocarditis, and meningitis.

 A speech called "The Fixed Period", given on February 22, 1905, included some controversial words about old age..

He envisaged a college where men retired at 67 and after a contemplative period of a year were "peacefully extinguished" by chloroform. 

He claimed that, "the effective, moving, vitalizing work of the world is done between the ages of twenty-five and forty" and it was downhill from then on.

This caused a strong controversy with the tabloids stating

“ Osler recommends chloroform at sixty!!”

In the conclusion “The French have a saying, plus ca change, plus

c'est la meme chose—the more things change, the more things stay the same”

William Osler was not just a great man of his times but speaks to us today in the dilemmas that we face about a way of practice and life

Despite having no modern diagnostics and relying only upon his eyes, his stethoscope, and a microscope, his approach to diagnosis and of dealing with patients remains fresh and energizing to anyone who would open his volumes and read his writings. 

*Proc (Bayl Univ Med Cent). 2011 July; 24(3): 227–235

To understand what Osler has to say to us today, 100 years later, is to listen to his own “way of life”:

“I have three personal ideals. One, to do the day's work well and not to bother about tomorrow…. The second has been to act the Golden Rule, as far as in my lay, towards my professional brethren and towards the patients committed to my care … and the 3rd has been to cultivate such a measure of equanimity as would enable me to bear success with humility, the affection of my friends without pride, and to be ready when the day of sorrow and grief came to meet it with the courage befitting a man.”  

Osler wrote his own epitaph, “that I taught medical students in the ward”

The answer is YES.

And perhaps, even more so

In the days when a complementary test is sometimes preferred to a good history then Osler can still teach us A LOT.

Back to the basics: A good clinical history A good physical examination A good bedside manner

Mcfarland.jonathan@gmail.com