Dominic Williams
OMS-IV LECOM – Bradenton

“Medicine is a science of uncertainty and an art of probability.”

Have you ever wondered why, as a third-year medical student, you’re cast out into the hospital to fend for yourself among patients? Have you ever stopped to think about which creative genius came up with the idea of years of torture post medical school? Ever wondered about the man behind the painful nodes of endocarditis? Well, wonder no more. In this brief article, we will take a whirlwind tour through the life of one of the physicians credited with birthing modern medicine from the classroom to the clinic – Sir William Osler.

William Osler, fondly referred to as “Willie,” was born on the 12th of July in 1849, about 40 miles north of Toronto in a frontier village called Bond Head. As one of nine children born to a reverend and his wife, his childhood was split between traveling with his father and tending the small farm attached to the parsonage. As Reverend Osler’s career progressed, the family moved to a larger parish in Dundas when William Osler was a mere eight years old.

Allegedly, as quite a mischievous young man, Osler decided to enter the theological field after taking his antics too far and deciding he must atone for his wrongdoing. Thankfully for the field of modern medicine, at Trinity College School in 1866, Reverend William Arthur Johnson set young Osler’s life on a trajectory quite different from the one he’d planned. Through Reverend Johnson’s introduction to the field of science, Osler awoke to the joy of understanding how things worked, and was no longer stuck in the monotony of translating classic texts from their original Greek and Latin. This newfound interest drove him to make the transition from “the study of nature to the study of man” and ended up working with a new mentor Dr. James Bovell, a faculty member at the Toronto School of Medicine. Osler transferred schools to complete his medical training at McGill University Faculty of Medicine in Montreal where he graduated as both an MD and CM – a medical doctor and a master of surgery. At this point, Osler sought clinical experience at that time not available in North America. So off he went to England and Germany where he worked with names such as John Burdon Sanderson, and perhaps the more well-known, Rudolf Virchow (of triad fame). Returning to Montreal in 1874 Osler swiftly took on the title of professor and became an active member in the scientific community. At this time, Osler became interested in the reformation of medical education. And after being inspired by his time in Europe and his visits to the United States, Osler introduced new classes at the medical school, altered the format of exams, and campaigned to promote greater clinical experience for students.

Osler’s full-time American adventure began in Pennsylvania, enticed by the clinical opportunities he could provide to his students there. He was famed for his fascinating autopsies and sharing the joy of learning with his students. He also became a regular public speaker in the medical profession and questioned the current medical school curriculum and the discrimination of women in medicine. Perhaps Osler’s more famous appointment came in 1889 when he became Physician in Chief of a medical school that even the average layperson recognizes – Johns Hopkins Hospital in Baltimore. In this position, he was given the freedom to structure his own course curriculum which he based on his time in Europe. Third-year students began in outpatient clinics and fourth-years were sent into the hospital under the supervision of the residents. Osler would also round on patients and gained a reputation for both his intricate exploration of each presentation and his superb rapport with patients and students. During this time Osler married Grace Revere Gross, the widow of a famous surgeon, and published his seminal work The Principles and Practice of Medicine, a conglomerate of his clinical experience and the most up to date information he could gather in the newer fields of medicine such as microbiology. A huge success, the book was a popular work for many years after printing.

In his mid-50s Osler’s commitments were beginning to overwhelm him and he accepted a job at Oxford University as the Regius Professor of Medicine. His family made the move to the United Kingdom and he swiftly settled into life there. Despite working clinically and academically, Osler also found time to build his literary collection and further explore medical history. In 1911, thanks to King George V, and due to his outstanding contributions to medicine, Dr. William Osler became Sir William Osler. As with many other retirees, the First World War brought many physicians out of retirement and into the forefront of their field again. As a Canadian by birth he helped organize many of the foreign military hospitals in the Oxford region, and opened his home to the vast number of displaced individuals that suffered as a result of the war. The war brought great tragedy to Sir William and his wife Lady Grace. Their only son to survive into adulthood (one was torn from them soon after birth) was killed in the fighting in Ypres, Belgium, the summer of 1917.

Osler battled respiratory issues, quite possibly undiagnosed bronchiectasis, much of his adult life. A short time after turning 70, Sir William Osler suffered from pneumonia, likely a complication of the Spanish influenza. He died in late December of 1919. Osler himself referred to pneumonia as “the old man’s friend,” in his writings and was controversially known to have joked about the swift downhill slide of the aging man. In death, as in life it seems, Osler embraced the science that he had founded his career upon.

Quotes

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

“Observe, record, tabulate, communicate. Use your five senses. Learn to see, learn to hear, learn to feel, learn to smell, and know that by practice alone you can become expert.”

The above quotes are a couple favorites among clinical faculty everywhere. Osler believed that the vast majority of diagnoses could come from a thorough history and physical. Although I stand by his statement, I feel that in this era of medicine even Osler would recognize that the armory of tests we have available far exceeds his arsenal at that time. This quote should still be an encouragement to us all to actively listen to the nuances of a patient’s history. Our testing should be to confirm and support, not simply because we “don’t know.”

“While medicine is to be your vocation, or calling, see to it that you have also an avocation – some intellectual pastime which may serve to keep you in touch with the world of art, of science, or of letters.”

It is impressive to me that nearly a century before all our Wellness seminars and Life/work balance advice that Dr. Osler recognized the importance of preventing losing touch with the rest of life for the sake of medicine.

“The good physician treats the disease; the great physician treats the patient who has the disease”.

Here, Osler shows his genial personality in his approach to treating patients. This theory seems positively Osteopathic in its foundation and I can’t think of a better physician to share a philosophy with.

“There is no disease more conducive to clinical humility than aneurysm of the aorta.”

This quote resonates with us all I’m sure. Despite the advances of modern medicine, some conditions remain heart-wrenchingly lethal.

“Too many men slip early out of the habit of studious reading, and yet that is essential.”

“By far the most dangerous foe we have to fight is apathy – indifference from whatever cause, not from a lack of knowledge, but from carelessness, from absorption in other pursuits, from a contempt bred of self-satisfaction.”

“No human being is constituted to know the truth, the whole truth and nothing but the truth; and even the best of men must be content with fragments, with partial glimpses, never the full fruition.”

Osler’s attitude to education and lifelong learning is one that I trust inspires us all. In our field, burgeoning with new and exciting information in more creative formats than ever before, we can continue to peak our own curiosity and better our patient care.

Interesting Asides (should probably go in a side bar somewhere)

•       Osler embraced humor in all aspects of his work; he used the pseudonym Egerton Yorrick Davis to help publish his musings. Once he tricked the Philadephia Medical News into publishing a report on penis captivus (one I’ll leave you to Google on your own time). He took on this alter-ego and used it to sign into conferences and hotels.
•       Osler’s literary works caught the eye of the Rockefeller family and resulted in their founding of the Rockefeller Institute of Medical Research.
•       Osler’s home in Oxford was known as the “Open Arms” due to all the visitors he and his wife would receive. This is a delightful play on words as many public houses in the UK are the ____ Arms, and his home was a constant hive of activity and hospitality.
•       Dr. Harvey Cushing, yes, that Cushing, wrote Osler’s biography “The Life of Sir William Osler” and published it in 1925.

References

About William Osler. American Osler Society. Website. http://www.americanosler.org/about/about-william-osler.php. Accessed August 17, 2017.

About William Osler. McGill Library. Website. http://www.mcgill.ca/library/branches/osler/oslerbio/. Accessed August 16, 2017.

Sir William Osler and His Inspirational Words. The Osler Symposia. Website. http://www.oslersymposia.org/about-Sir-William-Osler.html. 2017. Accessed August 17, 2017.

Sir William Osler quotes or Oslerisms. Life in the Fastlane – LITFL Collections. Website. https://lifeinthefastlane.com/collections/oslerisms/. Updated June 1 2016. Accessed August 15, 2017.

The William Osler Papers. Profiles in Science – U.S. Library of Medicine. Website. https://profiles.nlm.nih.gov/ps/retrieve/Narrative/GF/p-nid/348. Accessed August 16, 2017

William Osler. Wikipedia. Website. https://en.wikipedia.org/wiki/William_Osler. Updated August 17 2017. Accessed August 18, 2017.