William Osler

Sir William Osler, 1st Bt.
William Osler, M.D.,C.M.
Born	July 12, 1849(1849-07-12) Bond Head, Canada West
Died	December 29, 1919 (aged 70) Oxford, England
Nationality	Canada
Fields	physician
Institutions	McGill University, Johns Hopkins School of Medicine, Johns Hopkins Hospital, University of Pennsylvania, University of Oxford
Alma mater	McGill University

Sir William Osler, M.D.,C.M., 1st Baronet (July 12, 1849 – December 29, 1919) was a Canadian physician. (The "o" in "Osler" is pronounced like the "o" in "go".)

He has been called one of the greatest icons of modern medicine and described as the Father of Modern Medicine. Osler was a pathologist, educator, bibliophile, historian, author, and renowned practical joker.

Biography

Osler was born in Bond Head, Canada West (now Ontario), and raised after 1857 in Dundas, Ontario. His father, Featherstone Lake Osler (1805-1895), the son of a shipowner at Falmouth, Cornwall, was a former Lieutenant in the Royal Navy and served on H.M.S. Victory. In 1831 he was invited to serve on H.M.S. Beagle as the science officer on Charles Darwin's historic voyage to the Galápagos Islands, but he turned it down as his father was dying. As a teenager Featherstone Osler was aboard H.M.S. Sappho when it was nearly destroyed by Atlantic storms and left adrift for weeks. Serving in the Navy he was ship-wrecked off Barbados. In 1837 he retired from the Navy and emigrated to Canada, becoming a 'saddle-bag minister' in rural Upper Canada. On arriving in Canada he and his bride (Ellen Free Picton) were nearly ship-wrecked again on Egg Island in the Gulf of Saint Lawrence. William's great grandfather, Edward Osler, was variously described as either a merchant seaman or a pirate, and one of William's uncles, a medical officer in the Navy, wrote the Life of Lord Exmouth and the poem The Voyage. William was the brother of Britton Bath Osler and Sir Edmund Boyd Osler.

Educated at Trinity College School, Port Hope, as a teenager, William Osler's aim was to follow his father into the Anglican ministry and to that end he entered Trinity College, Toronto (now part of University of Toronto) in the autumn of 1867. However, his chief interest proved to be medicine and, forsaking his original intention, he enrolled in the Toronto School of Medicine. This was a proprietary, or privately owned, institution, not to be confused with the Medical Faculty of the University of Toronto, which was then not active as a teaching body. After two years at the Toronto School of Medicine, Osler came to McGill University in Montreal where he obtained his medical degree (MD,CM) in 1872.

Portrait Photograph

Following post-graduate training in Europe, Osler returned to McGill University as a professor in 1874. It is here that he created the first formalized journal club. In 1884 he was appointed Chair of Clinical Medicine at the University of Pennsylvania in Philadelphia. When he left Philadelphia in 1889, his farewell address Aequanimitas is on the equanimity necessary for physicians. In 1889 he became the first chief of staff at Johns Hopkins Hospital, and in 1893 one of the first professors of medicine at Johns Hopkins University School of Medicine in Baltimore. In 1905 he was appointed to the Regius Chair of Medicine at Oxford, which he held until his death. He was also an Fellow of Christ Church, Oxford. Osler was created a baronet in the Coronation Honours List of 1911 for his many contributions to the field of medicine.

Osler was a prolific author and a great collector of books and other material relevant to the history of medicine. He willed his library to McGill University where it forms the nucleus of McGill University's Osler Library of the History of Medicine, which opened in 1929. The printed and extensively annotated catalogue of this donation is entitled "Bibliotheca Osleriana: a catalogue of books illustrating the history of medicine and science, collected, arranged and annotated by Sir William Osler, Bt. and bequeathed to McGill University". Osler was a strong supporter of libraries and served on the library committees at most of the universities at which he taught and was a member of the Board of Curators of the Bodleian Library in Oxford. He was instrumental in founding the Medical Library Association in North America and served as its second President from 1901-1904. In Britain he was the first (and only) President of the Medical Library Association of Great Britain and Ireland^[1] and also a President of the Bibliographical Society of London (1913).^[2]

Perhaps Osler's greatest contribution to medicine was to insist that students learned from seeing and talking to patients and the establishment of the medical residency. This latter idea spread across the English-speaking world and remains in place today in most teaching hospitals. Through this system, doctors in training make up much of a hospital's medical staff. The success of his residency system depended, in large part, on its pyramidal structure with many interns, fewer assistant residents and a single chief resident, who originally occupied that position for years. In 1889, Osler accepted the position of Physician-in-Chief at the recently founded Johns Hopkins Hospital in Baltimore. There, he quickly increased his reputation as clinician, humanitarian and teacher. He presided over a rapidly expanding domain. In the Hospital's first year of operation, when it had 220 beds, 788 patients were seen for a total of over 15,000 days of treatment. Sixteen years later, when Osler left for Oxford, over 4,200 patients were seen for a total of nearly 110,000 days of treatment.

Soon after coming to Baltimore, Osler insisted that his medical students get to the bedside early in their training; by their third year they were taking patient histories, performing physicals and doing lab tests examining secretions, blood and excreta instead of sitting in a lecture hall, dutifully taking notes. He diminished 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." He established a tradition at Hopkins that became the goal of those who succeeded him. He once said, "I desire no other epitaph … than the statement that I taught medical students in the wards, as I regard this as by far the most useful and important work I have been called upon to do."

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

While at Hopkins, Osler also established the full-time, sleep-in residency system whereby staff physicians lived in the Administration Building of the Hospital. As established, the residency was open-ended, and long tenure was the rule. Doctors spent as long as seven or eight years as residents, during which time they led a restricted, almost monastic life. Osler's contribution to medical education of which he was proudest was his idea of clinical clerkships—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."

Osler is well known in the field of gerontology for the speech he gave when leaving Hopkins to become the Regius Professor of Medicine at Oxford. His speech "The Fixed Period", given on 22 February 1905, included some controversial words about old age. Osler, who had a well-developed humorous side to his character, was in his mid-fifties when he gave the speech and in it he mentioned Anthony Trollope's The Fixed Period (1882), which 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. Osler's speech was covered by the popular press which headlined their reports with "Osler recommends chloroform at sixty". The Fixed Period speech is included in the book of his collected addresses, "Aequanimitas with other Addresses to Medical Students etc.")

An inveterate prankster, he wrote several humorous pieces under the pseudonym "Egerton Yorrick Davis", even fooling the editors of the Philadelphia Medical News with a report on the supposed phenomenon of penis captivus.^[3]

He liked to say, "He who studies medicine without books sails an uncharted sea, but he who studies medicine without patients does not go to sea at all." He is also remembered for saying, "If you listen carefully to the patient they will tell you the diagnosis" which emphasises the importance of taking a good history.

Throughout his life Osler was a great admirer of the 17th century physician and philosopher Sir Thomas Browne. In 1994 he was inducted into the Canadian Medical Hall of Fame.

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 bible to students and clinicians alike. It continued to be published in many editions until 2001 and was translated into many languages. (See Osler Library Studies in the History of Medicine vol. 8.A History of William Osler’s The Principles and Practice of Medicine by Richard Golden. ISBN 07717-0615-4. Available from the Osler Library.) Though his own textbook was a major influence in medicine for many years, Osler described Avicenna as the 'author of the most famous medical textbook ever written.' He noted that Avicenna's Canon of Medicine remained 'a medical bible for a longer time than any other work. ^[4] Osler's essays were important guides to physicians. The title of his most famous essay, Aequanimitas, espousing the importance of imperturbability, is the motto on the Osler family crest and is used on the Osler housestaff tie and scarf at Hopkins.

He died, at the age of 70, in 1919, during the Spanish influenza epidemic; his wife, Grace, lived another nine years but succumbed to a series of strokes. Sir William and Lady Osler's ashes now rest in a niche within the Osler Library at McGill University. They had two sons, one of whom died shortly after birth. The other, Edward Revere Osler, was mortally wounded in combat in World War I at the age of 21, during the 3rd battle of Ypres (also known as the battle of Passchendaele). At the time of his death in August 1917, he was a Second Lieutenant in the (British) Royal Field Artillery; Lt. Osler's grave is in the Dozinghem Military Cemetery in West Flanders, Belgium. According to one biographer, Dr. Osler never recovered emotionally from the loss ^[5].

In 1925 a monumental biography of William Osler was written by Harvey Cushing. For this work, Cushing received the 1926 Pulitzer Prize for biography. A later and somewhat more balanced biography by Michael Bliss was published in 1999 ^[6].

Eponyms

Osler lent his name to a number of diseases and symptoms, as well as having buildings named after him.

Conditions

• Osler's sign is an artificially high systolic blood pressure reading due to the calcification of atherosclerotic arteries.
• Osler's nodes are raised tender nodules on the pulps of fingertips or toes, an autoimmune vasculitis that is suggestive of subacute bacterial endocarditis. They are usually painful, as opposed to Janeway lesions which are due to emboli and are painless.
• Rendu-Osler-Weber disease (also known as hereditary hemorrhagic telangiectasia) is a syndrome of multiple vascular malformations on the skin, in the nasal and oral mucosa, in the lungs and elsewhere.
• Osler-Vaquez disease (also known as Polycythemia vera)
• Osler-Libman-Sacks syndrome is an atypical, verrucous, nonbacterial, valvular and mural endocarditis. Final stage of systemic lupus erythematosus.
• Osler's filaria is a parasitic nematode.
• Osler's manoeuvre: In pseudohypertension, the blood pressure as measured by the sphygmomanometer is artificially high because of arterial wall calcification. Osler's manoeuvre takes a patient who has a palpable, although pulseless, radial artery while the blood pressure cuff is inflated above systolic pressure; thus they are considered to have "Osler's sign."
• 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.
• Sphryanura osleri is a trematode worm found in the gills of a newt.

Buildings

• Sir William Osler Elementary School - Elementary School in Vancouver, British Columbia
• Sir William Osler Elementary School - HWDSB Elementary School in Dundas, Ontario.
• Sir William Osler High School [1], Toronto, Ontario
• Sir William Osler Public SchoolSimcoe County District School Board Elementary School in Bradford West Gwillimbury, Ontario and 3 kilometres away from his birth place, Bond Head, Ontario.
• Osler Library of the History of Medicine, McGill University, Montreal. Osler left his 8000 volume collection of books on the history of medicine to his alma mater. The library now holds over 100,000 volumes and is Canada's de facto 'national library of the history of medicine'.
• Promenade Sir-William-Osler adjacent to the campus of McGill University in Montreal, Quebec and leading to the McIntyre Medical Sciences Building, which houses the Osler Library of the History of Medicine. (Formerly the upper section of rue Drummond.)
• William Osler Health Centre, renamed in 1998 is a union of Peel Memorial Hospital, in Brampton, Ontario, Etobicoke General Hospital in Toronto, Georgetown District Memorial Hospital which is now with Halton Health Care and the Brampton Civic Hospital which opened in late 2007.
• Osler House is the student mess for clinical medical students of Oxford University and is found at the John Radcliffe Hospital in Oxford. It provides a common room area, computers and freshly made sandwiches.
• In 1999, the Johns Hopkins University School of Medicine created the Osler Textbook Room, in the room in the Billings Building where Osler wrote "Principles and Practice of Medicine". It houses a collection of Osler memorabilia.
• In 2002 the Johns Hopkins University School of Medicine established the Osler Center for Clinical Excellence, devoted to teaching "the basic elements of a sound doctor patient relationship".

Notes

References

• Bliss, Michael. William Osler : a life in medicine, University of Toronto Press, c1999. ISBN 0-8020-4349-6
• Celebrating the Contributions of William Osler. Alan Mason Chesney Medical Archives 1999. Johns Hopkins Medical Institutions.
• Cushing, Harvey. The Life of Sir William Osler, Clarendon Press, Oxford, 1925.
• Famous Canadian Physicians: Sir William Osler at Library and Archives Canada.
• Osler, William. Bibliotheca Osleriana: A Catalogue of Books Illustrating the History of Medicine and Science. Revised Edition, McGill-Queen's University Press, 1969. ISBN 0-773590-50-1 , ISBN 9780773590502.
• Osler, William. The Quotable Osler, American College of Physicians, 2003. ISBN 1-930513-34-8
• Osler, Sir William. Obituary in the British Medical Journal, 3 January 1920.

External links

Wikiquote has a collection of quotations related to: William Osler

• Richard L. Golden, Charles G. Roland (1988). Sir William Osler. Norman Publishing. ISBN 0930405005. http://books.google.com/books?id=3Z33qBcbP6MC&pg=PA172&lpg=PA172&dq=insects+%22horace+knight%22+-imdb&source=web&ots=s33bkFEvBx&sig=XrTb3_Jd0vcmryr9s5oKpeZq408#PPR7,M1. 
• Biography at the Dictionary of Canadian Biography Online
• Osler Library, brief biography of William Osler
• Works by William Osler at Project Gutenberg
• Essays by William Osler at Quotidiana.org
• Aequanimitas from the Alan Mason Chesney Medical Archives of the Johns Hopkins Medical Institutions.
• Biography on WhoNamedIt.com
• Biography from Osler House, Oxford, focusing on his Oxford years
• Osler House - Dundas - B&B, Meetings, Celebrations, Receptions, Retreats
• Ontario Plaques — Sir William Osler
• House at 13 Norham Gardens, owned by Sir William Osler while Regius Professor of Medicine at Oxford University (information from Green College, Oxford)
• Osler House Club, Oxford University
• The American Osler Society
• The Osler Club of London
• Osler biography, chronology, bibliography & resources (from Johns Hopkins)
• systemofmedicine.com, Oslerian medical education resource
• William Osler Health Centre
• William Osler Photo Collection of McGill University Library