William Osler

Sir William Osler, Bt
William Osler, M.D.,C.M.
Born	July 12, 1849(1849-07-12) Bond Head, Canada West
Died	December 29, 1919(1919-12-29) (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, 1st Baronet (July 12, 1849 – December 29, 1919) was a physician. (pronounced "oh-sler") He was one of the "Big Four" founding professors at Johns Hopkins Hospital as the first Professor of Medicine and founder of the Medical Service there. (The "Big Four" were William Osler, Professor of Medicine; William Stewart Halsted, Professor of Surgery; Howard A. Kelly, Professor of Gynecology; and William H. Welch, Professor of Pathology.) Osler created the first residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training.^[1]

He has been called the "Father of modern medicine."^[2] Osler was a pathologist, physician, educator, bibliophile, historian, author, and renowned practical joker.

Family

William's great grandfather, Edward Osler, was variously described as either a merchant seaman or a pirate, and one of William's uncles (Edward Osler 1798-1863), a medical officer in the Navy, wrote the Life of Lord Exmouth and the poem The Voyage. William Osler's 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 HMS Victory. In 1831 Featherstone Osler was invited to serve on HMS 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 HMS 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 Featherstone Osler retired from the Navy and emigrated to Canada, becoming a 'saddle-bag minister' in rural Upper Canada. When Featherstone Osler and his bride (Ellen Free Picton) arrived in Canada they were nearly ship-wrecked again on Egg Island in the Gulf of Saint Lawrence. The Oslers had several children and William was the brother of Britton Bath Osler and Sir Edmund Boyd Osler.

Early life

William Osler was born in Bond Head, Canada West (now Ontario) on July 12, 1849, and raised after 1857 in Dundas, Ontario. (He was called William after William of Orange, who won the Battle of the Boyne on July 12, 1690.)

Educated at the original Trinity College School in Weston Ontario, 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 a constituent college of the 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. Osler left the Toronto School of Medicine after being accepted to the MDCM program at McGill University Faculty of Medicine in Montreal. He received his medical degree (MDCM) in 1872.

Career

Following post-graduate training in Europe, Osler returned to McGill University Faculty of Medicine 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 and 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." When he left Philadelphia in 1889, his farewell address Aequanimitas^[3] was on the equanimity necessary for physicians.

Dr. Osler in 1909, in the Bodleian Library, Oxford.

In 1889, he accepted the position as the first Physician-in-Chief of the new Johns Hopkins Hospital in Baltimore, Maryland USA. Shortly afterwards, in 1893, Osler was instrumental in the creation of the Johns Hopkins University School of Medicine and became one of the school's first professors in medicine. Osler quickly increased his reputation as a 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.

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. During his time at Oxford, he met many aspiring doctors, a notable example being Wilder Penfield.

In 1911, he initiated the Postgraduate Medical Association, of which he was the first President.^[4]

Osler was created a baronet in the Coronation Honours List of 1911 for his many contributions to the field of medicine.

Contribution

Photo-portrait

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. 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. While at Hopkins Osler 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.

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." His best-known saying was "Listen to your patient, he is telling you the diagnosis," which emphasises the importance of taking a good history.^[2]

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." Soon after arriving in Baltimore Osler insisted that his medical students attend at 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.

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

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." He also 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." 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 a great collector of books and other material relevant to the history of medicine. He willed his library to the Faculty of Medicine of McGill University where it now 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".^[5] 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^[6] and also a President of the Bibliographical Society of London (1913).^[7]

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. (See Osler Library Studies in the History of Medicine vol. 8.)^[8] It is notable in part for supporting the use of Bloodletting as recently as 1923.^[9] 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.^[10] 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.

Euthanasia

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.")

Personal life

An inveterate prankster, he wrote several humorous pieces under the pseudonym "Egerton Yorrick Davis", even fooling the editors of the Philadelphia Medical News into publishing a report on the imaginary phenomenon of penis captivus, on December 13, 1884.^[11] The letter (still cited in all seriousness in a number of textbooks) was apparently a response to a report on the phenomenon of vaginismus reported three weeks previously in the Philadelphia Medical News by Osler’s colleague Theophilus Parvin.^[12]

Davis, a prolific writer of letters to medical societies, purported to be a retired US Army surgeon living in Caughnawaga, Quebec (now called Kahnawake), author of a controversial paper on the obstetrical habits of Native American tribes which was suppressed and unpublished. Osler would enhance Davis' myth by signing Davis' name to hotel registers and medical conference attendance lists; Davis was eventually reported drowned in the Lachine Rapids in 1884.^[12]

Throughout his life, Osler was a great admirer of the 17th century physician and philosopher Sir Thomas Browne.

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.^[13] According to one biographer, Dr. Osler was emotionally crushed by the loss.^[14] Lady Osler (Grace Revere) was born in Boston in 1854; her paternal great-grandfather was Paul Revere. In 1876, she married Samuel W. Gross, chairman of surgery at Jefferson Medical College in Philadelphia. Dr Gross died in 1889 and in 1892 she married William Osler who was then professor of medicine at Johns Hopkins University.

In 1925, a monumental biography of William Osler was written by Harvey Cushing.^[15] 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.^[14] In 1994 he was inducted into the Canadian Medical Hall of Fame.^[16]

Eponyms

Osler lent his name to a number of diseases, signs 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 School - Elementary School in Winnipeg, Manitoba
• Sir William Osler Elementary School - HWDSB Elementary School in Dundas, Ontario.
• Sir William Osler High School,^[17] Toronto, Ontario
• Sir William Osler Public School^[18] Simcoe 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 (Formerly the upper section of rue Drummond.) 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.
• William Osler Health System, was created in 1998 as 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. In 2011 it was described as "William Osler Health System is one of Canada's largest community hospital corporations serving the growing and diverse communities of Brampton, Etobicoke and surrounding areas in the Greater Toronto Area (GTA). Osler's hospitals include Etobicoke General, Brampton Civic and the soon-to-be redeveloped Peel Memorial which together provide a comprehensive range of acute care, ambulatory and ancillary health services."
• Osler House is the student mess for clinical medical students of Oxford University and is found at the John Radcliffe Hospital in Oxford.
• Osler House is one of the two undergraduate hostels of the prestigious medical school JIPMER, Pondicherry, India.
• In 1999, the Johns Hopkins University School of Medicine created the Osler Textbook Room,^[19] 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,^[20] devoted to teaching "the basic elements of a sound doctor patient relationship".
• Osler Hall is the name of the Dining Hall at Trinity College School, Port Hope, Ontario.
• Osler Hall is the Main Hall of "Med Chi" or Medical and Chirurgical Faculty, the Maryland State Medical Society,^[21] located on Cathedral Street in Baltimore Md. The Med Chi House of Delegates meets and deliberates in Osler Hall wherein hang numerous portraits of famous Maryland physicians including a large portrait of Sir William Osler MD

Notes

1. ^ Johns Hopkins Medicine:The Four Founding Professors
2. ^ ^{a b} Tuteur, Amy, "The Skeptical OB
3. ^ Medicalarchives.jhmi.edu
4. ^ D. G. James. The portraiture of Sir William Osler. pmj.bmj.com
5. ^ Bibliotheca Osleriana
6. ^ Crawford DS (December 2004). "The Medical Library Association of Great Britain and Ireland". Health Info Libr J 21 (4): 266–8. doi:10.1111/j.1471-1842.2004.00533.x. PMID 15606885. http://www.blackwell-synergy.com/doi/full/10.1111/j.1471-1842.2004.00533.x. 
7. ^ "The Bibliographical Society - Past Presidents". Bibsoc.org.uk. 2008-11-18. http://www.bibsoc.org.uk/presidents.htm. Retrieved 2011-01-24. 
8. ^ A History of William Osler’s The Principles and Practice of Medicine by Richard Golden. ISBN 0-7717-0615-4. Available from the Osler Library.
9. ^ Bloodletting - UCLA Biomedical Library History and Special Collections for the Sciences
10. ^ Journal of Perinatology (2007-09-06). "Access : Avicenna (AD 980 to 1037) and the care of the newborn infant and breastfeeding : Journal of Perinatology". Nature.com. http://www.nature.com/jp/journal/v28/n1/full/7211832a.html. Retrieved 2011-01-24. 
11. ^ Davis, Egerton Yorrick (1999). Golden, Richard L. ed. The Works of Egerton Yorrick Davis, MD: Sir William Osler's Alter Ego. Osler Library studies in the history of medicine, no. 3. Montreal: Osler Library, McGill University. ISBN 9780771705489. OCLC 48551127.  A collection of writings by the fictitious surgical character created by Osler, E.Y. Davis
12. ^ ^{a b} "Egerton Y. Davis", Chris Nickson, Life in the Fastlane, November 16, 2008
13. ^ Starling, P H (March 2003). "The case of Edward Revere Osler" (PDF). Journal of the Royal Army Medical Corps 149 (1): 27–29. PMID 12743923. http://www.ramcjournal.com/2003/mar03/starling.pdf. 
14. ^ ^{a b} Bliss, Michael (1999)
15. ^ Cushing, Harvey (1925)
16. ^ "Sir William Osler". Canadian Medical Hall of Fame. http://www.cdnmedhall.org/sir-william-osler. Retrieved 2010-03-24. 
17. ^ "Sir William Osler High School - Welcome to Sir William Osler High School". Tdsb.on.ca. 2010-06-10. http://www.tdsb.on.ca/SchoolWeb/_site/viewitem.asp?siteid=10000&pageid=5942&menuid=6827. Retrieved 2011-01-24. 
18. ^ SWO.scdsb.on.ca
19. ^ Medicalarchives.jhmi.edu
20. ^ Hopkinsbayview.org
21. ^ Medchi.org

References

• Bliss, Michael (1999). William Osler : a life in medicine. Oxford, New York: Oxford University Press. ISBN 9780195123463. OCLC 41439631. 
• Celebrating the Contributions of William Osler. Alan Mason Chesney Medical Archives 1999. Johns Hopkins Medical Institutions.
• Cushing, Harvey (1925). The Life of Sir William Osler. Oxford: Clarendon Press. OCLC 268160. 
• Famous Canadian Physicians: Sir William Osler at Library and Archives Canada.
• Osler, William (1969) [1929]. Francis, William W; Hill, Reginald H; Malloch, Archibald. eds. Bibliotheca Osleriana: A Catalogue of Books Illustrating the History of Medicine and Science (Revised ed.). Montreal: McGill-Queen's University Press. ISBN 9780773590502. OCLC 75916.  The Introduction and other editorial matter is freely available on-line. The whole of the Bibliotheca is available online (for a fee) from McGill-Queen's University Press.
• Osler, William; Silverman, Mark E; Murray, T J; Bryan, Charles S (2002). The Quotable Osler. Philadelphia: American College of Physicians. ISBN 9781930513341. OCLC 50477294. 
• "Obituary - Sir William Osler". British Medical Journal 1 (3079): 30–33. 1920-01-03. doi:10.1136/bmj.1.3079.30. PMC 2337064. http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pmcentrez&artid=2337064. Retrieved 2010-03-24. 

External links

• Richard L. Golden, Charles G. Roland (1988). Sir William Osler. Norman Publishing. ISBN 0930405005. http://books.google.com/?id=3Z33qBcbP6MC&pg=PA172&lpg=PA172&dq=insects+%22horace+knight%22+-imdb. 
• 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
• [1] at 13 Norham Gardens, owned by Sir William Osler while Regius Professor of Medicine at Oxford University (information from Green Templeton 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

Persondata
Name	Osler, William
Alternative names
Short description
Date of birth	1849-07-12
Place of birth	Bond Head, Canada West
Date of death	1919-12-29
Place of death	Oxford, England