Sir William Osler“Doctor who carried medical education from classrooms to patients”

Father of modern Hippocratic medicine

A tribute on his 100th year after his death -2018

Bio data[1849–1919]

Born in rural Ontario, Canada

Son of an Anglican clergyman

Shaped by boyhood access to a microscope

Exposures to Sir Thomas Browne, Osler chose medicine

In later life he characterised his career as the childhood reduction of sap to maple syrup adapted to open new scientific vistas in medicine

After publishing as a young naturalist, Osler enrolled at Toronto Medical School

Fascinated with anatomy, parasites, the humanities, but unimpressed with lectures from faculty, he transferred to McGill for bedside experiences brought there from Edinburgh, UK

After graduation he studied in Europe for 2 years before joining the medical faculty at McGill.

1883-Professor at McGill and one of only two Canadian fellows of the British Royal College of Physicians.

McGill medical education that lasted throughout the 20th century

As a professor at Philadelphia and later Hopkins, he revolutionised American medical education by teaching students at the bedside.

Contd……

1884- Osler left Montreal for the larger centre at the University of Pennsylvania

1888-Professor at the planned Johns Hopkins Hospital and Medical School

1905-Encouraged by his wife to escape an ever-demanding Baltimore practice, he accepted the Regius Professorship of Medicine at Oxford University

1911-Never one to evidence his eminence to others, lived simply, saw rich and poor in his practice, and did not attend his baronet ceremony

1919-Died at Oxford University ,London

One piece

In learning, teaching, and practice Osler linked the clinic, Laboratory, autopsy room, and library. Osler’s values—learning at the patient’s bedside, observation, cautious induction, confirmation of impressions from patients, library, and laboratory, expansion of knowledge by correlation of autopsy findings with clinical observations, and working with a love of every person equally without regard to rank—still define for many how medicine is best practised

Tempered his enthusiasm for sciencewith controlled scepticism: CriticOsler admired Sydenham, the English Hippocrates, as “a man of many doubts.” Persuaded by what he could and could not learn from patients, books, and laboratories

Bedside teacher

“Let the patient, with history and physical examination, tell you the diagnosis.” “If you do not learn the diagnosis, repeat your history and examination.” “Use tests to confirm what you learned from your patient.” “In an epidemic immunise and protect the population.” “All drugs are poisons. Physicians use them to benefit patients.” “Diagnose by exclusion.” Osler teaches us how to balance what is known, not known, and uncertain in our knowledge”

Contribution

As the father of modern Hippocratic medicine, he moved 19th century foundations of medical education from classrooms to patients’ bedsides (figure), introduced routine uses of the laboratory and autopsy as part of a physician’s ongoing education and practice, and brought scholarship, humility, and humanities into the doctor–patient relationship. He was beloved by those who knew him and respected by his and following generations. He provided care for the patient by first caring for the person

He was telling

“Let the patient, with history and physical examination, tell you the diagnosis.” “If you do not learn the diagnosis, repeat your history and examination.” “Use tests to confirm what you learned from your patient.” “In an epidemic immunise and protect the population.” “All drugs are poisons. Physicians use them to benefit patients. ”Diagnose by exclusion.” Osler teaches us how to balance what is known, not known, and uncertain in our knowledge.

Same disease in 2 different patients

“Variability is the law of life, and as no two faces are the same, so no two bodies are alike, and no two individuals react alike and behave alike under the abnormal conditions which we know as disease.”

Profession

Osler replaced William Pepper as Professor of Medicine at the University of Pennsylvania. As a consequence of his childhood curiosity about what could not be seen but was present in pond water, Osler brought the first microscope into clinical practice at the school. Armed with his microscopic studies of blood, his bedside observations, and the autopsy room insights into pathological changes, Osler pioneered an emphasis on science providing methods that lead medicine to knowledge

Osler’s medicine

Medical education is “a preparation” “to recognize that the truth is hard to attain, that mistakes must be acknowledged, regretted, and above all learned from". Science and humanism cannot avoid mishaps rooted in errors; “Take as little as possible on trust.” The risks of being wrong cannot be separated from acquisitions and applications of knowledge. “Start out with the conviction that absolute truth is hard to reach in matters relating to our fellow creatures, healthy or diseased, that slips in observation are inevitable even with the best-trained faculties, that errors in judgement must occur in the practice of an art which consists largely in balancing probabilities.” “The best doctor, like the successful general, is the one who makes the fewest mistakes”. The avoidance and correction of mistakes are a primary task in Osler’s medicine.

Osler flavour

• 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 filarial- 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 rule: States that a neurological defect has to be related to a specific lesion, in contrast to Hickam's dictum, which states that the neurological defect can be due to several lesions.

• 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.

Double meaning