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| Sir William Henry Osler |
Due to the significance and respect for his character, the ideas he wrote about were seriously considered by the medical community, including what he wrote about asthma
The dawn of modern medicine:
Willie Osler was born in Canada on July 12, 1849. This was an era where age old habits, methods and ideals used by physicians were being reconsidered.
This was an era where physicians were just starting to adapt the use of the stethoscope, laryngoscope, thermometer and microscope into their daily practice.
It was from these devices that physicians were leaning that went on inside the body effected what went on outside the body. They were learning from the newly published writings of Louis Pasteur of the effects of microbes inside the human body.
Thanks to the works of Ignatz Semmelweis, who observed that the spread of microbes by not washing hands was the reason many mothers were dying at birth, physicians were becoming aware of the need to use antiseptics in surgery and to wash their hands between patients.
Surgeons, while they may have washed their hands, often wore their blood stained aprons all day long, and operated on blood stained tables. It was a challenge to change these old practices. Yet, thanks to observations by a few and thanks to science, the medical profession was slowly evolving.
Many ancient ideas about medicine were being reviewed. Hippocrates believed disease was caused by an imbalance of the four humours, and many doctors still prescribed therapies that correlated with this myth -- like bleeding.
Some doctors believed lung diseases, such as asthma, were caused when some peccant matter enters the body. An ideal sign that such a peccant matter is present is the increase of sputum. Sputum, in essence, was the bodies attempt to get rid of the peccant matter.
It was well known that physicians couldn't cure disease, yet they did have the ability to alleviate pain and dyspnea with medicines like opiates and morphine. They could help asthmatics patients by recommending asthma cigarettes and a variety of other options that may only have had palliative effects on their patients.
Quite often the gentlemanly touch of a physician's hand or the soft ring of his assuring voice was all that was needed to alleviate suffering, or to give a patient and the patient's family hope. Providing hope may have been the main job of physicians during this era. (3, pages 50-60
The growth of a legend:
Willie Osler was born to a family with a prominent history. His father was an Anglican minister, and Osler's goal was to follow in his father's footsteps, and it was this goal that landed him in 1867 at Trinity College in Toronto.
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| The Father of Modern Medicine |
Perhaps it was for this reason that Osler's heart just wasn't in the ministry. He spent most of his free time reading about medicine. His heart, and perhaps fate, lead him ultimately to switch from studying ministry to medical school where he excelled.
He started Medical School at Trinity College where the methods of teaching medicine were primitive and left to the desires of each respective professor. The college hospital admitted only 25 patients at a time, and medical students could only see patients taken care of by their own physician. (3, page 54)
Once Medical School was complete after three or four years young physicians had little experience working with real patients, and the young Olser took acceptance to this.
Much of his time was spent studying and performing autopsies. He was often so involved in his work that he ate in the same room he performed these autopsies. His goal was to learn as much as he could about the human body and medicine.
Most of the classes were taught by local physicians, and payment for these classes was given directly to the professor. Lectures were mainly given from old medical textbooks and were "flung at us pellmell without word of guidance, and leaving us standing helpless, bewildered, and starved in the midst of what seemed a superabundance of wealth," wrote Osler. (3, page 54)
He ultimately transferred to McGill University where his writings, research and ideas quickly won the attention of his fellow students and professors. He continued to study, research and perform autopsies (while eating in the same room).
During his final year in med school he worked so hard on his graduation thesis on pathologic anatomy that he was rarely seen by his fellow students His theses would ultimately win accolates "because it was greatly distinguished for originality and research." (1)
It was partly because of this work and the potential in the young Osler that he was offered a job as a teacher at McGill University. But he declined, choosing instead to attend school in Europe to further his medical wisdom. He did his studies in Vienna and Germany, which were considered to be leading nations in medicine and science at that time.
In 1874 he returned to Canada, and, coincidentally, one of the medical professors at McGill University had resigned. At the young age of only 25, and with very little experience as a physician, Osler was offered and accepted his first teaching job. Within a year he was named as a professor of medicine.
He wasn't paid enough money to make a good living as a teacher, so he had to start a practice. Yet he ultimately became so rapt in his job as a teacher that he gave little attention to his medical practice and other opportunities to make money. However, he did manage to see patients, including many famous ones.
His enthusiasm allowed him to get the most out of his students, and he became an instant hit as a teacher. A year later he became one of the seven founders of the Association of American Physicians, and in 1889 he became one of the first physicians at John Hopkins University. It was here that his career took off.
A transformation in medicine:
John Hopkins was built on the idea that it would be the best medical hospital in the world. To run its medical school Henry Osler was hired based on his reputation and his bold ideas for the medical profession.
This turned out to be a wise decision, because it was Osler who came up with the idea that medical students learn best when working with actual patients. He often repeated the maxim: "Listen to your patient, he is telling you the diagnosis."
While other medical schools were unorganized and offered two or three year programs, John Hopkins would offer a four year program that required a year as an intern working alongside physicians in the medical ward to obtain experience working with real patients. .
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| Osler writing "The Principles and Practice of Medicine" |
Through all this time Osler continued to do what he loved best, and that was to study the human body by performing autopsies and reading books. He spent a ton of time in the morgue, laboratory and library. He likewise continued to write about what he learned through his experiments and observations.
Osler would continue his work until his death in 1919, yet not before he became a legend in his own time. His name was known by physicians throughout much of the world. The debate had already begun as to whether he was the greatest physician to ever have lived.
How did The Father of Modern Medicine define asthma?
William Henry Osler is considered by many to the the Father of Modern Medicine. It was his ideals about medicine that transformed the way medicine is taught. He was well respected by physicians around the world, and his word was considered like words from the Bible.
In this way he was able to settle many debates about medicine, and push forward new ideas that were scientifically solid and old ideas that continued to have merit in the newly founded scientific world of medicine.
While he didn't have much new to add to asthma wisdom, he set the standards for future practices and research in this area. He believed the following to be true about asthma and allergies: (2):
- It's of nervous origin
- Various triggers set off an acute attack
- Attacks involve swelling of bronchial mucus membrane
- Attacks involve constriction of bronchial muscles
- Attacks involve increased secretions
- Flow is obstructed by this swelling, constriction and increased secretions
- Asthma and allergies are similar in origin and unique in their symptoms
- Asthma and allergies are hereditary
- Many asthmatics present with allergies (hay fever)
- Children are more affected than adults
- Men are affected more so than women
As with Frances Rackemann, his ideas about asthma being a nervous condition sent many researchers and scientists down the wrong path, and may ultimately have delayed progress in the field of asthma.
He wrote that "the affection sometimes runs in families, particularly those with irritable and unstable nervous systems."
Yet his understanding of the benefits of science in medicine would prove to benefit asthmatics.
He wrote that "the affection sometimes runs in families, particularly those with irritable and unstable nervous systems."
Yet his understanding of the benefits of science in medicine would prove to benefit asthmatics.
How did Dr. Osler recommend treating asthma?
However, Osler was among the first to note the urgency of treating asthma as he wrote "immediate and prompt relief is demanded." Remedies include any of the following:
- A few whiffs of chloroform will produce prompt but temporary relief
- Perles of nitrite of amyl may be broken on the handkerchief or 2-5 drops on cotton-wool and inhaled
- Strong stimulants given hot or a dose of spirits of chloroform in hot whiskey will sometimes induce relaxation
- Morphia or morphia with cocaine will produce more permanent relief (requires hypodermic injection). Good for obstinate attacks.
- Antispasmotics, such as belladonna, stramonium, and lobelia in solution or cigarettes
- Solanacae with nitrate or chlorate of potosh (common in most remedies)
- Any form of asthma cigarettes (one form benefits one pt while another benefits another)
- Nitre paper made with strong solution of potash. "Filling a room with the fumes of this paper may sometimes ward off a nocturnal attack."
- Tobacco smoke: sometimes as potent as the prepared cigarette
- Large meals early in the day as opposed to later
- Coffee is better than tea
- City is better than country
- High and dry altitudes are more beneficial than sea shore
- Oxygen may also be tried
- City living was better than country living
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| Osler believed pathology was essential to improving medical wisdom |
Many historians have noted that Osler was unique in that he mentioned that "death from the attack is unknown." However, many asthma experts during the 19th century, including Henry Hyde Salter, made similar observations.
Click here for more asthma history.
Click here for more asthma history.
References:
- "Sir William Osler At Seventy -- A Retrospect," The Journal of the American medical Association," 1919, Saturday, July 12, pages 106-108
- Osler, William, "The Principles and Practice of Medicine," 1892, New York, pages 497-501
- Bliss, Micheal, "William Osler: A Life in Medicine," 1999, New York
Further readings:
- Jackson, Mark, "Asthma: The Biography," 2009, New York, pages 211-12
- Brenner, Barry E, ed., "Emergency Asthma," 1998, New York, pages 212-14
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