Remembering Osler’s death 100 years ago

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Sir William Osler and his son Revere, in uniform, 1916, William Osler Photo Collection, CUS_064-032_P, Osler Library of the History of Medicine, McGill University

On December 29, 1919, Sir William Osler died in his home in Oxford from complications of a pleural infection.

A McGill University icon widely known as the “Father of Modern Medicine,” Osler (MDCM 1872) joined the Faculty of Medicine as a lecturer in 1874. He stayed on for 10 years, teaching physiology, pathology, and medicine, while developing his revolutionary idea that medicine should be taught at the bedside and not merely in the lecture hall. In 1884 he accepted a post at the University of Pennsylvania as Professor of Clinical Medicine and five years  and Hospital with William Henry Welch, William Stewart Halsted and Howard Atwood Kelly. In 1905, he took an appointment as Regius Professor of Medicine at Oxford University, where he remained until his death.

Many events and publications have commemorated his death and celebrated his life and achievements over the course of the past centenary year. Among them, the Osler Library Newsletter printed a special commemorative edition (PDF), and the Postgraduate Medical Journal, which Osler helped found, produced a special themed issue, which features two articles by the Osler Library of the History of Medicine’s Head Librarian Dr. Mary Hague-Yearl, as well as contributions from all over the world.

Enduring reverence, and relevance

So, why do people in the health sector still care so much about a doctor who died a century ago?

“He’s a hero that’s easy to worship,” says Dr. Richard Fraser, Professor of Pathology and Director of the Maude Abbott Medical Museum at McGill University. “His outlook towards humanity and medicine is a big part of the Faculty of Medicine culture. He seemed to embody the spirit of the wise physician.”

Adds Honorary Osler Librarian Dr. Rolando Del Maestro, who is also William Feindel Professor Emeritus in Neuro-Oncology and Director of the Neurosurgerical Simulation Research Centre at McGill University, “The mere mention of Osler’s name continues to inspire medical students and physicians with dreams of how to continue the eternal quest to improve the lives of patients.”

Dr. Fraser points out that Osler was at the vanguard of applying the science of the day to the practice of medicine, but he was equally devoted to preserving the human aspect when using science in the treatment of disease. “Not everybody does that, or has done that, particularly as the scientific part of medicine has become more prominent in the last half of the last century,” he says. Osler’s relevance is greater than ever, adds Dr. Fraser, given the increasing sentiment among health practitioners “that scientific medicine is important but the humanity of medicine is equally important when it comes to dealing with disease and illness.”

Final illness

Osler’s death at age 70 was a blow to his many friends and followers, though perhaps not a surprise. He had lost his only child, Revere, two years earlier at the Battle of Passchendaele, which naturally devastated him emotionally. On top of that, his workaholic tendencies and lifelong respiratory troubles had taken a toll on his physical health.

Thanks to Osler’s meticulous note taking and that of his physician, A. G. Gibson, we know a lot about his slow deterioration during the last months of 1919. Ultimately, Osler’s demise may have been the result of a respiratory system weakened by disease that began in childhood, speculates Dr. Fraser. “It is possible that he had underlying bronchiectasis for quite a while,” he says. Bronchiectasis is a condition in which the airways to the lungs are permanently damaged and inflamed, sometimes as a result of childhood pneumonia, which Osler may have had. Continues Dr. Fraser, “He may then have developed a super infection, which people with bronchiectasis are known to be prone to. The infection may then have extended to his pleural space and that’s what led to his final illness.”

Victim of the Spanish flu?

Osler is regularly listed as one of the 50 million victims of the Spanish flu pandemic of 1918-1919. However, Osler’s final illness began in September of 1919, by which time the pandemic had more or less died down. Osler and Gibson were quite sure flu was involved, citing it several times in their notes as the underlying cause of Osler’s lung infection, though they don’t connect it to the pandemic. Osler wrote ominously: “There is never but one ending to these protracted influenza cases in old age.”[1]

Results from a sputum culture in his medical records indicate the presence of Haemophilus influenzae in November 1919, a month before his death. At the time, it was believed that this recently-identified bacterium (known at the time as Pfeiffer influenza bacillae, for the German physician Richard Pfeiffer who isolated it in 1892, and referenced by Gibson in Osler’s chart simply as “Pfeiffer”) was responsible for influenza. It was only in the 1930s that it was established that influenza is in fact viral. H. influenzae, on the other hand, is commonly implicated in cases of pneumonia. A Spanish flu connection isn’t entirely ruled out: either of two earlier illnesses, one in late 1918 and one in July of 1919, may have been part of the pandemic and indirectly related to Osler’s decline.

Osler’s end

By December 1919, Osler’s pleurisy had progressed to frank empyema, a dangerous collection of pus in the pleural space. Empyema was frequently fatal in the pre-antibiotic era and still is sometimes, particularly in developing countries. “Empyema is still something that we see, although it’s probably not as common as it used to be. But it can be a very serious disease,” explains Dr. Fraser. “In Montreal today, it would be treated with antibiotics and perhaps surgery.”

Osler and Gibson had little choice but to try surgery to try to drain the pleural pus. “They knew enough clinical medicine, and he knew too, that he had a very serious illness and that it was likely to kill him, so they had to try something,” says Dr. Fraser. “I suspect they didn’t have too much hope. Osler knew, from having seen other patients, that his prognosis was not good.” Osler died a few days later from post-operative haemorrhaging.

Many years before his death, in 1911, Osler had formally decided to bequeath his extensive collection of rare medical and scientific books, along with a sum of money to maintain them, to McGill University to create what would become, in 1929, the Osler Library of the History of Medicine. On December 9, 1919, a few weeks before his death, he signed a new will reiterating the gift. His attending physicians, Gibson and Archie Malloch, signed as witnesses.

“The Osler library is one of the world’s great libraries and carries on the Osler tradition of excellence,” says Dr. Del Maestro. “Each student visiting the library, surrounded by Dr. Osler’s books and in the presence of his ashes, feels in tune with the rhythm and poetry of medicine and the slow but progressive advancement to eradicate disease and make the world a better place.”

[1] Quoted in Barondess, Jeremiah A. M.D., A case of empyema: notes on the last illness of Sir William Osler, Trans Am Clin Climatol Assoc 1975;86:59–72 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2441350/pdf/tacca00107-0110.pdf

 

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January 9, 2020

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