Monday, October 13, 2014

I RECENTLY spent some time in the Curragh Ward of Naas General Hospital suffering from pneumonia. As I improved, I began to look at the professionalism and work ethic of the medical staff, their competency with various machines, drips, injections, the dirty work of cleaning, washing and feeding sick patients incapable of doing so themselves. And it was all done with a smile, a chat and not a word of anger.

How they attended to every patient’s needs had to be seen to be believed, but this they did, and do every day. If you ever happen to be admitted to hospital, please try to understand that a nurse is not a personal assistant. Be patient and remember that you are not the only one who is sick. Each bed is occupied by someone like you, and one nurse can only look after one patient’s needs at a time. But, no doubt, you will get your share of attention. I just cannot thank them enough for their input to my recovery.

Watching the running of this ward, the thought ran through my mind that somewhere, someone, somehow had developed the system of treatment and care I witnessed and received. How did medical care, procedures and treatments become so effective that most of us are now living longer? We can go back in time to various physicians, who practiced and researched in specialised areas. Their contributions are, of course, invaluable. Many killer diseases are now either defunct or under control because of the dedication of members of the medical profession to find the ultimate treatment. We must also remember that many new bugs are arriving on a regular basis and the battle is ongoing to keep them under control.

As I trawled through the history of modern medicine, I found many heroes. But I am going to concentrate on a Canadian physician named William Osler as the focus of this story, as it seems that wherever I looked, practically all avenues lead back to him. He is widely known and respected as the father of modern medicine and is the physician who took medicinal care to the bedside, the one who took medical students from the lecture halls to clinical bedside training.

He was born in Bond Head, Canada West (now Ontario) on 12 July 1849. William Osler’s (he was given this name in honour of William of Orange) extended family is an interesting mixture. Looking back at the family tree, we see his great-grandfather Edward was either a merchant seaman or, more likely, a pirate, while an uncle of the same name was a navy medical officer who wrote poetry while at sea, his major work being The Voyage.

William’s father, Featherstone, was a naval officer who, at one stage, served on Nelsons flagship HMS Victory. Following an eventful navy career, Featherstone resigned and took up religion. In 1837, with his wife Ellen Free Picton, he emigrated as a Methodist minister to Canada, where he became “a saddlebag minister or preacher” (this term was bestowed on a minister who looked after two or more Methodist churches).

He was educated at Trinity College School (TCS), a co-ed boarding day-school in Weston, just north-east of Toronto (now part of Toronto University), which he entered in the autumn of 1867.

During this period he met and came under the influence of James Bovell, a renowned Canadian physician, miicroscopist and educator, among many other qualifications. Another influence was Rev William Arthur Johnston, who was also interested in medicine, being a miicroscopist and biologist. Both men had a direct bearing on Osler, whose thoughts turned more and more to a medical career.

In 1868, Osler enrolled in the Toronto School of Medicine, a private institution that is now part of the medical faculty of Toronto University. There, he was introduced to the writings of Sir Thomas Brown, whose 17th century works had a big influence on latter-day physicians.

Meanwhile, Osler would leave Toronto, having been accepted to the highly-coveted MCDM (doctor of medicine) at the McGill Faculty of Medicine in Montreal, which was established in 1823. And it was there that he received his medical degree (MDCM) in 1872. The complex had three teaching facilities – the school of communications, sciences and disorders, the school of nursing, and the school of physical and occupational therapy.

Osler travelled to Europe to complete his post-grad training, returning to McGill as a professor in 1874. Also, that year, he became chair of clinical medicine at the University of Pennsylvania in Philadelphia. A year later, he was one of the seven founder members of the Association of American Physicians. This society was dedicated to the advancement of scientific and practical medicine.

In 1889, William Osler continued his upward curve by being offered and taking the position of physician-in-chief and one of the first four professors of medicine at the newly-founded Johns Hopkins Hospital in Baltimore, Maryland. This hospital would be, and still is, regarded as the finest in North America. The finance for the construction and equipping of the hospital had been bequeathed  by Johns (his mother’s maiden name and how he acquired his Christian name) Hopkins who, in his lifetime, was one of the most charitable benefactors to the progression of medicine this world has seen, or is likely to see again. His legacy would allow Osler create the university bearing his name: the Johns Hopkins School of Nursing, the Johns Hopkins School of Medicine, and Johns Hopkins Bloomberg School of Public Health. When he died on Christmas Eve 1873 aged 78 he was worth $10 million dollars, most of which was ploughed into medicine.

On his appointment, Osler quickly showed his prowess as a clinician and teacher and his humanitarian approach to all in his presence. He also had the reputation of being a great practical joker and he used this trait to keep his peers and students in good humour. He was not averse to playing the odd prank on patients either, and would use this ability to raise the spirits of those who were feeling down. He became well-liked by staff and patients for his work, dedication and friendliness to all who knew him, but he was regarded first and foremost as a great physician.

Johns Hopkins Hospital opened in 1889 with 220 beds caring for 788 patients over 15,000 days of treatment. By the time Osler left his post to move to Oxford 16 years later, it was treating 4,200 patients over 110,000 days of treatment. Today, the Johns Hopkins Hospital provides 1,059 beds.

This teaching and biomedical hospital would be where Osler would change the face of modern medicine, and the traditions introduced there are now part and parcel of modern hospital practices all over the world. The practice of doing the rounds was introduced for the first time. So, too, was the introduction of house staff. The other founding professors were William Henry Welch, William Stewart Halstead and Howard Kelly. A famous 1905 painting of Osler and the above-mentioned physicians by John Singer Sargent hangs in the William H Welch Library in Hopkins Hospital.

The hospital pioneered and performed many procedures. Neurosurgery was introduced by Harvey Cushing. He born on 18 April 1869 in Cleveland, Ohio, and no more than Osler being regarded as the father of modern medicine, Cushing is looked upon in the same way as the father of modern neurosurgery. He was the first person to describe Cushing’s Syndrome, cardiac surgery by Alfred Blalock, while paediatrics and child psychiatry was established by Leo Kanner, whose work on autism is renowned. These were dedicated physicians led by Osler, who progressed medicine to new heights at Johns Hopkins Hospital faster than any other institution of that era. William Osler’s decision to pioneer bedside training brought forward the pace of learning and brought third- and fourth-year students to work with patients in the ward, taking histories, performing physicals and doing lab tests. He stated: “I require no other epitaph other than I taught students on the wards, as I regard this as by far the most important and useful work I have been called upon to do.”

Osler was a great author and collector of books and other material relevant to the history of medicine, and he changed the method of teaching the subject forever. Others who admired his work, such as Dutch physician PK Pel, translated it into other European languages, from where it reached medical schools across the world.

In 1905, Osler was appointed to the reigius chair of medicine at Oxford University, one of five regius professors founded by Henry VIII up to 1546. The others specialised in divinity, civil law, Greek and Hebrew.

The original title was regius professor of physic but became medicine in the 20th century. Osler was also appointed a fellow of Christ Church Cathedral on his appointment. In 1911, he initiated the first postgraduate medical, while also becoming its first president.

William Osler was appointed a baronet in the coronation honours list of 1911 for his contributions to the field of medicine.

Osler insisted that seeing and talking to patients ensured that student doctors became more complete physicians. His creation of the medical residency programme also improved and focussed the mind of the student. The residency programme spread throughout the English-speaking world and is still used in most teaching hospitals today.

While at Hopkins, he organised a sleep-in residency system, whereby staff slept in the administrative building. The tenure was open-ended and could last as long as seven or eight years, where the doctor would lead a restricted lifestyle.

Osler’s comment on this structure was that “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. Clinical clerkship was something he was very proud to have introduced. This saw third- and fourth-year students work on the wards. He was the first to teach at the bedside, making rounds with a handful of students, demonstrating as one of the students expressed his methods.

William Osler died in Oxford on 29 December 1919 aged 70

Comments are closed.

Contact Newsdesk: +353 59 9170100

More Times Past

Ireland home and away in WWI (part 4)

Ireland home and away in WWI (part 3)