Tag Archives: Sir William Osler

Sir William Osler on Military Medicine – Part The Final (3)

In two previous posts (here, and here), I discussed medicine’s beloved William Osler’s thought on military medicine in his early and middle years. In these times – up to about 1905, when he moved to Oxford to become the Regius Professor of Medicine – his concern was largely about individual workers and their work to discover and characterize diseases found throughout the world. Only lately (after 1900) had he come to write about the role of armies in their “public health” function of carrying out successful mass immunization programs against smallpox and, later, typhoid.

In 1914 speech to soldiers and officers (1), Osler – ever the internist’s internist – still keyed his thoughts to disease and its prevention. He said:

What I wish to urge is a true knowledge of your foes, not simply of the bullets, but of the much more important enemy, the bacilli.
In the wars of the world they have been as Saul and David—the one slaying thousands, the other tens of thousands. I can never see a group of recruits marching to the depot without mentally asking what percentage of these fine fellows will die legitimate and honourable deaths from wounds, what percentage will perish miserably from neglect of ordinary sanitary precautions ?

But, four months into the war, he noticed something which was to him remarkable. In a letter to the U S medical community published in the Journal of the American Medical Association (2) he wrote, “The outstanding medical feature of the campaign in France and Belgium is that wounded, not sick, are sent from the front. So far, disease has played a very small part and the troops have had wonderful health, in spite of exposure in the trenches.” In the same letter, he actually took notice of combat injuries, commenting that wounds from artillery weapons (shrapnel) were more dangerous than bullet wounds because the shrapnel was usually contaminated with mud and dirt. And the dirt and mud of this fertile region were heavily populated with bacterial pathogens. As Osler put it, “The surgeons are back in the pre-Listerian days and have wards filled with septic wounds.”

1915 appears to be the last time Osler spoke about war medicine, in a speech “Science and War”, given early in October. Here he acknowledged that science had, in the early 20th century, made the waging of war “more terrible, more devastating, more brutal in its butchery”. But Sir William Osler, non-surgeon, Professor of Medicine and honorary Colonel in the Oxfordshire Regiment, saw – perhaps only dimly – the future of combat medicine, also a product of science: “[an] enormous number spared the misery of sickness, the unspeakable tortures saved by anesthesia, the more prompt care of the wounded, the better surgical technique…”. Add effective shock management, antibiotics and modern imaging, and we have the picture of modern combat casualty care as practiced nearly 100 years later.

William Osler survived the war, but died at age 70 of pneumonia, in 1919. It is said that he never recovered from the loss of his only son, Edward Revere, an artilleryman  who succumbed to shrapnel wounds sustained at Ypres in August 1917.

(1) Osler, William, “Bacilli and Bullets” , Oxford Pamphlets, Oxford Press, 1914. Accessed online at http://ia600307.us.archive.org/5/items/bacillibulletsby00osle/bacillibulletsby00osle.pdf, 02 November 2012.
 
(2) Osler, William, “Medical Notes on England at War”, correspondence, in JAMA, vol LXIII [63], No 26, December 26, 1914, p 2303 ff
 
(3) Quoted in Cushing, Harvey, “The Life of Sir William Osler”, Vol 2, pp 492 – 495, Oxford, Clarendon Press, 1925.
 
©2012 Thomas L Snyder
 
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William Osler on Military Medicine

William Osler, MD

William Osler – later, Sir William Osler – is seen by many in the profession as the father of modern medicine. Born (1849) and educated in Canada (University of Toronto and McGill), he matured at McGill (1874 – 1885) and the University of Pennsylvania (1885 – 1889), and reached the apogee of his career as one – along with William Henry Welch (pathology), William Halstead (surgery) and Howard Kelly (Gynecology) –  of the “Founding Four” professors of the Johns Hopkins Medical School (1889 –  1905). In his maturity, Osler, still a Canadian citizen, was invited to become the Regius Professor of Medicine at Oxford (1905 – ), a post he held until his death in 1919. Osler introduced bedside teaching at Johns Hopkins, an innovation at that time. He was accused of being a therapeutic nihilist, when in reality he simply did not use treatments that had no backing in science or in experience. His textbook of medicine, first published in 1892, was very influential; with updates, it continued in publication until 2001. Osler’s humanitarian and scientific ideals are held in very high regard within western medicine to this day. There are Osler Societies throughout the English-speaking world, and in Japan.

I first “met” William Osler while I was researching the history of my (Albany) medical school’s World War I  (Army) Base Hospital No 33. Albany Med stood this unit up after the onset of hostilities in Europe, as did many US medical schools and hospitals, under provisions of the National Defense Act of June 3, 1916. When the outfit set up shop in Portsmouth England in 1918, William Osler, then an honorary Colonel in the Oxfordshire Militia and consultant to many Canadian Army hospitals in England, was on hand at the hospital’s commissioning and personally raised the American flag over the facility.

By this time, with England embroiled in that devastating war, and Osler’s  thought was inevitably dominated by military medicine. But this was not always the case. In fact, according to Osler’s biographer the great physician Harvey Cushing, Osler “hated war”. (1) Certainly the lack of writings on military medicine in his early professional years bespeaks at least of disinterest in the matter.

However, during his years at Penn, he developed friendships with several Army medical leaders, among them the eminent bacteriologist and epidemiologist George M Sternberg. When he became Army Surgeon General, Sternberg established the Army Medical School, and it was he who induced Osler to speak to the first graduating class of the school on “The Army Surgeon”. (2)

In his talk to the five members of the Class of 1894, Osler offered the thought that the isolation experienced by Army Surgeons stationed in remote forts could lead, in a man of independent nature, to a healthy self-reliance, and he named such medical luminaries as Jenner and Koch as men who did their pioneering medical research in isolated settings.  Addressing a strength of military organization, he noted the remarkable success that several armies had enjoyed in public health efforts to prevent diseases like smallpox (through systematic revaccination) and typhoid fever through careful attention to field sanitation.  He closed by emphasizing that these new graduates would have great opportunities to advance medical knowledge; all they had to do was to seize them. This was all pretty academic stuff, and Osler made no mention whatever of the matter of combat casualty care.

Two years later, in a talk  “On the Study of the Fevers of the South”, given at the AMA in Atlanta, Osler pondered war and pestilence. He gave the nod to pestilence:

Humanity has but three great enemies: fever, famine and war; of theses by far the greatest, by far the most terrible, is fever. Gad, the seer of David, estimated aright the relative intensity of these afflictions when he made three days’ pestilence the equivalent of three month’s flight before the enemy, and of three (or seven) years of famine. As far back as history will carry us, in ancient Greece, in ancient Rome, throughout the Middle Ages, down to our own day, the noisome pestilence, in whatsoever form it assumed, has been dreaded justly as the greatest of evils.

 Osler did appreciate recent advances in medicine to reduce the impact of “fever” – cinchona for treatment of (malarial) fever,  vaccination for prevention of diseases, and asepsis in surgery – he celebrated only the work of civilian medical workers in these successes.(3)

Despite the good news in medicine that Osler highlighted at the AMA, he did not report, and may have been unaware that a shift in the cause of soldier deaths was already under way. Nevertheless, the American Civil War bore out his conviction about the impact of pestilence – nearly twice as many men had died of non-combat causes, “pestilence” mostly, than had died of their wounds in that most horrific of armed conflicts. Just five years later, however, in the Franco-Prussian War, the numbers were reversed: about 28,000 Germans died of their wounds while around 12,000 succumbed to infectious diseases. (4) The data for French soldier deaths are more evenly distributed, but the trend was established: as scientific principles of disease prevention became applied, the impact of pestilence upon mortality in armies fairly rapidly declined. We do not know if Osler was aware of this change at the time.

It was only when he moved to England to take up the Regius Professorship of Medicine at Oxford, that military medicine began to enter the great physician’s thinking anew.

Next Post: The Evolving Thought on Military Medicine of Osler as Regius Professor of Medicine at Oxford

(1) Cushing, Harvey, The Life of Sir William Osler, Vol 1 (of 2), Oxford, Clarendon Press, 1925, p 631. Cushing wrote this in his commentary about Osler’s life in Baltimore, during his Johns Hopkins years. Cushing’s magisterial biography is available in many editions, including a one-volume book, published in 1940 and 1946. It is also available in a print-on-demand paperback edition, all from http://www.abebooks.com.

(2) Published in a collection entitled Aequanimitas with other Addresses to Medical Students, Nurses and Practitioners of Medicine. H.K.Lewis, London, 1904. The speech is available on-line at http://mcgovern.library.tmc.edu/data/www/html/people/osler/PA1/P25000.htm

(3) Osler, William, The Study of the Fevers of the South, JAMA, Vol XXVI, No. 21, May 23, 1894, pp 999-1004.

(4) The online source Statistics of Wars, Oppressions and Atrocities of the Nineteenth Century (the 1800s), http://necrometrics.com/wars19c.htm, accessed 14 October 2012, cites several authors with general agreement among them.

©2012 Thomas L Snyder