Saturday, September 07, 2019

Selections from the biography of Sir William Ostler, father of modern medicine

William Ostler, A Life in Medicine

Sir William Ostler was, some say, the greatest doctor ever. He was one of the three or four founders of modern medicine. I read his biography because he used to live near us, in Dundas, ON. Here are some of the best parts.

William Ostler, A Life in Medicine, University of Toronto Press, Toronto, 1999

Here are the three essays I wrote about this biography when I read it in 2006.

Saturday, July 29, 2006
Metademocracy; This is Not a Cause
John Taylor; 2006 July 29

 re Ostler's father:
"I am reading a fat biography of William Ostler right now, by most accounts the greatest physician in history. It is so long a book that I have not even got to his life yet, just his father's, who had an interesting life too. As an Anglican clergyman, it is startling to read how the elder Ostler also promoted massive memorization of scripture among the backwoodsmen of Canada's frontier in the 1840's and 50's -- amusingly, the place now swallowed by Toronto's sprawl, Newmarket, south of Barrie. Ostler had plowmen turning away from driving their teams and spinsters from their spinning to study selected passages from the Bible for memorization. Ostler handed out large numbers of scriptural knowledge prizes at the Church's annual picnic. His own saintly character rubbed off on his son -- curing people seems to be as much a spiritual as a scientific talent. Though not trained as a doctor he saved enough lives by observation and common sense that it became the practice among his parishioners to come to him before following doctor's orders."

Sunday, August 13, 2006
Ostler, Skulls and Autopsy
John Taylor; 2006 August 13

Tuesday, September 26, 2006
Superbrain; Curing and Teaching Around the Round Table
John Taylor; 2006 September 26

Selections from the biography

"Edith Gittings Reid, a writer, observed Ostler closely when Harry was sick with typhoid, when their children were ill, and during her own sicknesses."

"To have been a patient of Sir William Ostler's was to have obtained an almost impossible idea of what a physician could be.. It was not necessary for him to be sensitive to a social atmosphere, because he always made his own atmosphere. In a room full of discordant elements he entered and saw only his patient and only his patient's greatest need, and instantly the atmosphere was charged with kindly vitality, everyone felt that the situation under control, and all were attention. No circumlocution, no meandering. The moment Sir William gave you was yours. It was hardly ever more than a moment but there was curiously no abrupt beginning or end to it. With the easy sweep of a great artist's line, beginning in your necessity and ending in your necessity, the precious moment was yours, becoming wholly and entirely a part of the fabric of your life.

With his patients he recognized at once the thing or characteristic that concerned him and them; and for the rest, whatever was uncongenial or unattractive he put from his mind and prevented any expression of it. A pose or an attempt at serious chatter about unessentials was intolerable to him. But he was as merciful as he was masterful, and from the very poor and the genuinely afflicted he would even have borne being bored.

Such telling love, such perfect confidence were given him that he could do what he liked without causing offence. Three times in my life I have seen him, when in consultation, smash the attending physician's diagnosis and turn the entire sick room the other way about; but he left the room with his arm about the corrected physician's neck, and they seemed to be having a delightful time. The reason for this was perfectly evident: every physician felt himself safe in Sir William's hands; he knew that he could by no possibility have a better friend in the profession; that if, with the tip of his finger, Sir William gaily knocked down his house of cards, he would see to it that the foundation was left solid." (William Ostler, A Life in Medicine, pp. 263-264)

"A moderate health reformer in those years, Ostler today would have eschewed the extremes of modern food and exercise faddism, though he surely would have stopped smoking. He would certainly have endorsed devotion to good health as an almost religious pursuit. The very origin of his profession had been in the cult of Aesculapius, the worship of health. `In the old Greek there was deeply ingrained the idea of the moral and spiritual profit of bodily health. It was too bad, Ostler wrote at the beginning of the twentieth century, that the `beauty and majesty of this old therapeutic worship had degenerated into the sordid superstitions of Lourdes and other shrines to modern faith healers." (Michael Bliss, William Ostler, A Life in Medicine, 275)

Ostler's mastery of the uses of optimism, humor, and good cheer, what he
sometimes called his 'general cheer-up prescription' or the doctor's `transfusion of the spirits', could have an extraordinarily potent effect.
(William Ostler, A Life in Medicine, p. 264)

"His presidential address dwelt on physicians' need for fellowship as a corrective to the effect of daily practice in creating 'an egoism of a most intense kind. Ten years of successful work tends to make a man touchy, dogmatic, intolerant of correction and abominably self-centred.'" (William Ostler, A Life in Medicine, p. 248)

Ostler's mastery of the uses of optimism, humor, and good cheer, what he
sometimes called his 'general cheer-up prescription' or the doctor's `transfusion of the spirits', could have an extraordinarily potent effect.
(William Ostler, A Life in Medicine, p. 264)

Bliss: To have understood the self-limiting nature of disease was a great step forward by the medical profession. If only the laity would follow that!

Ostler: A desire to take medicine is, perhaps, the great feature which distinguishes man from other animals. Why this appetite should have developed, how it could have grown to its present dimensions, what it will ultimately reach, are interesting problems in psychology. Of one thing I must complain, that when we of the profession have gradually emancipated ourselves from a routine administration of nauseous mixtures on every possible occasion, and when we are able to say, without fear of dismissal, that a little more exercise, a little less food, and a little less tobacco and alcohol, may possibly meet the indications of the case - I say it is a just cause of complaint that when we, the priests, have left off the worship of Baal, and have deserted the groves and high places, and have sworn allegiance to the true god of science, that you, the people, should wander off after all manner of idols, and delight more and more in patent medicines and delight more than ever at the hands of advertising quacks. But for a time it must be so. This is yet the childhood of the world, and a supine credulity is still the most charming characteristic of man. (Michael Bliss, William Ostler, A Life in Medicine, 189)

And Clarence B. Farrer, a former student who became one of Canada’s leading psychiatrists, wrote that `Ostlers very presence brought healing. It was immediate unplanned psychotherapy There was healing in his voice.

"He usually tried to cushion a grim outlook, a habit some thought he took to a fault in later years. 'The careful physician has but one end in view not to depress his patient in any way whatever,' he wrote while reflecting on the humor of Rabelais. He cautioned students against saying anything in the hearing of a patient that would increase anxiety. If a man's terror at knowing his chest pains were angina would itself worsen them, Ostler told him he had 'a neuralgia of the pneumo-gastric nerve.' On the other hand, he advised telling tuberculous patients the truth about their condition right away. It was 'really not often necessary, since Nature usually does it quietly in good time, to tell a patient he was past all hope, Ostler maintained, he added, 'and yet, put in the right way to an intelligent man it is not always cruel.'" (Michael Bliss, William Ostler, A Life in Medicine, 265)

In a 1910 secular sermon called Mans Redemption of Man to 2,500 listeners at University of Edinburgh Ostler says that thanks to the new socialism of science,

"The outlook for the world as represented by Mary and John and Jennie and Tom has never been so hopeful. There is no place for despondency or despair. As for the dour dyspeptics in mind and morals who sit croaking like ravens let them come into the arena, let them wrestle for their flesh and blood against the principalities and powers represented by bad air and worse houses, by drink and disease, by needless pain, and by the loss annually to the state of thousands of valuable lives let them fight for the day when a man's life shall be more precious than gold. Now, alas! The cheapness of life is every days tragedy." (Michael Bliss, William Ostler, A Life in Medicine, 393-394)

"With the introduction of light beer there is not only less intemperance, but we see much less of the serious organic disease of heart, liver and stomach caused by alcohol, and less of the early general degeneration ... How few cases, comparatively, of alcoholic cirrhosis of the liver one sees. I wish that I could say the same of intemperance in eating ... We physicians are beginning to recognize that the early degenerations, particularly of the arteries and of the kidneys, which we formerly attributed in great part to alcohol, is due to too much food. The clinkers kill, and we all, I fear, habitually have clinkers and ashes in our machines which clog the workings, rust the bearings, and lead to premature break-down ... (Ostler, quoted in, Michael Bliss, William Ostler, A Life in Medicine, 274)

If public health measures could stave off infectious disease, good personal habits were called for to avoid or minimize bouts of heart pain. In his metaphoric way, Ostler had always advised young men against worship at the shrines of Venus, Bacchus, and Vulcan. Now he varied false-gods image with advice not to overstrain the human mechanism. In the early twentieth century his favorite image of the body was as a machine. Like transatlantic steamers Ostler and his well-to-do patients so often took, doubt using the crossing to rest and reflect on their health, the body would give out if the engines were overstoked, driven too long under high pressure, negligently maintained. During actual malfunction, you worked desperately to get things going again. Otherwise, for signs of overexertion, ranging from chest pains to nervous exhaustion, the prescription was often to reduce speed. Ostler found himself telling patient after patient (for his angina consultations continued to increase) to eat less, drink less, smoke less, work less, worry less. Look after the machine. Cut back from twenty-five to fifteen knots: 'Go slowly and attend to your work, live a life, and avoid mining shares ... I doubt if quinine could have very much influence.'

Such advice shaded into general maxims for healthy living. These fitted with and reinforced Ostler's dislike of unnecessary drugging as well as his personal temperance. To the Johns Hopkins graduating class of 1900 and at the Historical Club in 1901 he preached lay sermons about how the progress of the past century had culminated in 'a new school of medicine,' based on a return to natural methods for both the treatment and the prevention of disease. Hydrotherapy and massage were important in treating disease. Diet and exercise, he argued with a touch of hyperbolic fever, were crucial in preventing it:

Some one said he cared not who made the laws, so that he could write the songs of a nation, which I would paraphrase by saying, I care not who physics the people, provided that I could train their cooks. From the kitchen must come one of the great needed reforms in medicine. The besetting malady of this country is dyspepsia ... From it about one half of the income of doctors is derived, and at least two thirds of that of the patent medicine vendors ... If the women of the country whose energies are at present engaged in the problems of temperance, the suffrage, missions and millinery, would take a year off and spend it in the kitchen something might be done ... (Michael Bliss, William Ostler, A Life in Medicine, 272-273)

"Ostler condemned the chauvinistic spirit that built barriers between parishes, provinces, countries: `Nationalism has been the great curse of humanity. In no other shape has the Demon of ignorance assumed more hideous proportions; to no other obsession do we yield ourselves more readily.' Parochialism was running riot in North America, he warned, as state and provincial licensing boards put outrageous barriers in the way of medical mobility. Parochialism led to inbred medical schools and laboratories closed to outsiders.
The antidotes to chauvinism were openness, travel, liberal culture, and a sense of international fellowship. With `widened sympathies and heightened ideals' medical men might develop `something perhaps of a Weltculture which will remain through life as the best protection against the vice of nationalism.'" (William Ostler, A Life in Medicine, p. 298)

`To us as a profession belongs the chief glory of the century. The gradual growth of a deep sense of the brotherhood of man, such an abiding sense as pervades our own profession in its relation to the suffering, which recognizes the one blood of all the nations, may perhaps do it. In some development of socialism, something that will widen patriotism beyond the bounds of nationalism, may rest the desire of the race in this matter; but the evil is rooted and grounded in the abyss of human passion, and war with all its horrors is likely long to burden the earth." (Ostler to AMA, qi: William Ostler, A Life in Medicine, p. 250)

"Another reason for his pessimism, I suspect, was his having lost any
belief in aging as a progress towards a heavenly reward after bodily death. For Ostler, age was a time of physical and mental decline towards nothingness, death as end-all. Professionally, he preached the virtues of turning away from age and the aged, an attitude that would later be crudely but accurately labeled 'ageism.' Personally, while accepting his limits and going into retirement, really a form of early retirement, he could not look forward in his own old age to many developments other than gradual decline, death, and nothingness. No wonder he never celebrated birthdays. The prophet of medical progress, the Ingersoll lecturer on science and immortality, must have realized that his and his generation's life expectancy was infinitely less than that of his parents." (William Ostler, A Life in Medicine, p. 328)

Ostler thought he saw the prospect of a new era in the triumphs of metabolic therapy. He speculated to his audience in Toronto (more presciently than he could ever have dreamed) that 'as our knowledge of the pancreatic function and carbo-hydrate metabolism becomes more accurate we shall probably be able to place the treatment of diabetes on a sure foundation. In the meantime, he warned against false and misleading therapies, whether peddled through the old-fashioned faith in polypharmacy or through the
new products and pamphlets of the pharmaceutical houses. Far too large a
section of the treatment of disease is to-day controlled by the big manufacturing pharmacists, who have enslaved us in a plausible pseudo-science, Ostler warned in 1909." (William Ostler, A Life in Medicine, p. 361)

More likely, Ostler was thinking of his own experience when he came to write about continence for his textbook in 1892: 'There are other altars than those of Venus upon which a young man may light fires hard work of body and hard work of mind. Idleness is the mother of lechery; and a young man will find that absorption in any pursuit will do much to cool passions, which, though natural and proper, cannot in the exigencies of our civilization always obtain natural and proper gratification.'
Ostler almost never gossiped about weak medical brethren, as students
or practitioners. His dislike of malicious personal gossip was pronounced. If
you began to criticize someone in his presence, he would immediately
change the subject -- not always to the liking of his less saintly wife. He had
strong dislikes, to be sure, and on at least two occasions spoke out openly
in medical meetings against second-raters being allowed to stay on in first-
rate positions. Privately he knew there were a lot of 'damned fools' in the
world and in the medical profession, but publicly the worst the world
contained was 'sons of Belial.' To talk behind a person's back seemed to Ostler both professionally and personally unethical." (William Ostler, A Life in Medicine, p. 229)

"His presidential address dwelt on physicians' need for fellowship as a corrective to the effect of daily practice in creating 'an egoism of a most intense kind. Ten years of successful work tends to make a man touchy, dogmatic, intolerant of correction and abominably self-centred.'" (William Ostler, A Life in Medicine, p. 248)

p15 Ostler on Death

Most of his lecture was a demonstration of the irrelevance of belief in life after death. In the real world, the vast majority of people are indifferent to the issue, he argued: 'Immortality, and all that it may mean, is a dead issue in the great movements of the world... A living faith in a future existence has not the slightest influence in the settlement of the grave social and national problems which confront the race to-day ... over our fathers immortality brooded like the day; we have consciously thrust it out of lives so full and busy that we have no time to make an enduring covenant with the dead.' For the most part, science had made up its mind.

The battle to put man at the center of the universe had been won; the 'mental cataclysm' of the past forty years had seen a revolution 'from the days when faith was diversified with doubt, to the present days, when doubt is diversified with faith.' Psychology had dispensed with the soul. The scientific search for the spirit had been futile. As a physician, 'whose work lies on the confines of the shadow-land,
Ostler could only contribute the observations they had made at Hopkins.
Were people terrified of the transition?

"Popular belief is erroneous. As a rule, man dies as he has lived, uninfluenced practically by the thought of a future life ...I have careful records of about five hundred death beds ... Ninety suffered bodily pain or distress of one sort or another, eleven showed mental apprehension, two positive terror, one expressed spiritual exaltation, one bitter remorse. The great majority gave no sign one way or the other; like their birth, their death was a sleep and a forgetting. The Preacher was right: in this matter man hath no preeminence over the beast, - 'as the one dieth so dieth the other.' (William Ostler, A Life in Medicine, p. 291-292)

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