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2.
J Med Biogr ; 27(4): 229-241, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31488011

RESUMO

It has been suggested that beneath the sunny personality and enormous productivity of Sir William Osler (1849-1919) lurked a deep sorrow. A longstanding rumor suggests this sorrow was a prolonged affair with an older first cousin, Marian Osler (Bath) Francis (1841-1915), which resulted in Osler's paternity of William Willoughby Francis (1878-1959). Osler treated W.W. Francis like a son. Francis after Osler's death devoted the rest of his life to preserving Osler's memory. Osler's great-great niece Anne Wilkinson (1910-1961) strongly endorses this rumor; Osler scholar George T. Harrell (1908-1999) strongly suggests its truth, while Osler biographer Michael Bliss (1941-2017) dismisses it. Evidence supporting the rumor includes ample opportunities for mating, biographical details, and phenotypic resemblances that are hard to explain otherwise. Barring a DNA-based family study, the truth will probably never be known.

3.
Proc (Bayl Univ Med Cent) ; 32(3): 372-376, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31384189

RESUMO

Bloodletting has been called William Osler's "blind spot," especially with respect to pneumonia. Also puzzling has been his endorsement of bleeding in selected cases of heatstroke. Recent clinical observations on pneumonia and, to a lesser extent, heatstroke lend support to Osler's rationale for bloodletting in these conditions. A 21st-century rationale now exists for all eight indications for systemic bloodletting listed by Osler in the first edition of his textbook, The Principles and Practice of Medicine (1892): treatment of acute heart failure (seven of the eight indications) or rapid lowering of blood pressure (in subarachnoid hemorrhage accompanied by severe hypertension). These observations support the narrative that during Osler's lifetime, bloodletting became more "rational" largely on the basis of cumulative clinical experience.

4.
J Med Biogr ; 27(4): 186-188, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31167588
5.
J Med Biogr ; 27(4): 197-204, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30334668

RESUMO

On 16 May 1919, Sir William Osler (1849-1919) gave what would be his last public address, 'The Old Humanities and the New Science,' to the Classical Association of which he was president. British educators were locked in a struggle between classics teachers, who wished to preserve their dominance in public schools and universities, and science teachers, who wanted more time in the curriculum. Osler had supported the science teachers' position three years earlier in his presidential address to the Association of Public School Science Masters. What could he now say to the classicists without making enemies? He gently chided both groups, but he was less concerned that day with the curricular dispute than with the question whether 'Science … can rule without invoking ruin.' He averred that 'there must be a very different civilization or there will be no civilization at all.' He invoked the Hippocratic ideal of 'philanthropia and philotechnia' (love of humanity and love of science of technology) not just for medicine, but for all of humankind.

6.
Inquiry ; 55: 46958018763917, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29591539

RESUMO

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus post-mean annual visit rates and discharge emergency severity index (ESI; triage and resource use-based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) and occasional users. Annual adult ED visit volumes were 16 372 preintervention (47.5% by high-users), versus 18 496 postintervention. High-users' mean annual visit rates were 5.43 (top quartile) and 0.94 (bottom quartile) preintervention, versus 3.21 and 1.11, respectively, for returning high-users, postintervention (all P < .001). Postintervention, the visit rates of new high-users were lower (lowest and top quartile rates, 0.6 and 3.23) than preintervention high-users' rates in the preintervention period. Visit rates of the top quartile of occasional users also declined. Subgroup analysis of medically uninsured high-users showed similar results. Upon classifying preintervention high-users by emergency severity, postintervention mean ESI increased 24.5% among the lowest ESI quartile, and decreased 12.2% among the top quartile. Pre- and post-intervention sample demographics and comorbidities were similar. The observed reductions in overall ED visit rates, particularly low-severity visits; highest reductions observed among high-users and the top quartile of occasional users; and the pattern of changes in emergency severity support a positive impact of the primary care intervention.


Assuntos
Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Serviço Hospitalar de Emergência/economia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Estudos Longitudinais , Masculino , Pessoas sem Cobertura de Seguro de Saúde , Pessoa de Meia-Idade , Pobreza , Atenção Primária à Saúde/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Estados Unidos , Adulto Jovem
7.
Proc (Bayl Univ Med Cent) ; 31(4): 550-553, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30949010

RESUMO

William Osler's parting address to faculty at the Johns Hopkins University, given on February 22, 1905, and published as "The Fixed Period," clouded his departure from North America after reporters sensationalized a playful suggestion that aging professors be chloroformed. A newly available collection of newspaper clippings affords a semiquantitative analysis of the press reaction. Only 40% of the writers openly criticized Osler. Some (about 15%) defended him; many (33%) merely attempted humor; and a few (about 6%) wrote poetry. Often overlooked are the main points of Osler's address: awareness of one's place in the adult life cycle and the need for self-renewal with advancing age.

8.
Proc (Bayl Univ Med Cent) ; 30(1): 101-105, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28127152

RESUMO

William Osler was considered a universal friend by physicians of his era but, as with most people, his intimate friends were few. Henry Barton Jacobs became a close friend as one of the "latchkeyers" who lived next door to the Oslers in Baltimore, and the friendship intensified after Jacobs married Mary Sloan Frick Garrett, the fabulously wealthy widow of a former patient. The couples stayed close after the Oslers moved to Oxford, vacationing together and corresponding frequently. The couple friendship between the Oslers and the Jacobses benefited American medicine in specific ways, including the care of patients with tuberculosis and the care of children.

9.
Proc (Bayl Univ Med Cent) ; 29(3): 337-41, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27365894

RESUMO

Critics consider the 1908-1909 portrait of William Osler by S. Seymour Thomas the best of six oil-on-canvas portraits of Osler done from life, including those by the more acclaimed US artists John Singer Sargent and William Merritt Chase. Osler called it "the best pictorial diagnosis I have ever seen" and told Thomas "I am at your service." A reappraisal of Seymour Thomas explains why his portrait makes us feel much as the artist did in Osler's presence, which is the original English-language definition of "empathy." Thomas told his subject that "I feel that you can look clear through me and see the wall on the other side." The intensity of Osler's gaze affects us similarly. The portrait satisfied Osler, but his wife, Grace Revere Osler, never warmed to it, perhaps because it depicts so clearly a highly focused, agenda-driven man. Helen Thomas used the portrait to promote her husband's business, and, after a tortuous history, the portrait eventually returned to Oxford University, where it now hangs inconspicuously in the Radcliffe Science Library.

10.
Trans Am Clin Climatol Assoc ; 126: 20-45, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26330657

RESUMO

The conquest of pellagra is commonly associated with one name: Joseph Goldberger of the US Public Health Service, who in 1914 went south, concluded within 4 months that the cause was inadequate diet, spent the rest of his life researching the disease, and--before his death from cancer in 1929--found that brewer's yeast could prevent and treat it at nominal cost. It does Goldberger no discredit to emphasize that between 1907 and 1914 a patchwork coalition of asylum superintendents, practicing physicians, local health officials, and others established for the first time an English-language competence in pellagra, sifted through competing hypotheses, and narrowed the choices down to two: an insect-borne infection hypothesis, championed by the flamboyant European Louis Westerna Sambon, and the new "vitamine hypothesis," proffered by Casimir Funk in early 1912 and articulated later that year by two members of the American Clinical and Climatological Association, Fleming Mant Sandwith and Rupert Blue. Those who resisted Goldberger's inconvenient truth that the root cause was southern poverty drew their arguments largely from the Thompson-McFadden Pellagra Commission, which traces back to Sambon's unfortunate influence on American researchers. Thousands died as a result.


Assuntos
Suplementos Nutricionais/história , Pelagra/história , Saccharomyces cerevisiae , United States Public Health Service/história , Vitaminas/história , Suplementos Nutricionais/economia , Custos de Cuidados de Saúde , História do Século XX , Humanos , Estado Nutricional , Pelagra/diagnóstico , Pelagra/mortalidade , Pelagra/prevenção & controle , Pelagra/terapia , Pobreza/história , Fatores de Risco , Resultado do Tratamento , Estados Unidos/epidemiologia , United States Public Health Service/economia , Vitaminas/economia , Vitaminas/uso terapêutico
12.
J Med Biogr ; 23(4): 196-204, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-24585614

RESUMO

John Armstrong, the first honours graduate of the University of Edinburgh School of Medicine, was famous in his day for a lengthy didactic poem entitled The Art of Preserving Health (1744). He is now obscure except to scholars specializing in the 18th century and, when discussed at all, often dismissed as a failed physician who wrote mediocre poetry in a quest for money and fame. A new exegesis by Adam Budd exhumes Armstrong as an original voice who offered timely and reassuring advice to Britons as they braced for another epidemic of plague; who depicted illness through the lens of a vulnerable and sympathetic physician, and who was perhaps above all else a leveller of medical knowledge. Elaborating on Budd's thesis, it would seem that Armstrong, a complicated man, has frequently been misread and was in some ways ahead of his time.


Assuntos
História do Século XVIII , Médicos/história , Poesia como Assunto/história , Humanos , Literatura Moderna/história , Escócia
14.
Trans Am Clin Climatol Assoc ; 125: 313-29; discussion 330, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25125748

RESUMO

During the natural history movement of the 18th and early 19th centuries, Charleston as a center was rivaled in the United States only by Philadelphia, New York, and Boston. Prominent physician-naturalists included Alexander Garden (for whom the gardenia is named), John Edwards Holbrook ("father of American herpetology"), and Francis Peyre Porcher (whose Resources of Southern Fields and Forests helped Confederates compensate for drug shortages). The Charleston physician-naturalists belonged to an "aristocracy of talent" as distinguished from the "aristocracy of wealth" of lowcountry planters, who probably did more than any other group to perpetuate slavery and propel the South toward a disastrous civil war. None of the physician-naturalists actively opposed slavery or secession, a reminder that we are all prisoners of the prevailing paradigms and prejudices of our times.


Assuntos
Guerra Civil Norte-Americana , Escravização/história , História Natural/história , Médicos/história , Educação Médica/história , História do Século XIX , Humanos , História Natural/educação , South Carolina
15.
Tex Heart Inst J ; 40(2): 125-39, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23678210

RESUMO

The consequences of deep wound infections before, during, and after coronary artery bypass grafting have prompted research to clarify risk factors and explore preventive measures to keep infection rates at an irreducible minimum. An analysis of 42 studies in which investigators used multivariate logistic regression analysis revealed that diabetes mellitus and obesity are by far the chief preoperative risk factors. A 4-point preoperative scoring system based on a patient's body mass index and the presence or absence of diabetes is one practical way to determine the risk of mediastinitis, and other risk-estimate methods are being refined. Intraoperative risk factors include prolonged perfusion time, the use of one or more internal mammary arteries as grafts, blood transfusion, and mechanical circulatory assistance. The chief postoperative risk factor is reoperation, usually for bleeding. Unresolved issues include the optimal approach to Staphylococcus aureus nasal colonization and the choice of a prophylactic antibiotic regimen. We recommend that cardiac surgery programs supplement their audit processes and ongoing vigilance for infections with periodic, multidisciplinary reviews of best-practice standards for preoperative, intraoperative, and postoperative patient care.


Assuntos
Ponte de Artéria Coronária/efeitos adversos , Controle de Infecções , Mediastinite/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia , Ponte de Artéria Coronária/normas , Fidelidade a Diretrizes , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Modelos Logísticos , Mediastinite/diagnóstico , Mediastinite/microbiologia , Análise Multivariada , Guias de Prática Clínica como Assunto , Padrões de Prática Médica , Qualidade da Assistência à Saúde , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento
16.
J S C Med Assoc ; 109(2): 39-42, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24902388

RESUMO

The HIV/AIDS pandemic richly illustrates the historian Charles Rosenberg's construct of epidemics as four-act plays: progressive revelation, the management of randomness, the negotiation of a public response, and subsidence and retrospection. In developed countries, we are now in Act Four. Among the numerous areas of HIV/AIDS that invite reflection, I've focused on its implications for medicine as a profession as opposed to a job or trade. The availability of effective technology determines the relative importance of competence (doing the right thing well; basic professionalism) and "compassion" (service that clearly transcends self-interest; higher professionalism). Those of us who became "AIDS doctors" during the pandemic's early years were privileged to live through what amounted to a truncated history of medicine. It was quite a ride. But most of all, I remember patients, both individually and collectively, from those early years. My proudest achievement is that none of my private patients died in a hospital. My most-cherished memento is a paperback book bequeathed to me by the widow of "Jake"-the early AIDS victim who never told his wife how he got those scars on his forearms. She'd inscribed it: "Dear Dr. Bryan, Thank you for letting me die gracefully." She and many others gave me lessons in courage and in what it means to be a doctor.


Assuntos
Fármacos Anti-HIV/história , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Infecções por HIV/história , Pandemias/história , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/história , Fármacos Anti-HIV/uso terapêutico , História do Século XX , História do Século XXI , Humanos , Estados Unidos/epidemiologia
17.
J S C Med Assoc ; 109(2): 43-4, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24902389

RESUMO

A returning traveler presenting with fever accompanied by abdominal "pressure" and pain proved to have amebic appendicitis, amebic liver abscess, and probable recent amebic dysentery--a rare combination of findings amply illustrating the value of asking "Unde venis--from where do you come?"


Assuntos
Amebíase/diagnóstico , Amebíase/terapia , Apendicite/parasitologia , Adulto , Amebicidas/uso terapêutico , Apendicectomia , Terapia Combinada , Diagnóstico Diferencial , Humanos , Laparoscopia/métodos , Masculino
18.
Acad Med ; 88(1): 97-101, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23165269

RESUMO

Many predict a takeover (seen by some as hostile, and by others as inadvertent) of professional virtues and values by government and capitalism. One source of professional virtues and values consists of lessons from the history of medicine as taught and mentored by Sir William Osler. Some medical schools have required courses in medical history, but proposing a new requirement would probably be a tough sell to most curriculum committees. Osler himself argued against compulsory courses in medical history. The authors propose that exposing medical students to the history of medicine promotes at least two of the seven types of professionalism identified by Hafferty and Castellani. Exposure to the evolution of medical science and to exemplary physicians of bygone eras promotes nostalgic professionalism, which, although in some ways suspect and naïve, fosters a sense of belonging and solidarity as members of a profession, not a trade, whereas exposure to the evolution of medicine as a public service, to the sad history of health care disparities, and to patients' perspectives promotes activist professionalism, fostering a sense of civic responsibility and opposition to excessive commercialism.Steps to promote such exposure include (1) identifying faculty, community physicians, and others interested in the history of medicine, (2) including the history of medicine in faculty development programs, (3) considering a segment in the history of medicine during the introduction to each major course, (4) sponsoring history clubs, and (5) promoting environments favorable for mentor-protégé relationships for faculty and students with further interest.


Assuntos
Educação Médica/métodos , História da Medicina , Mentores , Prática Profissional , Ensino , Currículo , Pessoas Famosas , Humanos , Faculdades de Medicina
20.
J S C Med Assoc ; 108(4): 95-7, 2012 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-23270102

RESUMO

A patient with diabetes mellitus who had recently been started on peritoneal dialysis presented with headaches, confusion, falling episodes, and multiple white matter abnormalities affecting the frontal, temporal, parietal, and occipital lobes on MRI of the brain. He developed stupor and frequent seizures despite control of hypertension with intravenous nicardipine. Diagnosis of atypical PRES and institution of successful empiric therapy was based on electronic searches (Google and MEDLINE) facilitated by verbal communication between and among the specialists involved in his care.


Assuntos
Diálise Peritoneal/efeitos adversos , Síndrome da Leucoencefalopatia Posterior/etiologia , Encéfalo/patologia , Nefropatias Diabéticas/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndrome da Leucoencefalopatia Posterior/diagnóstico , Síndrome da Leucoencefalopatia Posterior/terapia
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