Abstract
One of the most important legacies of Sir William Osler was his textbook The Principles and Practice of Medicine. A common criticism of the book when it was first published was its deficiency in the area of therapeutics. In this article, the 1st edition of The Principles and Practice of Medicine is compared with the 11th edition of Harrison's Principles of Internal Medicine. The analysis focuses on the treatment recommendations for 4 conditions that were covered in both books (diabetes mellitus, ischemic heart disease, pneumonia and typhoid fever). Osler's textbook dealt with typhoid fever and pneumonia at greater length, whereas Harrison's placed more emphasis on diabetes mellitus and ischemic heart disease. Notwithstanding Osler's reputation as a therapeutic nihilist, the 2 books devoted equivalent space to treatment (in terms of proportion of total sentences for the conditions). For all conditions except ischemic heart disease, Osler concentrated on general measures and symptomatic care. Throughout Osler's textbook numerous negative comments are made about the medicinal treatment of various conditions. A more accurate statement about Osler's therapeutic approach was that he was a "medicinal nihilist." His demand for proof of efficacy before use of a medication remains relevant.
Full Text
The Full Text of this article is available as a PDF (204.7 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Beeson P. B. One hundred years of American internal medicine. A view from the inside. Ann Intern Med. 1986 Sep;105(3):436–444. doi: 10.7326/0003-4819-105-3-436. [DOI] [PubMed] [Google Scholar]
- Bryan C. S. Mr. Gates's summer vacation: a centennial remembrance. Ann Intern Med. 1997 Jul 15;127(2):148–153. doi: 10.7326/0003-4819-127-2-199707150-00010. [DOI] [PubMed] [Google Scholar]
- Carron A. T., Lynn J., Keaney P. End-of-life care in medical textbooks. Ann Intern Med. 1999 Jan 5;130(1):82–86. doi: 10.7326/0003-4819-130-1-199901050-00037. [DOI] [PubMed] [Google Scholar]
- Davidson W., Molloy D. W., Somers G., Bédard M. Relation between physician characteristics and prescribing for elderly people in New Brunswick. CMAJ. 1994 Mar 15;150(6):917–921. [PMC free article] [PubMed] [Google Scholar]
- Edelson P. J. Adopting Osler's principles: medical textbooks in American medical schools, 1891-1906. Bull Hist Med. 1994 Spring;68(1):67–84. [PubMed] [Google Scholar]
- Fye W. B. The literature of American internal medicine: a historical view. Ann Intern Med. 1987 Mar;106(3):451–460. doi: 10.7326/0003-4819-106-3-451_1. [DOI] [PubMed] [Google Scholar]
- Golden R. L. Osler's legacy: the centennial of The Principles and Practice of Medicine. Ann Intern Med. 1992 Feb 1;116(3):255–260. doi: 10.7326/0003-4819-116-3-255. [DOI] [PubMed] [Google Scholar]
- Harrell G. T. Osler's practice. Bull Hist Med. 1973 Nov-Dec;47(6):545–568. [PubMed] [Google Scholar]
- Herman J. Therapeutic nihilism? Isr J Med Sci. 1996 Mar-Apr;32(3-4):259–264. [PubMed] [Google Scholar]
- Hookman P. Sir William Osler--contrasts between the saint-like legend and the rough-edged man. Md Med J. 1992 Nov;41(11):997–1004. [PubMed] [Google Scholar]
- McMICHAEL J. Osler; the textbook, and education in medicine. Can Med Assoc J. 1948 Jan;58(1):84–89. [PMC free article] [PubMed] [Google Scholar]
- Roland C. G. Osler's rough edge. Ann Intern Med. 1974 Nov;81(5):690–692. doi: 10.7326/0003-4819-81-5-690. [DOI] [PubMed] [Google Scholar]
- Tamblyn R. M., McLeod P. J., Abrahamowicz M., Laprise R. Do too many cooks spoil the broth? Multiple physician involvement in medical management of elderly patients and potentially inappropriate drug combinations. CMAJ. 1996 Apr 15;154(8):1177–1184. [PMC free article] [PubMed] [Google Scholar]
- Tamblyn R. M., McLeod P. J., Abrahamowicz M., Monette J., Gayton D. C., Berkson L., Dauphinee W. D., Grad R. M., Huang A. R., Isaac L. M. Questionable prescribing for elderly patients in Quebec. CMAJ. 1994 Jun 1;150(11):1801–1809. [PMC free article] [PubMed] [Google Scholar]