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106 HISTORY OF MEDICINE: OSLER AND GASTROENTEROLOGY H Chaun Sir William Osler (1848-1919), Canada's most illustrious physician, is often regarded as the greatest physician of the past century. He wrote over 1500 articles and books, and one of his main interests was learning about the natural history of diseases. His publications included many topics in gastroenterology.
Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia
It is of interest to reflect on the diversity of gastrointestinal disorders in his writings, some of which remain clinical challenges to the physicians of today. His topics included Extrinsic pressure of aortic aneurysm upon esophagus; Etiology of gastric ulcer; Diagnosis of duodenal ulcer; Perforated pyloric ulcer of stomach; Congenital hypertrophic stenosis of pylorus; Gastric lavage; Treatment of peptic ulcer; Cancer of stomach; Amebic dysentery, amebic abscess of liver; intestinal gangrene; Jejunal diverticula; Clinical, pathological relationships of cecum and appendix; Hirschsprung's disease; Jaundice; Cirrhosis of liver; Perihepatitis; Aneurysm of hepatic artery; Cancer of liver and gallstones; Alcoholic jaundice; Gallstones; Ball-valve mechanism in gallstones; Visceral syphilis; Angina abdominis; Abdominal tumors; Typhoid fever.
In addition to his numerous celebrated attributes as the outstanding physician, Osler developed a reputation as an excellent clinical gastroenterologist.
He referred to dyspepsia as "the besetting malady", and the stomach as "the hardest worked and most abused organ of the body, more subject to irritation than any other." He classified gastric and duodenal ulcer into eight categories: latent, acute perforating, acute hemorrhagic, gastralgia, chronic hemorrhagic, cachectic form, recurrent type, and stenotic type.
Osler's sayings are legendary. "A calm equanimity is the desirable attitude. How difficult to attain, yet how necessary in success and failure", so relevant in the management of patients with functional gastrointestinal disorders. The advent of endoscopy followed many years after Osler, but it is worthy to heed his advice that "The value of experience is not in seeing much but in seeing wisely".