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  • Pathology Research and Practice 209 (2013) 264 265

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    Pathology Research and Practice

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    Oslers Qu

    Sir Willihoned his ebers of autallowed himthe bedsideIn fact, Oslewent to greeven whenfrom the ne

    One of thto Sir Williwhich has bassociation

    As a paslide contaiOsler Socieient of theWilliam Ospaused andwhich Sir W

    I assumeinitial Googattributed tbut proved to my fairlyreference foquote was nmention. I ithe preeminimmediatelrized by qudocumente

    Where dBoyd [7,10]sequentiallyitoba, Torona prolic aability to wincluding ainternists, abecause of hciously collgreat doctorwritten meto record compelling bits of poetry, prose, or oratory [6]. Boyd laterused some of these quotes to make his textbooks so readable andpopular. I rst found this quote, which Boyd attributed to Osler, onthe title page of one of his textbooks [5] as I was preparing to give


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    Boyd knew Osler (personal communication, Boyd biographer, IanCarr, June 14, 2012, and Osler biographer, Michael Bliss, June 17,2012), and this would seem logical as they were barely contempo-raries.

    0344-0338/$ http://dx.doi.o see front matter 2013 Elsevier GmbH. All rights reserved.rg/10.1016/j.prp.2013.02.003jo u r n al hom epa ge: www.elsev i


    ote: As is Our Pathology So is Our Practice

    am Osler, one of the most revered physicians of all time,xpertise in internal medicine by performing vast num-opsies in Montreal and Philadelphia; this experience

    to correlate the signs and symptoms he observed at with his pathologic ndings at the autopsy table [4,12].r had such a passion for pathology that he sometimesat lengths to obtain coveted pathological specimens,

    it was not always possible to obtain autopsy consentxt of kin [15,16].e more popular quotes related to pathology attributedam Osler is As is our pathology so is our practice,een widely quoted by Canadian pathologists, pathologys, and the press [8,14].thologist preparing a lecture, I had already added aning this quote when, as a member of the Americanty ( and a past recip-

    American Association for the History of Medicinesler Medal ( past.htm), I

    decided that I really needed to know the context inilliam uttered these famous words.d this could be accomplished in minutes; however, anle search provided pages of quote citations (all simplyo Osler) and even a paper with the quote as its title [3],fruitless in providing additional context. I then turned

    extensive personal Osler library, including the standardr Oslerian quotes, The Quotable Osler [13]. The famousot there. Even Rodins Oslerian Pathology [12] made nommediately e-mailed three individuals I consider to beent current day Osler scholars, who responded almosty. Their e-mail discussion can essentially be summa-oting one: I dont think he said it, or at least it isntd!!!.id I rst hear these words? My source was William, the famous Scottish/Canadian pathologist who served

    as Professor/Chair of Pathology at Universities of Man-to, and British Columbia from 1915 to 1954. Boyd wasuthor who became legendary (and very rich) for hisrite pathology textbooks directed at specic audiences,llied health professionals, medical students, surgeons,nd pathologists [1,10]. Boyds textbooks were popularis engaging writing style. From the age of 17, Boyd vora-ected quotes from literature, poetry, historical gures,s, etc. and put them in his commonplace book, a hand-mory device used historically by Renaissance scholars

    the Ca2003.

    Wittually addresMedicaProfesslished phraseexpertI thinkcal Patreprinand pathis quOne [5over a[n.b., twLea & FdepresOslers

    Howspeculwith hhospitHowevsies, an1909. relatiosentenpathollikely simplyuntil 1tion oftime wof clinstark cdetailspatholrapherPracticupon timage toms toAlthoum/locate /prp

    n Association of Pathologists William Boyd Lecture in

    rseverance (and a more comprehensive search), I even-tied the source of the quote, a lecture entitled Anthe treatment of disease that Osler gave to the Ontarioociation in Toronto on June 3, 1909, while he was Regiusf Medicine at Oxford, and which was fortuitously pub-e BMJ, allowing it to be found on-line [11]. How did this

    an obscure lecture that had eluded the most scholarlyhe life of Osler become part of Canadian pathology lore?linkage of this quote to William Boyds textbook Surgi-y, which was published through eight editions and 17s from 1925 to 1967 and which targeted both surgeonsgists, is responsible [n.b., most or all editions includen both the title page and as the rst sentence of Chapternsidering that Boyd was widely read and that he soldion books during his >50 year long publishing careerf Boyds text books were actually credited with keepinger Publishing Co. (Philadelphia) solvent during the great[10]], I think we can safely credit Boyd with preservingte.d found and remembered the quote is somewhat more, as he had only graduated from Edinburgh UniversityBChB in 1908 and was practicing psychiatry at mental

    the English midlands when it was published in 1909.oyd was also responsible for performing asylum autop-

    published his rst pathology case report in the BMJ iny, Boyd read Oslers article and, recognizing the close

    between pathology and sound clinical practice, thissonated with him as he was functioning as a clinician-

    just as Osler had earlier in his career; therefore, her copied the quote into his commonplace book [6] ormitted it to memory for future use. Interestingly, 1925

    the time period in which Boyd wrote the rst edi- of his four most popular pathology textbooks, was a

    competitive pathology textbooks were almost devoidnformation, focusing only on pathological ndings. Inst, Boyd was rather fanatical about inclusion of clinicalll of his textbooks, which were often designed to teacho clinicians rather than pathologists. One Boyd biog-tely noted that in Oslers book (i.e., The Principles andedicine) the pathology played an essential part, basedthors autopsy dissections. Boyds book seemed a mirrorslers in that Boyd emphasized the relations of symp-ons, making the pathology clinically important . . . [10].learly kindred spirits, there is no known evidence that

  • Correspondences / Pathology Research and Practice 209 (2013) 264 265 265

    Oslers love of pathology and the knowledge that Osler gainedby performing autopsies made him a better internist. So, it seemedintuitively obvious to me why this statement resonated with SirWilliam on a personal basis, as his practice was intimately tiedto pathology. However, in actuality, this is not what Osler meantas Boyd took the quote out of context. The quote was clearlymeant for a broader audience, as most of the members of theOntario Medical Association and the readership of the BMJ were notinternist-pathologists like Osler. In fact, the entire quote was: Asis our pathology so is our practice; what the pathologist thinks to-day, the physician does to-morrow. Removing the second sentenceand the context allows multiple interpretations. Oslers lecture wason treatment of disease, and he made his statement in the con-text of a quote by Celsus, the Roman encyclopedist who wrotein De Medicina that the dominant view of the nature of diseasecontrols its treatment. Osler simply meant that there had histor-ically been three sequential broad concepts of disease causation(i.e., direct outcome of sin, imbalance of the four humors, and themodern concept of chemico-physical processes caused by exter-nal agents, abnormal metabolism, etc.) and that determination ofrational forms of treatment was entirely dependent upon onesconceptual framework as to the cause of the disease [11].

    Oslers quote, minus the second sentence, was the perfect wayfor Boyd to start his book, as it highlighted the important relation-ship between a basic understanding of pathology and sound clinicalpractice. Diis improbabfor later usparticular qdecades aft

    In presenuance. In ttreatment, examinatiothese basedpathology anow more athe quote iof the readmedical antory resultsanyone to dmedical and

    As is ouing quote, i

    quote is ever true today as >70% of all critical clinical decision-making such as admittance, discharge, and medication is basedupon laboratory results [9] and laboratory data comprises >70% ofthe content of a typical electronic medical record [2].


    [1] Anonymous, William Boyd and his books, CMAJ 86 (1962) 2931.[2] M.J. Becich, J.R. Gilbertson, D. Gupta, A. Patel, D.M. Grzybicki, S.S. Raab,

    Pathology and patient safety: the critical role of pathology informat-ics in error reduction and quality initiatives, Clin. Lab. Med. 24 (2004)913943.

    [3] J. Biswas, As is our pathology, so is our practice, Middle East Afr. J. Ophthalmol.18 (2011) 259260.

    [4] M. Bliss, William Osler: A Life in Medicine, University of Toronto Press, Toronto,1999.

    [5] W. Boyd, Surgical Pathology, fourth ed., W.B. Saunders Co., Philadelphia, 1938,p. 17.

    [6] I. Carr, William Boyd the commonplace and the books, CBMH/BCHM 10 (1993)7786.

    [7] I. Carr, William Boyd: Silver Tongue and Golden Pen, Associated Medical Ser-vices Inc./Fitzhenry & Whiteside, Markham, Ont, 1993.

    [8] K. Chorneyko, J. Butany, P.C. Hebert, R. Kale, M.B. Stanbrook, B. Sibbald, K. Flegel,N. MacDonald, Canadas pathology, CMAJ 178 (2008) 15231526.

    [9] R.W. Forsman, Why is the laboratory an afterthought for managed care orga-nizations? Clin. Chem. 42 (1996) 813816.

    [10] J.F.A. McManus, William Boyd: a biographical sketch, Am. J. Surg. Pathol. 3(1979) 377381, quote p. 379.

    [11] W. Osler, An address on the treatment of disease, Br. Med. J. 2 (2534) (1909)185189.

    . Rodin, Oslerian Pathology: An Assessment and Annotated Atlas of Museumcimens, Coronado Press, Lawrence, KS, 1981.. Silvetion, ASolomdicinee/200

    Wrigh deved. 133

    Wrighol. Lad Boyd intentionally misinterpret Oslers quote? Thisle as Boyd was known to collect large numbers of quotese, and it seems unlikely that he would remember thisuotes precise context when writing a book almost twoer reading Oslers paper in the BMJ.nt day context, the quote has taken on a differenthe time of Osler and Boyd, clinical diagnosis, and hencewas mostly dependent upon the history and physicaln as well as the clinicians ability to astutely interpret

    upon the clinicians fundamental understanding ofnd pathophysiology. In contrast, clinical treatment isnd more dependent upon laboratory test results. Now,s probably best interpreted, the way I, and likely mostership, have always interpreted it. Today, high qualityd surgical care is dependent upon high quality labora-, a sort of motherhood statement that would be hard forisagree with, but that shows deep insight into modern

    surgical care.r pathology so is our practice, like any good and endur-s readily generalized and stands the test of time. Oslers

    [12] A.ESpe

    [13] M.EEdi

    [14] S. Meissu

    [15] J.R.theMe

    [16] J.R.Patrman, T.J. Murray, C.S. Bryan, The Quotable Osler: Revised Paperbackmerican College of Physicians, Philadelphia, 2008.on, Canadian pathology mired in crisis, National Review of

    5 (April (4)) (2008) patients practice01 4.html (accessed 09.06.12).t Jr., Sins of our fathers: two of The Four Doctors and their roles in

    lopment of techniques to permit covert autopsies, Arch. Pathol. Lab. (2009) Jr., Why did Osler not perform autopsies at Johns Hopkins? Arch.b. Med. 132 (2008) 1710 (letter).

    James R. Wright Jr.

    University of Calgary, Pathology and Lab Medicine,Diagnostic and Scientic Centre, 9-3535 Research

    Road NW, Calgary, Alta., Canada T2L 2K8

    Tel.: +1 403 770 3569; fax: +1 403 770 3292.E-mail address: [email protected]

    4 October 2012

    Osler's Quote: As is Our Pathology So is Our PracticeReferences