They did not observe myositis. Death was usually from cardiac or cerebrovascular disease. In the light of Osler's concern about trichinosis, it is of import that in 4 of the patients described by Churg and Strauss, the result of a skin test for Trichinella antigen was negative, but the level of precipitins was very high. Both would have explained the cyanosis that perplexed Osler, but the patient's tolerance of the condition and his spontaneous recovery suggest that eosinophilic pneumonia was more likely. The wheezing may have resulted from asthma.
Abdominal pain is common in the syndrome, but diarrhea less so.
The renal involvement is usually benign and fits with the albuminuria and the low number of casts. Myalgia is common, and myositis occurs. Blind biopsy of muscle, as performed by Osler, was not recommended by Lanham and colleagues 7 because of its low diagnostic yield. Osler's case report is an example of the scholarly contribution of a clinician who practises at the bedside and records carefully the observations made in this natural laboratory. I gratefully acknowledge the help of Ms. L. Szczygiel, Osler Library of the History of Medicine, McGill University, Montreal, and the staff of the N.J. MacLean Health Sciences Library, University of Manitoba, Winnipeg.