Osler, used and abused—an eponymic essay

O name has been attached to diseases, to nodes, to a maneuver, to a trematode (Sphyranura osleri), to a nematode (Filaria osleri), and his extensive collection of books is known as Bibliotheca Osleriana. There is an Internet publication with his name, The Osler Medical Journal, edited by the Johns Hopkins Osler Medical House staff. Numerous wards, rooms, and services in hospitals are also named after him, and there is the Osler Club of London and the American Osler Society with its own publication, The Oslerian. Recently, his name appeared in the title of a book: Osler’s Web, Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic. The controversy about the usefulness of medical eponyms is far from over and engenders unresolved issues. Should any syndrome and disease ever be identified by a name? Once a precise delineation or understanding of the pathophysiology of a syndrome or disease becomes available, it would seem best to drop any name. However, aside from any controversy surrounding the coining of eponyms, there can be no doubt about the stimulation of scholarship and contributions to medical history. Although William Osler (1849 to 1919) never attached his name to any of his findings, he did express an opinion as to how credit might be given. There exist numerous affiliations between his name and diseases and phenomena as any dictionary on eponyms will readily document. The best known connection is probably hereditary hemorrhagic teleangiectasia, which has long been called Osler-Weber-Rendu syndrome, a name encompassing 3 describers and a name attached to this disease by Osler’s loyal medical residents at Johns Hopkins University, who wanted to honor their beloved mentor and teacher, Osler. In a similar fashion, the form of plethora (polycythemia vera) that bears the names of Henri Louis Vaquez and William Osler, was not so labeled by either one. Osler nodes, which are practically pathognomonic of bacterial endocarditis, have been described before, as credited by Osler, by the Canadian John A. Mullin and even earlier by Lancereaux. Janeway also described similar but perhaps nonidentical lesions during Osler’s period; however, one might quibble to claim distinctive differences between these lesions. Another eponym is the helpful maneuver to identify pseudohypertension—an erroneous measurement of very high pressure by the pneumatic cuff—which was the palpatory examination of an arterial segment distal to the inflated cuff: if the artery is still palpable (due to its stiffness), pseudohypertension is probably present. This phenomenon was first described by Osler in 1892. One hundred years ago, Osler published a lecture on the ball-valve gall-stone in the common duct, a rare clinical entity that sometimes bears his name. Among the lesser known connections to his name was his discovery of platelets in thrombi, for which he did claim priority: “It is when the current is slow that the white thrombi are formed, and I was the first to observe, in 1881, that in the most superficial part of the white thrombi the blood-plaques were present.” This aggregation of platelets has sometimes been referred to as Osler’s phenomenon. His intense work with and description of platelets might have even justified to call these cells Oslercytes, but thrombocyte is a better term and more appropriate than blood-plaques or platelets. As a young man, Osler studied a small epidemic in dogs at the Montreal Hunt Club and described a form of verminous bronchitis in dogs. The parasite, originally named Strongylus canis bronchialis by Osler was later named Filaria osleri, a name now abandoned. However, a small nematode is still known as Filaroides osleri. His veterinarian interests led to his early discovery of a worm in the gills of a newt and this trematode was named by R. Ramsey Sphyranura osleri. With justification, many other observations by Osler could bear his name. His apt interpretation of some of the findings in Dickens’ Fat Boy “with dropsy” could warrant the label of Osler’s rather than Pickwickian syndrome when discussing sleep apnea in an obese patient. His description did not appear in the first edition of his text book, but is found in the 1906 edition. His recognition of the possibility of a spastic component in a form of angina pectoris deserves recognition and the term “Osler’s angina” or “OslerDock angina” could be used. We consider these connections of Osler’s name to disease states just as laudable as those to various clinical wards, rooms, and special services, his wonderful book collection, the new electronic journal, and the various clubs and societies. In contrast, we allege that use of his name should be considered as abused in a recent book written by Hillary Johnson, Osler’s Web, Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic. Here, the mere employment of Oslerian quotations prefacing the book’s chapters seem to be the main justification for the use of his name. Seemingly, there is the intent to fit this disease From the University of Minnesota Medical School and Abbott Northwestern Hospital, Minneapolis, Minnesota. Manuscript received and accepted August 6, 2001. Address for reprints: Claus A. Pierach, MD, Abbott Northwestern Hospital #11135, 800 East 28th Street, Minneapolis, Minnesota 55407-3799. E-mail: claus.a.pierach-2@tc.umn.edu.