In Osler’s letters to his friend, Ned Milburn, there are a few instances of clinical advice, but most are social in nature. However, one situation in particular prompts Osler to reach out to his friend as a compassionate physician. In early September of 1904, Osler learns from a mutual friend that Ned’s only son, Edward Milburn, is suffering from the deadly contagious disease, tuberculosis. During the next few weeks that sadly ended with Edward’s passing, Osler gives clinical advice from afar. His concern for the young man (only 24 at the time) is evident by the increased frequency of his letters and his sympathetic guidance, as he knew the situation was grave upon hearing of the early onset of hemorrhaging. Still, Osler tries to offer hope and his best medical recommendations.
Osler Recommends the “Open Air” Treatment
Osler first recommends the so-called “open air” treatment popularized by his friend and colleague, Dr. Edward Livingston Trudeau of New York. It is also recommended by Osler in his classic work, The Principles and Practice of Medicine, stating “The value of fresh air and out-of-door life is well illustrated by an experiment of Trudeau” (6th ed., 1905, p. 353). Osler’s advice to Ned sounds like a friendlier, less academic, adaptation of the corresponding portion of his acclaimed book.
On September 9, Osler writes to Ned, “…I hope you are keeping him in the ‘open’ on these fine days. While he has fever he should be flat on his back, but the autumns out of door life seems so good for the digestion & for the fever. Who is your doctor? Why not let him write me a description of the case? I might be able to be of help…”
After communicating with Edward’s physician, Dr. Sprague, Osler writes on September 13, “…I have urged a rigid out of door plan of treatment. He may object at first… After the fever subsides & his blood condition improves he might be able to get away to some more suitable climate… Do urge upon the lad the importance of giving the open-air treatment a full trial…”
In addition to recommending the open air treatment, Osler provides advice on controlling the symptoms, especially after hearing that Edward was showing some improvement.
On September 17, he writes to Ned, “Glad to hear that the poor laddie is better. Tell the doctor not to hesitate to give enough morphia at night to keep his cough under control. Possibly the inhalation of the creosote would help it. The form of inhaler which you mention seems excellent. Poor boy, he seems to be in a bad way. I am sorry for you all. Please let me hear how he gets on from time to time.”
And on October 5, he writes, “It is a very difficult thing to check the fever in tuberculosis. The cool spongings are, I think, less exhausting than the use of the powerful, depressing medicines, such as anti-pyrine, etc. Tell the doctor not to hesitate to give him enough morphia to keep him comfortable at night as it helps, too, in reducing the fever. It is terribly sad for you all. I wish I could do something more for you.”
Concern over Contagion
In the last letter written during Edward’s suffering, Osler responds to Ned’s concerns about contagion. The contagious bacteria responsible for tuberculosis had been discovered by Robert Koch and detailed in his Die aetiologie der tuberculose (1882). The mode of disease transmission was beginning to be commonly appreciated by this time (Holley, Continual Remembrance, p. 70).
On October 11, Osler explains to Ned that, “Scrupulous care must be taken of the sputum. He should be careful, always, to cough into a handkerchief or into a towel…”
Sadly, Osler is informed of Edward’s passing somewhere around the beginning of November, 1904. From the letter, it is clear that Osler understood the desperate situation from the start, though he always provided hope and help to his friend. Nevertheless, an effective cure of tuberculosis was still decades away, awaiting the development of antibiotic treatment in the 1940s.
Osler sends his sympathy for the loss of Edward on November 11: “Dear Ned, How heartbreaking to part from your dear boy - & an only son! I feared all along from the symptoms that it was one of those acute types for which there is rarely any hope. Better so perhaps than a slow lingering two or three years – illness with all its illusive hopes & anxious dread. Do give my love & heartfelt sympathy to your wife & the girls. They will be inconsolable, poor things! Affectionately yours, Wm Osler.”