Osler's service: A view of the charts

Abstract

It has been asserted that William Osler (1849–1919) shaped the Medical Clinic of the Johns Hopkins Hospital ‘to become a pre-eminent facility, first in patient care and later in medical education’. Osler's impact on medical education in the United States is beyond dispute, but few, if any, data support the assertion that patients at the Johns Hopkins Hospital fared better than those at similar hospitals during the late 19th century. Patient records were scanty and were seldom, if ever, signed by Osler or other senior professors. The numerous publications that arose from Osler's service suggest the data were derived not from the hospital charts, but rather from a parallel system of data collection designed mainly for research. Issues raised by this review of the charts on Osler's service reverberate in American medicine.

Get full access to this article

View all access options for this article.

References

Chesney

. The Johns Hopkins Hospital and The Johns Hopkins University School of Medicine: A Chronicle. Volume I. Early Years, 1867-1893. Baltimore: The Johns Hopkins Press, 1943. Second edition. Philadelphia: P. Blakiston's Son & Co, 1906: pp. 469-74

Osler

, ed. L'Envoi. Aequanimitas, With other Addresses to Medical Students, Nurses and Practitioners of Medicine: 2nd edn. Philadelphia: P. Blakiston's Son & Co, 1906: pp. 467-74

Harvey

, McKusick

, Stobo

. Osler's Legacy: The Department of Medicine at Johns Hopkins, 1889-1899. Baltimore: The Department of Medicine, The Johns Hopkins University, 1990: p. 4

Chesney

. The Johns Hopkins Hospital and The Johns Hopkins University School of Medicine: A Chronicle. Volume II. 1893-1905. Baltimore: The Johns Hopkins Press, 1958

Ludmerer

. Learning to Heal: The Development of American Medical Education. New York: Basic Books, Inc., 1985: p. 154

Osler

. The Principles and Practice of Medicine. New York: D. Appleton and Company, 1892: pp. 264-5

Camac

CNB

. Hospital and ward clinical laboratories. Journal of the American Medical Association 1900; 35: 219-27

William Sidney Thayer to Lewellys Franklin Barker, 6 May 1899. Lewellys F Barker papers, Alan Mason Chesney Archives, The Johns Hopkins University, Baltimore, Maryland

Reiser

. Creating form out of mass: The development of the medical record. In: Mendelsohn

, ed. Transformation and Tradition in the Sciences. Essays in Honour of I Bernard Cohen. Cambridge, England: Cambridge University Press, 1984: pp. 303-16

10.

Warner

. The Therapeutic Perspective: Medical Practice, Knowledge, and Identity in America, 1820-1885. Cambridge, Massachusetts: Harvard University Press, 1986

11.

Howell

. Early use of X-ray machines and electrocardiographs at The Pennsylvania Hospital. Journal of the American Medical Association 1986; 255: 2320-3

12.

Craig

. Hospital records and record-keeping, c1850-c1950. Part II. The development of record-keeping in hospitals. Archivania 1990; 30 (Summer): 21-38

13.

Risse

, Warner

. Reconstructing clinical activities: patient records in medical history. Social History of Medicine 1992; 5: 183-205

14.

Howell

. Technology in the Hospital. Baltimore: The Johns Hopkins University Press, 1995

15.

Thayer

. Osler, the teacher. In: Sir William Osler, Bart. Brief Tributes to His Personality, Influence and Public Service, Written by His friends, Associates and Former Pupils, in Honour of His Seventieth Birthday. Baltimore: The Johns Hopkins Press, 1920: pp. 51-1

16.

Hinohara

. Sir William Osler's philosophy of death. Annals of Internal Medicine 1993; 118: 638-12